Skip to main content
Erschienen in: Pediatric Cardiology 2/2018

02.11.2017 | Original Article

Vortex Flow in the Right Atrium Surrogates Supraventricular Arrhythmia and Thrombus After Atriopulmonary Connection-Type Fontan Operation: Vortex Flow Analysis Using Conventional Cine Magnetic Resonance Imaging

Erschienen in: Pediatric Cardiology | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

We developed a novel imaging technique, designated as vortex flow (VF) mapping, which presents a vortex flow visually on conventional two-dimensional (2D) cine MRI. Using it, we assessed circumferential VF patterns and influences on RA thrombus and supraventricular tachycardia (SVT) in AP connection-type Fontan circulation. Retrospectively, we enrolled 27 consecutive patients (25.1 ± 9.2 years) and 7 age-matched controls who underwent cardiac MRI. Conventional cine images acquired using a 1.5-Tesla scanner were scanned for axial and coronal cross section of the RA. We developed “vortex flow mapping” to demonstrate the ratio of the circumferential voxel movement at each phase to the total movement throughout a cardiac cycle towards the RA center. The maximum ratio was used as a magnitude of vortex flow (MVF%) in RA cine imaging. We also measured percentages of strong and weak VF areas (VFA%). Furthermore, in 10 out of 27, we compared VF between previous CMR (3.8 ± 1.5 years ago) and latest CMR. Of the patients, 15 had cardiovascular complications (Group A); 12 did not (Group B). A transaxial image showed that strong VFA% in Group A was significantly smaller than that in Group B or controls. A coronal view revealed that strong VFA% was also smaller, and weak VFA% was larger in Group A than in Group B or controls (P < 0.05, and P < 0.05). Maximum MVF% in Group A was significantly smaller than in other groups (P < 0.001). Univariate logistic analyses revealed weak VFA% on a coronal image, and serum total bilirubin level as factors affecting cardiovascular complications (Odds ratio 1.14 and 66.1, 95% CI 1.004–1.30 and 1.59–2755.6, P values < 0.05 and < 0.05, respectively). Compared to the previous CMR, smaller maximum VMF%, smaller strong VFA%, and larger weak VFA% were identified in the latest CMR. Circumferentially weak VFA% on a coronal image can be one surrogate marker of SVT and thrombus in AP connection-type Fontan circulation. This simple VF assessment is clinically useful to detect blood stagnation.
Literatur
2.
Zurück zum Zitat Egbe AC, Connolly HM, Dearani JA, Bonnichsen CR, Niaz T, Allison TG, Johnson JN, Poterucha JT, Said SM, Ammash NM (2016) When is the right time for Fontan conversion? The role of cardiopulmonary exercise test. Int J Cardiol 1(220):564–568CrossRef Egbe AC, Connolly HM, Dearani JA, Bonnichsen CR, Niaz T, Allison TG, Johnson JN, Poterucha JT, Said SM, Ammash NM (2016) When is the right time for Fontan conversion? The role of cardiopulmonary exercise test. Int J Cardiol 1(220):564–568CrossRef
3.
Zurück zum Zitat Egbe AC, Connolly HM, McLeod CJ, Ammash NM, Niaz T, Yogeswaran V, Poterucha JT, Qureshi MY, Driscoll DJ (2016) Thrombotic and embolic complications associated with atrial arrhythmia after fontan operation: role of prophylactic therapy. J Am Coll Cardiol 68(12):1312–1319CrossRefPubMed Egbe AC, Connolly HM, McLeod CJ, Ammash NM, Niaz T, Yogeswaran V, Poterucha JT, Qureshi MY, Driscoll DJ (2016) Thrombotic and embolic complications associated with atrial arrhythmia after fontan operation: role of prophylactic therapy. J Am Coll Cardiol 68(12):1312–1319CrossRefPubMed
4.
