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Odemis E, Gumus T, Aka İB, Ozkok S, Pekkan K. Evaluation of the total hydrodynamic energy loss using 4D flow MRI in a case with Fontan failure. Heliyon 2024; 10:e28140. [PMID: 38515711 PMCID: PMC10956053 DOI: 10.1016/j.heliyon.2024.e28140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 02/25/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
Fontan Failure (FF) is a common problem for single-ventricle patients as they reach adulthood. Although several mechanisms may cause FF, an optimized blood flow stream through the surgical conduits is essential to avoid excessive energy loss (EL). Recent clinical studies showed EL is related to the quality of life, exercise capacity, and hepatic function since the single-ventricle feeds pulmonary and systemic circulation serially. 4D flow MRI effectively estimates EL in Fontan circulation and allows clinicians to compare the effectiveness of the treatment strategy concerning pre-intervention. Here, we present 26-year-old women with FF who had normal cardiac catheterization findings and were treated according to high EL definitions that are measured through 4D flow MRI.
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Affiliation(s)
- Ender Odemis
- Koc University, Faculty of Medicine, Department of Pediatric Cardiology, Faculty of Biomedical Science and Engineering, Turkey
| | - Terman Gumus
- Koc University, Faculty of Medicine, Department of Radiology, Turkey
| | - İbrahim Başar Aka
- İstanbul Bilgi University, Faculty of Engineering and Natural Sciences, Department of Mechatronics Engineering, Turkey
| | - Sercin Ozkok
- Koc University, Faculty of Biomedical Science and Engineering, Turkey
| | - Kerem Pekkan
- Koc University, Faculty of Engineering Department of Mechanical Engineering, Turkey
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Umehara T, Takumi K, Ueda K, Tokunaga T, Harada-Takeda A, Sato M. Hemodynamic features underlying pulmonary vein stump thrombus formation after left upper lobectomy: four-dimensional flow magnetic resonance imaging study. Quant Imaging Med Surg 2022; 12:992-1003. [PMID: 35111600 DOI: 10.21037/qims-21-472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND We previously reported that to-and-fro blood movement near the pulmonary vein stump was particularly prominent after left upper lobectomy compared with other lobectomy, which may be the cause of the high susceptibility of pulmonary vein thrombus after left upper lobectomy. The aim of the present study was to compare the hemodynamics in patients who developed pulmonary vein thrombus after left upper lobectomy with those in patients who did not develop pulmonary vein thrombus using four-dimensional flow magnetic resonance imaging (4D MRI). METHODS This was a retrospective evaluation of a prospectively collected clinical and radiological database of 37 patients who underwent 4D MRI 7 days after left upper lobectomy for lung cancer (n=37). We obtained two parameters by 4D MRI: the grade of to-and-fro blood movement and the flow energy loss around the pulmonary vein stump. The length of the pulmonary vein stump, a known risk factor for pulmonary vein thrombus, was also measured. RESULTS According to a scatterplot of the grade of to-and-fro blood movement versus the flow energy loss, patients with pulmonary vein thrombus (n=15) were concentrated in an area which appears to be a 'dangerous' hemodynamic condition. There were few patients without pulmonary vein thrombus in this 'dangerous' area, except for one who unfortunately developed delayed pulmonary vein thrombus and cerebral infarction. We proposed a formula using the 4D MRI-derived parameters based on a stepwise multiple regression analysis that was more closely associated with the development of pulmonary vein thrombus than the length of the pulmonary vein stump (area under the receiver operating characteristics curve: 0.918 vs. 0.705, P=0.0500). CONCLUSIONS We proposed the existence of a 'dangerous' hemodynamic condition responsible for pulmonary vein thrombus formation. 4D MRI before the development of pulmonary vein thrombus may help identify patients requiring preventive therapy against pulmonary vein thrombus and subsequent thromboembolic complications.
