title: Hemodynamic assessment in patients with one-and-a-half ventricle repair revealed by four-dimensional flow magnetic resonance imaging.
abstract: 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.
authors.affiliation: Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. suribe@med.puc.cl
authors.forename: Sergio
authors.initials: S
authors.lastname: Uribe
authors.forename: Pablo
authors.initials: P
authors.lastname: Bächler
authors.forename: Israel
authors.initials: I
authors.lastname: Valverde
authors.forename: Gérard R
authors.initials: GR
authors.lastname: Crelier
authors.forename: Philipp
authors.initials: P
authors.lastname: Beerbaum
authors.forename: Cristian
authors.initials: C
authors.lastname: Tejos
authors.forename: Pablo
authors.initials: P
authors.lastname: Irarrazaval
mesh_terms: D000293:Adolescent; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D011651:Pulmonary Artery / Q000601:surgery*; D018633:Pulmonary Atresia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014683:Vena Cava, Superior / Q000601:surgery*