Zurück zum Zitat Monagle P, Cochrane A, Roberts R, Manlhiot C, Weintraub R, Szechtman B, Hughes M, Andrew M (2011) McCrindle BW; Fontan anticoagulation study group. a multicenter, randomized trial comparing heparin/warfarin and acetylsalicylic acid as primary thromboprophylaxis for 2 years after the Fontan procedure in children. J Am Coll Cardiol 58(6):645–651CrossRefPubMed Monagle P, Cochrane A, Roberts R, Manlhiot C, Weintraub R, Szechtman B, Hughes M, Andrew M (2011) McCrindle BW; Fontan anticoagulation study group. a multicenter, randomized trial comparing heparin/warfarin and acetylsalicylic acid as primary thromboprophylaxis for 2 years after the Fontan procedure in children. J Am Coll Cardiol 58(6):645–651CrossRefPubMed
5.
Zurück zum Zitat McCrindle BW, Manlhiot C, Cochrane A, Roberts R, Hughes M, Szechtman B, Weintraub R, Andrew M (2013) Monagle P; Fontan Anticoagulation Study Group. Factors associated with thrombotic complications after the Fontan procedure: a secondary analysis of a multicenter, randomized trial of primary thromboprophylaxis for 2 years after the Fontan procedure. J Am Coll Cardiol 61(3):346–353CrossRefPubMed McCrindle BW, Manlhiot C, Cochrane A, Roberts R, Hughes M, Szechtman B, Weintraub R, Andrew M (2013) Monagle P; Fontan Anticoagulation Study Group. Factors associated with thrombotic complications after the Fontan procedure: a secondary analysis of a multicenter, randomized trial of primary thromboprophylaxis for 2 years after the Fontan procedure. J Am Coll Cardiol 61(3):346–353CrossRefPubMed
6.
Zurück zum Zitat Li W, Storey P, Chen Q, Li BS, Prasad PV, Edelman RR (2004) Dark flow artifacts with steady-state free precession cine MR technique: causes and implications for cardiac MR imaging. Radiology 230(2):569–575CrossRefPubMed Li W, Storey P, Chen Q, Li BS, Prasad PV, Edelman RR (2004) Dark flow artifacts with steady-state free precession cine MR technique: causes and implications for cardiac MR imaging. Radiology 230(2):569–575CrossRefPubMed
7.
Zurück zum Zitat Storey P, Li W, Chen Q, Edelman RR (2004) Flow artifacts in steady-state free precession cine imaging. Magn Reson Med 51(1):115–122CrossRefPubMed Storey P, Li W, Chen Q, Edelman RR (2004) Flow artifacts in steady-state free precession cine imaging. Magn Reson Med 51(1):115–122CrossRefPubMed
8.
Zurück zum Zitat Moyle KR, Mallinson GD, Occleshaw CJ, Cowan BR, Gentles TL (2006) Wall shear stress is the primary mechanism of energy loss in the Fontan connection. Pediatr Cardiol 27(3):309–315CrossRefPubMed Moyle KR, Mallinson GD, Occleshaw CJ, Cowan BR, Gentles TL (2006) Wall shear stress is the primary mechanism of energy loss in the Fontan connection. Pediatr Cardiol 27(3):309–315CrossRefPubMed
9.
Zurück zum Zitat Bächler P, Valverde I, Pinochet N, Nordmeyer S, Kuehne T, Crelier G, Tejos C, Irarrazaval P, Beerbaum P, Uribe S (2013) Caval blood flow distribution in patients with Fontan circulation: quantification by using particle traces from 4D flow MR imaging. Radiology 267(1):67–75CrossRefPubMed Bächler P, Valverde I, Pinochet N, Nordmeyer S, Kuehne T, Crelier G, Tejos C, Irarrazaval P, Beerbaum P, Uribe S (2013) Caval blood flow distribution in patients with Fontan circulation: quantification by using particle traces from 4D flow MR imaging. Radiology 267(1):67–75CrossRefPubMed
10.