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Affiliation(s)
- Tadashi Umehara
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuhiro Ueda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takuya Tokunaga
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Aya Harada-Takeda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masami Sato
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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3
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Rijnberg FM, Juffermans JF, Hazekamp MG, Helbing WA, Lamb HJ, Roest AAW, Westenberg JJM, van Assen HC. Segmental assessment of blood flow efficiency in the total cavopulmonary connection using four-dimensional flow magnetic resonance imaging: vortical flow is associated with increased viscous energy loss rate. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab018. [PMID: 35919267 PMCID: PMC9241567 DOI: 10.1093/ehjopen/oeab018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022]
Abstract
Aims To study flow-related energetics in multiple anatomical segments of the total cavopulmonary connection (TCPC) in Fontan patients from four-dimensional (4D) flow magnetic resonance imaging (MRI), and to study the relationship between adverse flow patterns and segment-specific energetics. Methods and results Twenty-six extracardiac Fontan patients underwent 4D flow MRI of the TCPC. A segmentation of the TCPC was automatically divided into five anatomical segments [conduit, superior vena cava (SVC), right/left pulmonary artery (LPA), and the Fontan confluence]. The presence of vortical flow in the pulmonary arteries or Fontan confluence was qualitatively scored. Kinetic energy (KE), viscous energy loss rate, and vorticity were calculated from the 4D flow MRI velocity field and normalized for segment length and/or inflow. Energetics were compared between segments and the relationship between vortical flow and segment cross-sectional area (CSA) with segment-specific energetics was determined. Vortical flow in the LPA (n = 6) and Fontan confluence (n = 12) were associated with significantly higher vorticity (P = 0.001 and P = 0.015, respectively) and viscous energy loss rate (P = 0.046 and P = 0.04, respectively) compared to patients without vortical flow. The LPA and conduit segments showed the highest KE and viscous energy loss rate, while most favourable energetics were observed in the SVC. Conduit CSA inversely correlated with KE (r = −0.614, P = 0.019) and viscous energy loss rate (r = −0.652, P = 0.011). Conclusions Vortical flow in the Fontan confluence and LPA associated with significantly increased viscous energy loss rate. Four-dimensional flow MRI-derived energetics may be used as a screening tool for direct, MRI-based assessment of flow efficiency in the TCPC.
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Affiliation(s)
- Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
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Sturla F, Piatti F, Jaworek M, Lucherini F, Pluchinotta FR, Siryk SV, Giese D, Vismara R, Tasca G, Menicanti L, Redaelli A, Lombardi M. 4D Flow MRI hemodynamic benchmarking of surgical bioprosthetic valves. Magn Reson Imaging 2020; 68:18-29. [PMID: 31981709 DOI: 10.1016/j.mri.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE We exploited 4-dimensional flow magnetic resonance imaging (4D Flow), combined with a standardized in vitro setting, to establish a comprehensive benchmark for the systematic hemodynamic comparison of surgical aortic bioprosthetic valves (BPVs). MATERIALS AND METHODS 4D Flow analysis was performed on two small sizes of three commercialized pericardial BPVs (Trifecta™ GT, Carpentier-Edwards PERIMOUNT Magna and Crown PRT®). Each BPV was tested over a clinically pertinent range of continuous flow rates within an in vitro MRI-compatible system, equipped with pressure transducers. In-house 4D Flow post-processing of the post-valvular velocity field included the quantification of BPV effective orifice area (EOA), transvalvular pressure gradients (TPG), kinetic energy and viscous energy dissipation. RESULTS The 4D Flow technique effectively captured the 3-dimensional flow pattern of each device. Trifecta exhibited the lowest range of velocity and kinetic energy, maximized EOA (p < 0.0001) and minimized TPGs (p ≤ 0.015) if compared with Magna and Crown, these reporting minor EOA difference s (p ≥ 0.042) and similar TPGs (p ≥ 0.25). 4D Flow TPGs estimations strongly correlated against ground-truth data from pressure transducers; viscous energy dissipation proved to be inversely proportional to the fluid jet penetration. CONCLUSION The proposed 4D Flow analysis pinpointed consistent hemodynamic differences among BPVs, highlighting the not negligible effect of device size on the fluidynamic outcomes. The efficacy of non-invasive 4D Flow MRI protocol could shed light on how standardize the comparison among devices in relation to their actual hemodynamic performances and improve current criteria for their selection.
