Longitudinal Intracardiac Right Ventricular Flow Analysis in Infants With Hypoplastic Left Heart Syndrome in Interstage I Using Novel Doppler Velocity Reconstruction

Figures

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  Figure 1. Visual demonstration of DoVeR reconstruction process. A, Apical 4‐chamber view showing color Doppler imaging of tricuspid inflow. The inflow jet demonstrates slight aliasing, which is corrected as part of the DoVeR algorithm. B, Delineation of endocardial boundaries within the right ventricle to enable calculation of intracardiac flow parameters. C, Vorticity map computed from reconstructed velocity fields, illustrating regions of vortical flow during diastolic filling. D, Time‐resolved velocity (blue: dashed=peak, solid=mean) and total kinetic energy (orange) in the right ventricle during 1 cardiac cycle. Peaks in kinetic energy correspond to diastolic filling phases. DoVeR indicates Doppler velocity reconstruction.

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  Figure 2. Trends over interstage period. Error bars represent SD from the mean. FEL indicates flow energy loss; KE, kinetic energy; and VS, vortex strength.

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  Figure 3. Correlation of clinical and flow parameters across all echocardiographic studies. 95% CIs for key correlations are reported in the Results text and in Table S2. BSA indicates body surface area, total, systole+diastole; and TAPSE, tricuspid annular plane systolic excursion.

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  Figure 4. Longitudinal analysis of VS and KE (diastolic average) with or without adverse event. Red line indicates patients who experienced adverse events, blue line indicates no adverse events. Error bars represent SD from the mean. KE indicates kinetic energy; and VS, vortex strength.

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  Figure 5. Representative changes of intracardiac flow and vorticity (color scale) in a patient with HLHS after birth (left) and 2 to 4 weeks after initial surgical palliation (right). Prominent increase to tricuspid inflow/ventricular filling occurs during this period. HLHS indicates hypoplastic left heart syndrome.

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  Figure 6. Comparison of flow parameters before intervention (pre) vs 2 to 4 weeks after intervention (post), in patients with HLHS with or without adverse events. Green lines indicate initial Norwood palliation; red lines indicate initial hybrid palliation. FEL indicates flow energy loss; HLHS, hypoplastic left heart syndrome; KE, kinetic energy; RVGLS, right ventricular global longitudinal strain; and VS, vortex strength.

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  Figure 7. Associations of significant TR with FEL and VS. Green points indicate studies from patients undergoing Norwood palliation; red points indicate studies from patients undergoing hybrid palliation. Each point represents an individual echocardiographic study. These cross‐sectional comparisons do not account for repeated measures. TR=0, no; TR=1, greater than moderate TR by echocardiography report. FEL indicates flow energy loss; TR, tricuspid regurgitation; and VS, vortex strength; and total, systole+diastole.