Zurück zum Zitat Cibis M, Jarvis K, Markl M, Rose M, Rigsby C, Barker AJ, Wentzel JJ (2015) The effect of resolution on viscous dissipation measured with 4D flow MRI in patients with Fontan circulation: evaluation using computational fluid dynamics. J Biomech 48(12):2984–2989CrossRefPubMedPubMedCentral Cibis M, Jarvis K, Markl M, Rose M, Rigsby C, Barker AJ, Wentzel JJ (2015) The effect of resolution on viscous dissipation measured with 4D flow MRI in patients with Fontan circulation: evaluation using computational fluid dynamics. J Biomech 48(12):2984–2989CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Uchita S, Imai Y, Takanashi Y, Hoshino S, Terada M, Nagatsu M (1997) A case of modified Fontan operation with reconstruction of the nonconfluent pulmonary artery. Nihon Kyobu Geka Gakkai Zasshi 45(12):1986–1991PubMed Uchita S, Imai Y, Takanashi Y, Hoshino S, Terada M, Nagatsu M (1997) A case of modified Fontan operation with reconstruction of the nonconfluent pulmonary artery. Nihon Kyobu Geka Gakkai Zasshi 45(12):1986–1991PubMed
12.
Zurück zum Zitat Nakamura M et al (2015) Quantitative circumferential strain analysis using adenosinetriphosphate-stress/rest 3-T tagged magnetic resonance to evaluate regional contractile dysfunction in ischemic heart disease. Eur J Radiol 84:1493–1501CrossRefPubMed Nakamura M et al (2015) Quantitative circumferential strain analysis using adenosinetriphosphate-stress/rest 3-T tagged magnetic resonance to evaluate regional contractile dysfunction in ischemic heart disease. Eur J Radiol 84:1493–1501CrossRefPubMed
13.
Zurück zum Zitat Yamasaki Y, Nagao M, Abe K, Hosokawa K, Kawanami S, Kamitani T et al (2016) Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-016-098 Yamasaki Y, Nagao M, Abe K, Hosokawa K, Kawanami S, Kamitani T et al (2016) Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study. Int J Cardiovasc Imaging. https://​doi.​org/​10.​1007/​s10554-016-098
14.
Zurück zum Zitat Sughimoto K, Okauchi K, Zannino D, Brizard CP, Liang F, Sugawara M, Liu H, Tsubota K (2015) Total cavopulmonary connection is superior to atriopulmonary connection fontan in preventing thrombus formation: computer simulation of flow-related blood coagulation. Pediatr Cardiol 36(7):1436–1441CrossRefPubMed Sughimoto K, Okauchi K, Zannino D, Brizard CP, Liang F, Sugawara M, Liu H, Tsubota K (2015) Total cavopulmonary connection is superior to atriopulmonary connection fontan in preventing thrombus formation: computer simulation of flow-related blood coagulation. Pediatr Cardiol 36(7):1436–1441CrossRefPubMed
15.
Zurück zum Zitat Mavroudis C, Backer CL, Deal BJ, Johnsrude CL (1998) Fontan conversion to cavopulmonary connection and arrhythmia circuit cryoblation. J Thorac Cardiovasc Surg 115:547–556CrossRefPubMed Mavroudis C, Backer CL, Deal BJ, Johnsrude CL (1998) Fontan conversion to cavopulmonary connection and arrhythmia circuit cryoblation. J Thorac Cardiovasc Surg 115:547–556CrossRefPubMed
16.
Zurück zum Zitat Yoshikawa Y, Ishibashi-Ueda H, Uemura H, Kawahira Y, Yagihara T (2002) Pathologic findings in atrial musculature seven years after the intraatrial tunnel Fontan. Ann Thorac Surg 73:663–664CrossRefPubMed Yoshikawa Y, Ishibashi-Ueda H, Uemura H, Kawahira Y, Yagihara T (2002) Pathologic findings in atrial musculature seven years after the intraatrial tunnel Fontan. Ann Thorac Surg 73:663–664CrossRefPubMed
17.
Zurück zum Zitat Neuberger HR, Schotten U, Blaauw Y et al (2006) Chronic atrial dilation, electrical remodeling, and atrial fibrillation in the goat. J Am Coll Cardiol 47:644–653CrossRefPubMed Neuberger HR, Schotten U, Blaauw Y et al (2006) Chronic atrial dilation, electrical remodeling, and atrial fibrillation in the goat. J Am Coll Cardiol 47:644–653CrossRefPubMed
18.
19.