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Affiliation(s)
- Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Filippo Piatti
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesca R Pluchinotta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy; Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Pediatric and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sergii V Siryk
- CONCEPT Lab, Istituto Italiano di Tecnologia, Genova, Italy
| | | | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lorenzo Menicanti
- Department of Cardiovascular Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Characterization of Hemodynamics in Great Arteries of Wild-Type Mouse Using Computational Fluid Dynamics Based on Ultrasound Images. Ultrasound Q 2016; 32:51-7. [PMID: 26938034 DOI: 10.1097/ruq.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hemodynamic factors in cardiovascular system are hypothesized to play a significant role in causing structural heart development. It is thus important to improve our understanding of velocity characteristics and parameters. We present such a study on wild-type mouse to characterize the vessel geometry, flow pattern, and wall shear stress in great arteries. Microultrasound imaging for small animals was used to measure blood boundary and velocity of the great arteries. Subsequently, specimens' flow boundary conditions were used for 3-dimensional reconstructions of the great artery and aortic arch dimensions, and blood flow velocity data were input into subject-specific computational fluid dynamics for modeling hemodynamics. Measurement by microultrasound imaging showed that blood velocities in the great artery and aortic arch had strong correlations with vascular sizes, whereas blood pressure had a weak trend in relation to vascular size. Wall shear stress magnitude increased when closer to arterial branches and reduced proximally in the aortic root and distally in the descending aorta, and the parameters were related to the fluid mechanics in branches in some degree. We developed a method to investigate fluid mechanics in mouse arteries, using a combination of microultrasound and computational fluid dynamics, and demonstrated its ability to reveal detailed geometric, kinematic, and fluid mechanics parameters.
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6
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Elbaz MSM, van der Geest RJ, Calkoen EE, de Roos A, Lelieveldt BPF, Roest AAW, Westenberg JJM. Assessment of viscous energy loss and the association with three-dimensional vortex ring formation in left ventricular inflow: In vivo evaluation using four-dimensional flow MRI. Magn Reson Med 2016; 77:794-805. [PMID: 26924448 PMCID: PMC5297883 DOI: 10.1002/mrm.26129] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/20/2015] [Accepted: 12/24/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate viscous energy loss and the association with three-dimensional (3D) vortex ring formation in left ventricular (LV) blood flow during diastolic filling. THEORY AND METHODS Thirty healthy volunteers were compared with 32 patients with corrected atrioventricular septal defect as unnatural mitral valve morphology and inflow are common in these patients. 4DFlow MRI was acquired from which 3D vortex ring formation was identified in LV blood flow at peak early (E)-filling and late (A)-filling and characterized by its presence/absence, orientation, and position from the lateral wall. Viscous energy loss was computed over E-filling, A-filling, and complete diastole using the Navier-Stokes energy equations. RESULTS Compared with healthy volunteers, viscous energy loss was significantly elevated in patients with disturbed vortex ring formation as characterized by a significantly inclined orientation and/or position closer to the lateral wall. Highest viscous energy loss was found in patients without a ring-shaped vortex during E-filling (on average more than double compared with patients with ring-shape vortex, P < 0.003). Altered A-filling vortex ring formation was associated with significant increase in total viscous energy loss over diastole even in the presence of normal E-filling vortex ring. CONCLUSION Altered vortex ring formation during LV filling is associated with increased viscous energy loss. Magn Reson Med 77:794-805, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
| | | | - Emmeline E Calkoen
- Division of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn P F Lelieveldt
- Division of Image Processing, Department of Radiology.,Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Arno A W Roest
- Division of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Altered Right Ventricular Kinetic Energy Work Density and Viscous Energy Dissipation in Patients with Pulmonary Arterial Hypertension: A Pilot Study Using 4D Flow MRI. PLoS One 2015; 10:e0138365. [PMID: 26418553 PMCID: PMC4587751 DOI: 10.1371/journal.pone.0138365] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/27/2015] [Indexed: 01/08/2023] Open
Abstract
Introduction Right ventricular (RV) function has increasingly being recognized as an important predictor for morbidity and mortality in patients with pulmonary arterial hypertension (PAH). The increased RV after-load increase RV work in PAH. We used time-resolved 3D phase contrast MRI (4D flow MRI) to derive RV kinetic energy (KE) work density and energy loss in the pulmonary artery (PA) to better characterize RV work in PAH patients. Methods 4D flow and standard cardiac cine images were obtained in ten functional class I/II patients with PAH and nine healthy subjects. For each individual, we calculated the RV KE work density and the amount of viscous dissipation in the PA. Results PAH patients had alterations in flow patterns in both the RV and the PA compared to healthy subjects. PAH subjects had significantly higher RV KE work density than healthy subjects (94.7±33.7 mJ/mL vs. 61.7±14.8 mJ/mL, p = 0.007) as well as a much greater percent PA energy loss (21.1±6.4% vs. 2.2±1.3%, p = 0.0001) throughout the cardiac cycle. RV KE work density and percent PA energy loss had mild and moderate correlations with RV ejection fraction. Conclusion This study has quantified two kinetic energy metrics to assess RV function using 4D flow. RV KE work density and PA viscous energy loss not only distinguished healthy subjects from patients, but also provided distinction amongst PAH patients. These metrics hold promise as imaging markers for RV function.
