title: Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging.
abstract: Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3-29) and eight healthy volunteers (median age 26 years, range 23-36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of the controls' left ventricle (LV) or right ventricle (RV) depending on the patients' ventricular morphology (Cohen´s κ = 1.0). Peak systolic KE/SV did not differ in patients compared to the LV in controls (0.016 ± 0.006 mJ/ml vs 0.020 ± 0.004 mJ/ml, p = 0.09). Peak diastolic KE/SV in Fontan patients was lower than in the LV of the control group (0.028 ± 0.010 mJ/ml vs 0.057 ± 0.011 mJ/ml, p < 0.0001). The KE during diastole showed a plateau in patients with aortopulmonary collaterals. This is to our knowledge the first study that quantifies the intraventricular KE of Fontan patients. KE is dependent on the morphology of the ventricle, and diastolic KE indexed to SV in patients is decreased compared to controls. The lower KE in Fontan patients may be a result of impaired ventricular filling.
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.|Department of Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Sjöberg
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.|Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.|Center for Mathematics, Faculty of Engineering, Lund University, Lund, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Heiberg
authors.affiliation: Department of Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Wingren
authors.affiliation: Department of Clinical Sciences Lund, Pediatric Heart Center, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Jens
authors.initials: J
authors.lastname: Ramgren Johansson
authors.affiliation: Department of Clinical Sciences Lund, Pediatric Heart Center, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Torsten
authors.initials: T
authors.lastname: Malm
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.|Department of Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
authors.affiliation: Department of Clinical Sciences Lund, Pediatric Heart Center, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Petru
authors.initials: P
authors.lastname: Liuba
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden. marcus.carlsson@med.lu.se.|Department of Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden. marcus.carlsson@med.lu.se.
authors.forename: Marcus
authors.initials: M
authors.lastname: Carlsson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003971:Diastole; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007700:Kinetics; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult
keywords: CMR; Congenital heart disease; Fontan; Kinetic energy; MRI; Magnetic resonance imaging