Hemodynamic evaluation using four-dimensional flow magnetic resonance imaging for a patient with multichanneled aortic dissection Baolei Guo, MD, PhD,

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Presentation transcript:

Hemodynamic evaluation using four-dimensional flow magnetic resonance imaging for a patient with multichanneled aortic dissection Baolei Guo, MD, PhD, Selene Pirola, PhD, Daqiao Guo, MD, Zhihui Dong, MD, PhD, Xiao Yun Xu, PhD, Weiguo Fu, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 4, Issue 1, Pages 67-71 (March 2018) DOI: 10.1016/j.jvscit.2017.11.005 Copyright © 2017 Terms and Conditions

Fig 1 Three-dimensional (3D) computed tomography (CT) reconstruction (A) showed three channels: an inner narrowed true lumen (TL), a middle false lumen (FL), and an outer FL of a “true-false-false” lumen configuration (B). The axial CT image (C) at the primary entry tear showed an additional FL on the same side of the original FL and the compression of the TL. The cleavage plane of the dissection extended into the ostium of the left renal artery and compromised inflow, which caused static ischemia (D). Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 67-71DOI: (10.1016/j.jvscit.2017.11.005) Copyright © 2017 Terms and Conditions

Fig 2 Hemodynamic analysis was performed using four-dimensional (4D) flow magnetic resonance imaging (MRI) data for the through-plane velocity in the ascending aorta (Plane A) and proximal thoracic aorta (Plane B) throughout the systolic period. The through-plane blood flow pattern and velocity in the ascending aorta (a) significantly differed from those in the dissecting aorta (b and c), which showed complex spatial and temporal flow distribution among the three channels. The increasing velocity in the true lumen (TL) was much higher than that of false lumens (FLs), whereas the velocity and direction of the FLs were becoming asynchronous. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 67-71DOI: (10.1016/j.jvscit.2017.11.005) Copyright © 2017 Terms and Conditions

Fig 3 Quantitative comparison between through-plane flow and velocity (mean value of velocity magnitude) at peak systole (t2) in the three-channeled dissecting aorta. The flow and velocity magnitude were shown to be similar in the true lumen (TL) from the proximal (Plane B) to distal dissection (Plane C). Of note, flow and velocity throughout the cardiac cycle showed significant differences between the false lumens (FLs). The outer channel (FL-1) had a bidirectional flow; however, the middle one (FL-2) had only an antegrade flow. There was substantial flow in FL-2, and the velocities there were not much lower than in FL-1. Even within the same FL, the flow and velocity curves throughout the cardiac cycle changed considerably from Plane B to Plane C. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 67-71DOI: (10.1016/j.jvscit.2017.11.005) Copyright © 2017 Terms and Conditions

Fig 4 Digital subtraction angiography demonstrated abdominal true lumen (TL) with full collapse, and the left renal artery presented with malperfusion (A). Digital subtraction angiography confirmed the three-channeled morphology in the aortic arch (B). The angiogram showed the stent graft deployed with obliteration of the primary false lumens (FLs; C), whereas the abdominal TL failed to expand adequately (D). Abdominal aortography after bare stent deployment showed TL expansion without FL flow (E). Computed tomography (CT) scan (F-H) at 12 months after endovascular repair showed obliteration of the FLs in the thoracic aorta, nearly complete thrombosis of the FLs, expansion of the TL, and perfusion to all visceral arteries. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 67-71DOI: (10.1016/j.jvscit.2017.11.005) Copyright © 2017 Terms and Conditions