Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects Emmeline.

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Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects Emmeline E. Calkoen, MD, Mohammed S.M. Elbaz, MSc, Jos J.M. Westenberg, PhD, Lucia J.M. Kroft, MD, PhD, Mark G. Hazekamp, MD, PhD, Arno A.W. Roest, MD, PhD, Rob J. van der Geest, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 5, Pages 1233-1240.e1 (November 2015) DOI: 10.1016/j.jtcvs.2015.07.048 Copyright © 2015 Terms and Conditions

Figure 1 The 3-dimensional quantitative vortex core parameters. The cylindrical position of the (A) vortex core center (asterisk) was defined using L, C, and R coordinates relative to LV (A, B). L and R were normalized relative to the LV long-axis length and the radius of the LV endocardial cavity, respectively. The orientation angle was defined relative to the long-axis (C). The circularity index was defined as the ratio between the longest (D1) and shortest (D2) diameter (D). (modified after Elbaz and colleagues9). R, Radial; L, longitudinal; C, circumferential; sept, septal; lat, lateral; D1, longest diameter; D2, shortest diameter. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1233-1240.e1DOI: (10.1016/j.jtcvs.2015.07.048) Copyright © 2015 Terms and Conditions

Figure 2 Shape of vortex core corresponds with the inflow area. Vortex cores depicted on reformat planes of through-plane flow at peak inflow velocity (B, E, H, K) during E-peak and A-peak in a healthy subject (A-F) and a patient (G-L). AVSD, Atrioventricular septal defect; E-peak, early filling; A-peak, late filling; LA, left atrium; LV, left ventricle; Sept, septal side. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1233-1240.e1DOI: (10.1016/j.jtcvs.2015.07.048) Copyright © 2015 Terms and Conditions

Figure 3 Example of a vortex core during early filling in a patient (E-H) and a healthy subject (A-D). Streamline visualization (color coding represents velocity magnitude) shows a more lateral inflow direction in the patient (F) compared with the control (B). The vortex core has a more-tilted orientation (G) and elliptical shape (H) in the patient, compared with the healthy control (C-D). LA, Left atrium; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1233-1240.e1DOI: (10.1016/j.jtcvs.2015.07.048) Copyright © 2015 Terms and Conditions

Figure E1 Patient with a double-orifice LAVV showed 2 separate inflow jets. Streamlines (color coding representing velocity magnitude) show (A) 2 inflow jets (white arrows). The vortex core had a complex shape (B), but fit with streamlines (C). (D) Through-plane flow analysis showed3 jets in the LAVV (dotted line). Positioning the streamlines (E) and vortex core (F) on top of the velocity map shows that a core is formed around both jets. LA, Left atrium; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1233-1240.e1DOI: (10.1016/j.jtcvs.2015.07.048) Copyright © 2015 Terms and Conditions

Figure E2 Reversed orientation of the vortex ring core in a corrected AVSD patient. Healthy subject (A), and patients (B). LA, Left atrium; LV, left ventricle; ant, anterior. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1233-1240.e1DOI: (10.1016/j.jtcvs.2015.07.048) Copyright © 2015 Terms and Conditions

Different vortex core orientation and shape in patient with corrected AVSD compared with control. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1233-1240.e1DOI: (10.1016/j.jtcvs.2015.07.048) Copyright © 2015 Terms and Conditions