Alterations in pulmonary artery flow patterns and shear stress determined with three- dimensional phase-contrast magnetic resonance imaging in fontan patients

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Alterations in pulmonary artery flow patterns and shear stress determined with three- dimensional phase-contrast magnetic resonance imaging in fontan patients Victoria L. Morgan, PhDa,b, Thomas P. Graham, MDc, Robert J. Roselli, PhDa, Christine H. Lorenz, PhDd The Journal of Thoracic and Cardiovascular Surgery Volume 116, Issue 2, Pages 294-304 (August 1998) DOI: 10.1016/S0022-5223(98)70130-8 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Diagrams showing the Fontan repair in the RA group (A) and the BC group (B). SVC, Superior vena cave; IVC, inferior vena cave; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; LV, left ventricle;LA, left atrium;LPA, left pulmonary artery; Ao, aorta. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 T1-weighted transverse image through the pulmonary arteries. The main pulmonary artery bifurcates into the LPA and RPA. The velocity encoded cine imaging slice positions through (A) both vessels in the control group and (B) the RPA in the BC group is shown. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 A section of the vessel showing a single pixel and its axial velocity (vz), circumferential velocity (vτ), radial velocity (vr), the axial shear stress (τrz), the circumferential shear stress (τrτ), and the radial shear stress (τrr). The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Flow versus percent RR interval averaged over subject group in the RPA (A) and LPA (B). Control group (solid line), RA group (dotted line), and BC group (dashed line). Standard deviations were similar in all groups, in the range 15 to 30 cm/sec. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 Two dimensional in-plane blood velocity vectors during systole in the cross section of (A) a normal control subject immediately distal to the main pulmonary artery bifurcation, (B) an RA group subject immediately distal to Fontan connection, and (C) a BC group subject immediately distal to the Fontan connection. The magnitude of the velocity is represented by the length of the vector and the direction of the velocity is represented by the direction of the vector. The axis scale is in pixels at 1.17 mm/pixel. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 6 Two-dimensional in-plane blood velocity vectors during systole in the LPA cross section immediately distal to the main pulmonary artery bifurcation of (A) a normal control subject, (B) an RA group subject, and (C) a BC group subject. The magnitude of the velocity is represented by the length of the vector and the direction of the velocity is represented by the direction of the vector. The axis scale is in pixels at 1.17 mm/pixel. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 7 Axial shear stress near the wall of the vessel averaged over each subject group in the (A) RPA and (B) LPA estimated using three-dimensional phase contrast MRI. Control group (solid line), RA group (dashed line), BC group (dash/dot/dash line). The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 8 Circumferential shear stress near the wall of the vessel averaged over each subject group in the (A) RPA and (B) LPA estimated using three-dimensional phase contrast MRI. Control group (solid line), RA group (dashed line), BC group (dash/dot/dash line). Standard deviation of circumferential shear stress was in the range of 120 to 170 dynes/cm2 in the control group and 53 to 260 dynes/cm2in the patient groups. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 9 Radial shear stress near the wall of the vessel averaged over each subject group in the (A) RPA and (B) LPA estimated using three-dimensional phase contrast MRI. Control group (solid line), RA group (dashed line), BC group (dash/dot/dash line). Standard deviation of radial shear stress was in the range 132 to 138 dynes/cm2 in the control group and 75 to 302 dynes/cm2in the patient groups. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 294-304DOI: (10.1016/S0022-5223(98)70130-8) Copyright © 1998 Mosby, Inc. Terms and Conditions