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8
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Cibis M, Jarvis K, Markl M, Rose M, Rigsby C, Barker AJ, Wentzel JJ. The effect of resolution on viscous dissipation measured with 4D flow MRI in patients with Fontan circulation: Evaluation using computational fluid dynamics. J Biomech 2015; 48:2984-9. [PMID: 26298492 DOI: 10.1016/j.jbiomech.2015.07.039] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/03/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
Viscous dissipation inside Fontan circulation, a parameter associated with the exercise intolerance of Fontan patients, can be derived from computational fluid dynamics (CFD) or 4D flow MRI velocities. However, the impact of spatial resolution and measurement noise on the estimation of viscous dissipation is unclear. Our aim was to evaluate the influence of these parameters on viscous dissipation calculation. Six Fontan patients underwent whole heart 4D flow MRI. Subject-specific CFD simulations were performed. The CFD velocities were down-sampled to isotropic spatial resolutions of 0.5mm, 1mm, 2mm and to MRI resolution. Viscous dissipation was compared between (1) high resolution CFD velocities, (2) CFD velocities down-sampled to MRI resolution, (3) down-sampled CFD velocities with MRI mimicked noise levels, and (4) in-vivo 4D flow MRI velocities. Relative viscous dissipation between subjects was also calculated. 4D flow MRI velocities (15.6 ± 3.8 cm/s) were higher, although not significantly different than CFD velocities (13.8 ± 4.7 cm/s, p=0.16), down-sampled CFD velocities (12.3 ± 4.4 cm/s, p=0.06) and the down-sampled CFD velocities with noise (13.2 ± 4.2 cm/s, p=0.06). CFD-based viscous dissipation (0.81 ± 0.55 mW) was significantly higher than those based on down-sampled CFD (0.25 ± 0.19 mW, p=0.03), down-sampled CFD with noise (0.49 ± 0.26 mW, p=0.03) and 4D flow MRI (0.56 ± 0.28 mW, p=0.06). Nevertheless, relative viscous dissipation between different subjects was maintained irrespective of resolution and noise, suggesting that comparison of viscous dissipation between patients is still possible.
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Affiliation(s)
- Merih Cibis
- Biomedical Engineering, Erasmus Medical Center, Rotterdam, Netherlands.
| | - Kelly Jarvis
- Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Michael Markl
- Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Michael Rose
- Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Cynthia Rigsby
- Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Alex J Barker
- Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Jolanda J Wentzel
- Biomedical Engineering, Erasmus Medical Center, Rotterdam, Netherlands
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van Ooij P, Allen BD, Contaldi C, Garcia J, Collins J, Carr J, Choudhury L, Bonow RO, Barker AJ, Markl M. 4D flow MRI and T1 -Mapping: Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy. J Magn Reson Imaging 2015; 43:107-14. [PMID: 26227419 DOI: 10.1002/jmri.24962] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/15/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. MATERIALS AND METHODS Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 × 2.1-4.0 × 2.5-3.2 mm(3) ; venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15°) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 ± 15 years) and 10 age-matched healthy controls (45 ± 14 years). In addition, pre- and postcontrast myocardial T1 -mapping (resolution = 2.3 × 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35°) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss EL ' as well as left ventricular ECV. RESULTS HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 ± 16 mmHg vs. 9 ± 2 mmHg) and energy loss EL ' (3.8 ± 2.5 mW vs. 1.5 ± 0.7 mW, P < 0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R(2) = 0.44, P < 0.001) and energy loss EL ' (R(2) = 0.46, P < 0.001). CONCLUSIONS The integration of 4D-flow and T1 -mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM.
