Systemic ventricular flow pattern disorder in dTGA ... · 4D-flow MRI assessment of d-TGA | Dr....
Transcript of Systemic ventricular flow pattern disorder in dTGA ... · 4D-flow MRI assessment of d-TGA | Dr....
Systemic ventricular flow pattern disorder in d-TGA patients – a 4D-
flow MRI study
ESPR 2019
Dr Fraser Callaghan
B. Burkhardt, E.R. Valsangiacomo Buechel, C. J. Kellenberger, J. Geiger
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 2
Systemic ventricular flow pattern disorder in d-TGA patients – a 4D-
flow MRI study
Adapted from: Dasgupta, S. et al. Evaluation of the Cyanotic Newborn:
Part 2--A Cardiologists Perspective. NeoReviews 2016
D-TGA Arterial Switch Atrial Switch
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 3
Normal and d-TGA patients – LV paths derived from 4D-flow MRI
Control Arterial Switch Atrial Switch
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 4
Subject cohort and systemic ventricle volumetric assessment
N (%male) Age (yrs) BSA EDV / BSA SV / BSA EF
Arterial switch 11(63%) 12.6±4.8 1.29±0.3 85.0±10.3 50.9±8.1 59.7±5.5
Atrial switch 10 (70%) 34.4±6.7*** 1.81±0.16** 121.1±34.2** 51.6±14.3 42.6±3.7***
Controls 10 (70%) 11.7±3.4 1.36±0.3 76.9±13.8 44.9±8.2 58.4±3.9
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 5
Systemic ventricle flow energetics
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 7
Flow disorder and energetics
Disordered flow (mixing) yields high viscous energy losses.
High viscous energy loss leads to increasedventricle work requirementsSvalbring, PlosOne, 2016
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 8
Flow disorder and energetics
Disordered flow (mixing) yields high viscous energy losses.
High viscous energy loss leads to increasedventricle work requirements
Ordered flow.
Low viscous energy loss
Disordered flow.
High viscous energy loss
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 9
Flow disorder and energetics
Ordered flow.
Low viscous energy loss
Disordered flow.
High viscous energy loss
Disordered flow.
High viscous energy loss
Ordered flow.
Low viscous energy loss
d-TGA Atrial switch correction d-TGA Arterial switch correction
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 10
Flow disorder and energetics
Disordered flow (mixing) yields high viscous energy losses.
High viscous energy loss leads to increasedventricle work requirements
Ordered flow.
Low viscous energy loss
Disordered flow.
High viscous energy loss
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 11
Subject specific assessment of corrected d-TGA patients using 4D-
flow MRI
Disordered flow (mixing) yields high viscous energy losses• Mixing of ventricle flow components obvious with 4D-flow MRI• Viscous energy losses appear elevated due to this mixing• Viscous energy losses appear to correlate with increased EDV
High viscous energy loss leads to increased ventricle work requirements• Larger population studies• Longitudinal studies
4D-flow MRI assessment of d-TGA | Dr. Fraser Callaghan | ESPR 2019 12
Thank you for your attention
Cardiac MR team at Children’s hospital Zurich
Prof. Christian KellenbergerProf. Emanuela Valsangiacomo BuechelDr. Barbara BurkhardtDr Julia Geiger