In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging Shiva Sharma, MD, Ann E Ensley,

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In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging Shiva Sharma, MD, Ann E Ensley, BS, Katharine Hopkins, MD, George P Chatzimavroudis, PhD, Timothy M Healy, BS, Vincent K.H Tam, MD, Kirk R Kanter, MD, Ajit P Yoganathan, PhD The Annals of Thoracic Surgery Volume 71, Issue 3, Pages 889-898 (March 2001) DOI: 10.1016/S0003-4975(00)02517-0

Fig 1 Vector maps from sagittal views cut along the lines shown in the inset of the coronal plane of patient 1. The maps display the helical flow set up at the connection site with the anterior–posterior vectors profiled clearly. The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 2 A vector map in a coronal slice from the same patient as in Figure 6 (Patient 1). Note the disordered flow in the inferior caval conduit. The increased superior vena caval velocity and its dominance is demonstrated by the inferior displacement of the stagnation line. (ICC = inferior caval conduits; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 3 (A) Schematic of extracardiac total cavopulmonary connection with the superior vena caval offset and flared toward the left pulmonary artery. (B) Magnetic resonance magnitude image of a coronal slice from an extracardiac type of total cavopulmonary connection. Note the waist at the midinferior caval conduit level. This figure corresponds with Figure 5 and Patient 11. The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 4 A vector map in a coronal slice from a patient with bilateral superior vena cava (Patient 7). The picture demonstrated a complex anteriorly directed swirl in the lower inferior caval conduit from which an area of acceleration emerges. Note superior vena caval flow influx into inferior caval conduit and secondary swirl in the left pulmonary artery. (ICC = inferior caval conduits; LPA = left pulmonary artery; LSVC = left superior vena cava; RSVC = right superior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 5 A vector map in a coronal slice from the patient in Figure 3B (Patient 11). Note the increased velocity flow in the inferior caval conduit. Streamlined superior vena cava and left pulmonary artery flow can be seen as well as a secondary swirl. (ICC = inferior caval conduits; LPA = left pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 6 Magnetic resonance magnitude image taken from coronal slice of a patient with an intraatrial type total cavopulmonary connection with no offset. This figure corresponds with Figure 2 and Figure 1 inset. The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 7 A vector map in the coronal plane of the branch pulmonary arteries demonstrating posteriorly directed flow. (LPA = left pulmonary artery; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 8 Particle flow visualization in the flared and 14-mm offset in vitro total cavopulmonary connection glass model. The superior vena cava-to-inferior caval conduit flow ratio was 40:60 with 70% of total flow (4 L/min) directed to the right pulmonary artery. A swirl is noted in the pulmonary artery between the two caval offsets. The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 9 Schematics of total cavopulmonary connections that are desirable and undesirable. (IVC = inferior vena cava; LPA = left pulmonary artery; LSVC = left superior vena cava; RPA = right pulmonary artery; RSVC = right superior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)

Fig 9 Schematics of total cavopulmonary connections that are desirable and undesirable. (IVC = inferior vena cava; LPA = left pulmonary artery; LSVC = left superior vena cava; RPA = right pulmonary artery; RSVC = right superior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2001 71, 889-898DOI: (10.1016/S0003-4975(00)02517-0)