Hemodynamic Assessment in Patients with One-and-a-Half Ventricle Repair Revealed by Four-Dimensional Flow Magnetic Resonance Imaging
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We report hemodynamic findings in two patients with pulmonary atresia and intact ventricular septum (PAIVS) after “one-and-a-half ventricle repair” and placement of a bidirectional Glenn shunt using four-dimensional (4D) flow magnetic resonance imaging. Quantification of flow and analysis of flow patterns revealed the hemodynamic “battle” between the right ventricle (RV) and the Glenn shunt. Moreover, with a novel approach we calculated during Glenn anastomosis the flow distribution from the superior vena cava (SVC) to the pulmonary arteries. Our results showed a highly asymmetric flow distribution, with most of the flow from the SVC toward the RV and not to the lungs. The evidence provided by 4D flow demonstrates poor efficiency of this system and suggests that both patients might benefit from adding an artificial pulmonary valve to avoid right heart failure.
KeywordsFour-dimensional flow Magnetic resonance imaging Pulmonary atresia Congenital heart defects Bidirectional Glenn shunt
Funding Sources Fondecyt 11100427, ACT 079, Vicerrectoría de Investigación, Pontificia Universidad Católica de Chile.
Conflict of interest
Video 1. Particles emitted from the confluent RPA and LPA demonstrate strong retrograde flow in the pulmonary circulation. (MPG 5672 kb)
Video 2. Particles emitted from the SVC demonstrate that most of the SVC flow is mainly directed to the p-RPA and the main PA. (MPG 5138 kb)
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