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Affiliation(s)
- Pim van Ooij
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Carla Contaldi
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lubna Choudhury
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Robert O Bonow
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
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10
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Casas B, Lantz J, Dyverfeldt P, Ebbers T. 4D Flow MRI-based pressure loss estimation in stenotic flows: Evaluation using numerical simulations. Magn Reson Med 2015; 75:1808-21. [DOI: 10.1002/mrm.25772] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Belen Casas
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Jonas Lantz
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Division of Media and Information Technology; Department of Science and Technology/Swedish e-Science Research Centre (SeRC); Linköping University; Linköping Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Division of Media and Information Technology; Department of Science and Technology/Swedish e-Science Research Centre (SeRC); Linköping University; Linköping Sweden
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11
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Roldán-Alzate A, García-Rodríguez S, Anagnostopoulos PV, Srinivasan S, Wieben O, François CJ. Hemodynamic study of TCPC using in vivo and in vitro 4D Flow MRI and numerical simulation. J Biomech 2015; 48:1325-30. [PMID: 25841292 DOI: 10.1016/j.jbiomech.2015.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 03/06/2015] [Accepted: 03/10/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Altered total cavopulmonary connection (TCPC) hemodynamics can cause long-term complications. Patient-specific anatomy hinders generalized solutions. 4D Flow MRI allows in vivo assessment, but not predictions under varying conditions and surgical approaches. Computational fluid dynamics (CFD) improves understanding and explores varying physiological conditions. This study investigated a combination of 4D Flow MRI and CFD to assess TCPC hemodynamics, accompanied with in vitro measurements as CFD validation. 4D Flow MRI was performed in extracardiac and atriopulmonary TCPC subjects. Data was processed for visualization and quantification of velocity and flow. Three-dimensional (3D) geometries were generated from angiography scans and used for CFD and a physical model construction through additive manufacturing. These models were connected to a perfusion system, circulating water through the vena cavae and exiting through the pulmonary arteries at two flow rates. Models underwent 4D Flow MRI and image processing. CFD simulated the in vitro system, applying two different inlet conditions from in vitro 4D Flow MRI measurements; no-slip was implemented at rigid walls. Velocity and flow were obtained and analyzed. The three approaches showed similar velocities, increasing proportionally with high inflow. Atriopulmonary TCPC presented higher vorticity compared to extracardiac at both inflow rates. Increased inflow balanced flow distribution in both TCPC cases. Atriopulmonary IVC flow participated in atrium recirculation, contributing to RPA outflow; at baseline, IVC flow preferentially traveled through the LPA. The combination of patient-specific in vitro and CFD allows hemodynamic parameter control, impossible in vivo. Physical models serve as CFD verification and fine-tuning tools.
