title: Counter-clockwise vortical blood flow in the main pulmonary artery in a patient with patent ductus arteriosus with pulmonary arterial hypertension: a cardiac magnetic resonance imaging case report.
abstract: In patients with pulmonary hypertension (PH), duration of vortical blood flow along the main pulmonary artery enables estimation of the mean pulmonary arterial pressure (mPAP) non-invasively. It remains to date not known, if this method is applicable in patients with pulmonary arterial hypertension (PAH) and abnormal aortic-to-pulmonary shunting.
  
  
  
  The present case analyzes the effect of a patent ductus arteriosus (PDA) on pulmonary artery flow patterns in PAH (mPAP from right heart catheterization, 75 mmHg). PH-associated vortical blood flow, which is typically observed rotating in a clockwise direction when viewed in right ventricular outflow tract orientation, was found nested in PDA left-to-right shunting. Even though rotating counter-clockwise, duration of vortical flow translated into correct non-invasive mPAP estimate.
  
  
  
  This case indicates that PH-associated vortex rotation is not restricted to clockwise direction, and that vortex-based estimation of elevated mPAP might also be feasible in patients with PAH and PDA.
authors: Siemens Healthcare, Graz, Austria.
authors: Gert
authors: G
authors: Reiter
authors: Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, A-8036, Graz, Austria. ursula.reiter@medunigraz.at.
authors: Ursula
authors: U
authors: Reiter
authors: Division of Pulmology, Department of Internal Medicine, Medical University of Graz, & LBI for Lung Vascular Research Graz, Graz, Austria.
authors: Gabor
authors: G
authors: Kovacs
authors: Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, A-8036, Graz, Austria.
authors: Gabriel
authors: G
authors: Adelsmayr
authors: Siemens Healthcare, Erlangen, Germany.
authors: Andreas
authors: A
authors: Greiser
authors: Siemens Healthcare, Erlangen, Germany.
authors: Aurelien F
authors: AF
authors: Stalder
authors: Division of Pulmology, Department of Internal Medicine, Medical University of Graz, & LBI for Lung Vascular Research Graz, Graz, Austria.
authors: Horst
authors: H
authors: Olschewski
authors: Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, A-8036, Graz, Austria.
authors: Michael
authors: M
authors: Fuchsjäger
mesh_terms: D001783:Blood Flow Velocity; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology*; D055815:Young Adult
keywords: 4D blood flow; Cardiac magnetic resonance imaging; Patent ductus arteriosus; Pulmonary arterial hypertension