Zurück zum Zitat Schaaf M, Andre P, Altman M, Maucort-Boulch D, Placide J, Chevalier P, Bergerot C, Thibault H (2016) Left atrial remodelling assessed by 2D and 3D echocardiography identifies paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging 18(1):46–53CrossRefPubMed Schaaf M, Andre P, Altman M, Maucort-Boulch D, Placide J, Chevalier P, Bergerot C, Thibault H (2016) Left atrial remodelling assessed by 2D and 3D echocardiography identifies paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging 18(1):46–53CrossRefPubMed
20.
Zurück zum Zitat Navaratnam D, Fitzsimmons S, Grocott M, Rossiter HB, Emmanuel Y, Diller GP, Gordon-Walker T, Jack S, Sheron N, Pappachan J, Pratap JN, Vettukattil JJ, Veldtman G (2016) Exercise-induced systemic venous hypertension in the fontan circulation. Am J Cardiol 117(10):1667–1671CrossRefPubMed Navaratnam D, Fitzsimmons S, Grocott M, Rossiter HB, Emmanuel Y, Diller GP, Gordon-Walker T, Jack S, Sheron N, Pappachan J, Pratap JN, Vettukattil JJ, Veldtman G (2016) Exercise-induced systemic venous hypertension in the fontan circulation. Am J Cardiol 117(10):1667–1671CrossRefPubMed
21.
Zurück zum Zitat Bae JM, Jeon TY, Kim JS, Kim S, Hwang SM, Yoo SY, Kim JH (2016) Fontan-associated liver disease: spectrum of US findings. Eur J Radiol 85(4):850–856CrossRefPubMed Bae JM, Jeon TY, Kim JS, Kim S, Hwang SM, Yoo SY, Kim JH (2016) Fontan-associated liver disease: spectrum of US findings. Eur J Radiol 85(4):850–856CrossRefPubMed
22.
Zurück zum Zitat Evans WN, Acherman RJ, Ciccolo ML, Carrillo SA, Galindo A, Rothman A, Winn BJ, Yumiaco NS (2016) Restrepo H An observation from liver biopsies two decades post-fontan. Pediatr Cardiol 37(6):1119–1122CrossRefPubMed Evans WN, Acherman RJ, Ciccolo ML, Carrillo SA, Galindo A, Rothman A, Winn BJ, Yumiaco NS (2016) Restrepo H An observation from liver biopsies two decades post-fontan. Pediatr Cardiol 37(6):1119–1122CrossRefPubMed
23.
Zurück zum Zitat Agnoletti G, Ferraro G, Bordese R, Marini D, Gala S, Bergamasco L, Ferroni F, Calvo PL, Barletti C, Cisarò F, Longo F, Pace Napoleone C (2016) Fontan circulation causes early, severe liver damage. Should we offer patients a tailored strategy? Int J Cardiol 15(209):60–65CrossRef Agnoletti G, Ferraro G, Bordese R, Marini D, Gala S, Bergamasco L, Ferroni F, Calvo PL, Barletti C, Cisarò F, Longo F, Pace Napoleone C (2016) Fontan circulation causes early, severe liver damage. Should we offer patients a tailored strategy? Int J Cardiol 15(209):60–65CrossRef
24.
Zurück zum Zitat Greenberg SB, Morrow WR, Imamura M, Drummond-Webb J (2004) Magnetic resonance flow analysis of classic and extracardiac Fontan procedures: the seesaw sign. Int J Cardiovasc Imaging 20(5):397–405CrossRefPubMed Greenberg SB, Morrow WR, Imamura M, Drummond-Webb J (2004) Magnetic resonance flow analysis of classic and extracardiac Fontan procedures: the seesaw sign. Int J Cardiovasc Imaging 20(5):397–405CrossRefPubMed
Metadaten
Titel
Vortex Flow in the Right Atrium Surrogates Supraventricular Arrhythmia and Thrombus After Atriopulmonary Connection-Type Fontan Operation: Vortex Flow Analysis Using Conventional Cine Magnetic Resonance Imaging
Publikationsdatum
02.11.2017
Erschienen in
Pediatric Cardiology / Ausgabe 2/2018
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-017-1765-8

Weitere Artikel der Ausgabe 2/2018

Pediatric Cardiology 2/2018 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.