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Affiliation(s)
| | | | - Petros V Anagnostopoulos
- Department of Pediatric Cardiology, University of Wisconsin-Madison, USA; Department of Pediatric Cardiothoracic Surgery, University of Wisconsin-Madison, USA
| | - Shardha Srinivasan
- Department of Pediatric Cardiology, University of Wisconsin-Madison, USA
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin-Madison, USA; Department of Medical Physics, University of Wisconsin-Madison, USA
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Barker AJ, van Ooij P, Bandi K, Garcia J, Albaghdadi M, McCarthy P, Bonow RO, Carr J, Collins J, Malaisrie SC, Markl M. Viscous energy loss in the presence of abnormal aortic flow. Magn Reson Med 2014; 72:620-8. [PMID: 24122967 PMCID: PMC4051863 DOI: 10.1002/mrm.24962] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/29/2013] [Accepted: 08/31/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE To present a theoretical basis for noninvasively characterizing in vivo fluid-mechanical energy losses and to apply it in a pilot study of patients known to express abnormal aortic flow patterns. METHODS Four-dimensional flow MRI was used to characterize laminar viscous energy losses in the aorta of normal controls (n = 12, age = 37 ± 10 yr), patients with aortic dilation (n = 16, age = 52 ± 8 yr), and patients with aortic valve stenosis matched for age and aortic size (n = 14, age = 46 ± 15 yr), using a relationship between the three-dimensional velocity field and viscous energy dissipation. RESULTS Viscous energy loss was elevated significantly in the thoracic aorta in patients with dilated aorta (3.6 ± 1.3 mW, P = 0.024) and patients with aortic stenosis (14.3 ± 8.2 mW, P < 0.001) compared with healthy volunteers (2.3 ± 0.9 mW). The same pattern of significant differences was seen in the ascending aorta, where viscous energy losses in patients with dilated aortas (2.2 ± 1.1 mW, P = 0.021) and patients with aortic stenosis (10.9 ± 6.8 mW, P < 0.001) were elevated compared with healthy volunteers (1.2 ± 0.6 mW). CONCLUSION This technique provides a capability to quantify the contribution of abnormal laminar blood flow to increased ventricular afterload. In this pilot study, viscous energy loss in patient cohorts was significantly elevated and indicates that cardiac afterload is increased due to abnormal flow.
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Affiliation(s)
- Alex J Barker
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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Itatani K, Miyaji K, Tomoyasu T, Nakahata Y, Ohara K, Takamoto S, Ishii M. Optimal Conduit Size of the Extracardiac Fontan Operation Based on Energy Loss and Flow Stagnation. Ann Thorac Surg 2009; 88:565-72; discussion 572-3. [DOI: 10.1016/j.athoracsur.2009.04.109] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 04/26/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
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Sundareswaran KS, Frakes DH, Fogel MA, Soerensen DD, Oshinski JN, Yoganathan AP. Optimum fuzzy filters for phase-contrast magnetic resonance imaging segmentation. J Magn Reson Imaging 2009; 29:155-65. [PMID: 19097101 DOI: 10.1002/jmri.21579] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop and validate a multidimensional segmentation and filtering methodology for accurate blood flow velocity field reconstruction from phase-contrast magnetic resonance imaging (PC MRI). MATERIALS AND METHODS The proposed technique consists of two steps: (1) the boundary of the vessel is automatically segmented using the active contour approach; and (2) the noise embedded within the segmented vector field is selectively removed using a novel fuzzy adaptive vector median filtering (FAVMF) technique. This two-step segmentation process was tested and validated on 111 synthetically generated PC MRI slices and on 10 patients with congenital heart disease. RESULTS The active contour technique was effective for segmenting blood vessels having a sensitivity and specificity of 93.1% and 92.1% using manual segmentation as a reference standard. FAVMF was the superior technique in filtering out noise vectors, when compared with other commonly used filters in PC MRI (P < 0.05). The peak wall shear rate calculated from the PC MRI data (248 +/- 39 sec(-1)), was significantly decreased to (146 +/- 26 sec(-1)) after the filtering process. CONCLUSION The proposed two-step segmentation and filtering methodology is more accurate compared to a single-step segmentation process for post-processing of PC MRI data.
