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Postoperative pulmonary and aortic 3D haemodynamics in patients after repair of transposition of the great arteries

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Abstract

Objectives

To characterise aortic and pulmonary haemodynamics and investigate the correlation with post-surgical anatomy in patients with dextro-transposition of the great arteries (d-TGA).

Methods

Four-dimensional (4D) MRI was performed in 17 patients after switch repair of TGA and 12 healthy controls (age, 11.9 ± 5.4 vs 23.3 ± 1.6 years). Patients were divided according to the pulmonary trunk (TP) position in relation to the ascending aorta (AAo): anterior (n = 10) and right/left anterior position (n = 7). Analysis included visual grading (ranking 0–2) of pulmonary and aortic vortical and helical flow, flow velocity quantification, blood-flow distribution to the right and left pulmonary arteries (flow ratio rPA:lPA), and vessel lumen areas.

Results

Anterior TP position was associated with increased vortices in six out of ten patients compared with right anterior TP position (one out of seven) and controls (none). Reduced systolic lPA and TP lumina in patients resulted in significantly increased peak systolic velocities (P < 0.001). Flow ratio rPA:lPA was more heterogeneous in patients (rPA:lPA = 1.56 ± 0.78 vs volunteers 1.09 ± 0.15; P < 0.05) with predominant flow to the rPA. Eleven patients presented increased helices in the AAo (grade 1.6).

Conclusions

Evaluation of post-surgical haemodynamics in TGA patients revealed increased vortical flow for anterior TP position, asymmetric flow and increased systolic flow velocity in the pulmonary arteries owing to reduced vascular lumina.

Key Points

• 3D phase contrast MRI with velocity encoding (4D MRI) has numerous cardiovascular applications

• 4D MRI demonstrates postoperative haemodynamics following surgery for transposition of the great arteries

• Flow visualisation depicted enhanced pulmonary vortices in the anterior pulmonary trunk

• Narrow pulmonary arterial systolic lumina resulted in increased peak systolic velocities

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Abbreviations

AAo:

Ascending aorta

lPA:

Left pulmonary artery

PC:

Phase contrast

rPA:

Right pulmonary artery

TP:

Pulmonary trunk

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Acknowledgements

This work was undertaken with grant support from the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL115828.

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Authors and Affiliations

  1. Department of Radiology, Medical Physics, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    Julia Geiger, Jonas Bürk, Bernd Jung & Mathias Langer

  2. Department of Congenital Heart Disease and Paediatric Cardiology, University Medical Center Freiburg-Bad Krozingen, Freiburg, Germany

    Daniel Hirtler & Brigitte Stiller

  3. Department of Congenital Heart Disease and Paediatric Cardiology, University Medical Center Heidelberg, Heidelberg, Germany

    Raoul Arnold

  4. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA

    Michael Markl

  5. Department Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA

    Michael Markl

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  1. Julia Geiger
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Correspondence to Julia Geiger.

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Geiger, J., Hirtler, D., Bürk, J. et al. Postoperative pulmonary and aortic 3D haemodynamics in patients after repair of transposition of the great arteries. Eur Radiol 24, 200–208 (2014). https://doi.org/10.1007/s00330-013-2998-4

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  • DOI: https://doi.org/10.1007/s00330-013-2998-4

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