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Affiliation(s)
- Kartik S Sundareswaran
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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15
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Pekkan K, Dur O, Sundareswaran K, Kanter K, Fogel M, Yoganathan A, Ündar A. Neonatal Aortic Arch Hemodynamics and Perfusion During Cardiopulmonary Bypass. J Biomech Eng 2008; 130:061012. [DOI: 10.1115/1.2978988] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of this study is to quantify the detailed three-dimensional (3D) pulsatile hemodynamics, mechanical loading, and perfusion characteristics of a patient-specific neonatal aortic arch during cardiopulmonary bypass (CPB). The 3D cardiac magnetic resonance imaging (MRI) reconstruction of a pediatric patient with a normal aortic arch is modified based on clinical literature to represent the neonatal morphology and flow conditions. The anatomical dimensions are verified from several literature sources. The CPB is created virtually in the computer by clamping the ascending aorta and inserting the computer-aided design model of the 10 Fr tapered generic cannula. Pulsatile (130 bpm) 3D blood flow velocities and pressures are computed using the commercial computational fluid dynamics (CFD) software. Second order accurate CFD settings are validated against particle image velocimetry experiments in an earlier study with a complex cardiovascular unsteady benchmark. CFD results in this manuscript are further compared with the in vivo physiological CPB pressure waveforms and demonstrated excellent agreement. Cannula inlet flow waveforms are measured from in vivo PC-MRI and 3 kg piglet neonatal animal model physiological experiments, distributed equally between the head-neck vessels and the descending aorta. Neonatal 3D aortic hemodynamics is also compared with that of the pediatric and fetal aortic stages. Detailed 3D flow fields, blood damage, wall shear stress (WSS), pressure drop, perfusion, and hemodynamic parameters describing the pulsatile energetics are calculated for both the physiological neonatal aorta and for the CPB aorta assembly. The primary flow structure is the high-speed canulla jet flow (∼3.0 m/s at peak flow), which eventually stagnates at the anterior aortic arch wall and low velocity flow in the cross-clamp pouch. These structures contributed to the reduced flow pulsatility (85%), increased WSS (50%), power loss (28%), and blood damage (288%), compared with normal neonatal aortic physiology. These drastic hemodynamic differences and associated intense biophysical loading of the pathological CPB configuration necessitate urgent bioengineering improvements—in hardware design, perfusion flow waveform, and configuration. This study serves to document the baseline condition, while the methodology presented can be utilized in preliminary CPB cannula design and in optimization studies reducing animal experiments. Coupled to a lumped-parameter model the 3D hemodynamic characteristics will aid the surgical decision making process of the perfusion strategies in complex congenital heart surgeries.
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Affiliation(s)
- Kerem Pekkan
- Department of Biomedical Engineering, Carnegie Mellon University, 2100 Doherty Hall, Pittsburgh, PA 15213-3890
| | - Onur Dur
- Department of Biomedical Engineering, Carnegie Mellon University, 2100 Doherty Hall, Pittsburgh, PA 15213-3890
| | - Kartik Sundareswaran
- Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 315 Ferst Drive, Atlanta, GA 30332-0535
| | - Kirk Kanter
- Pediatric Cardiothoracic Surgery, Emory University School of Medicine, 1440 Clifton Road, Atlanta, GA 30322
| | - Mark Fogel
- Children’s Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104
| | - Ajit Yoganathan
- Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 315 Ferst Drive, Atlanta, GA 30332-0535A
| | - Akif Ündar
- Department of Pediatrics, Surgery and Bioengineering, Penn State College of Medicine, Hershey, PA 17033
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Dasi LP, Pekkan K, Katajima HD, Yoganathan AP. Functional analysis of Fontan energy dissipation. J Biomech 2008; 41:2246-52. [PMID: 18508062 DOI: 10.1016/j.jbiomech.2008.04.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/09/2008] [Accepted: 04/14/2008] [Indexed: 11/20/2022]
Abstract
We formalize the hydrodynamic energy dissipation in the total cavopulmonary connection (TCPC) using dimensional analysis and examine the effect of governing flow variables; namely, cardiac output, flow split, body surface area, Reynolds number, and certain geometric characteristics. A simplistic and clinically useful mathematical model of the dependence of energy dissipation on the governing variables is developed. In vitro energy loss data corresponding to six patients' anatomies validated the predicted dependency of each variable and was used to develop a predictive, semi-empirical energy dissipation model of the TCPC. It is shown that energy dissipation is a cubic function of pulmonary flow split in the physiological range. Furthermore, non-dimensional energy dissipation, which is a measure of resistance of the connection, is dependent on Reynolds number and geometrical factors alone. Non-dimensional energy dissipation decreases with Reynolds number as Re(-0.25) (R(2)>0.95). In addition, for high Reynolds numbers, within physiological exercise limits, dissipation strongly correlates to minimum PA area as a power law decay with an exponent of -5/4 (R(2)>0.88). This study presents a simple analytical form of energy dissipation rate in complex patient-specific TCPCs that accurately captures the effect of cardiac output, flow split, body surface area, Reynolds number, and pulmonary artery size within physiological limits. Further studies with larger sample sizes are necessary for incorporating finer geometrical parameters such as vessel curvatures and offsets.
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Affiliation(s)
- Lakshmi P Dasi
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0535, USA
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