Discordances in Kinetic Energy Between the Superior Cavopulmonary Connection and Single Ventricle Are Associated With Suboptimal Fontan Outcomes: A Pre‐Fontan 4‐Dimensional Flow Study

Figures

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  Figure 1. Model segmentation and intracardiac flow analysis. A, Three‐dimensional segmentation of the atrium, SCPC and (SV). B, C, Measurement of viscous energy loss (mJ) and kinetic energy (mJ) over the cardiac cycle. SCPC indicates superior cavopulmonary connection; and SV, single ventricle.

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  Figure 2. Pre‐Fontans with higher KE in the SV and lower KE in the SCPC is associated with composite outcome (n=26) versus without composite outcome (n=33). The bar and cap represent mean and standard deviation respectively. KE indicates kinetic energy; SCER, superior cavopulmonary circulation energy ratio; SCPC, superior cavopulmonary connection; and SV, single ventricle.

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  Figure 3. Odds ratio plot of associations between KE in SV/SCPC with individual/composite clinical outcomes. KE indicates kinetic energy; SCER, superior cavopulmonary circulation energy ratio; SCPC, superior cavopulmonary connection; and SV, single ventricle.

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  Figure 4. Correlation matrix of 4‐dimensional flow intracardiac flow parameters (columns) against conventional cardiac magnetic resonance indices (rows). Only statistically significant correlations are illustrated with a color scale for the r value. APC indicates aortopulmonary collateral; AVVR, atrioventricular valve regurgitation; EDVi end‐diastolic volume index; KE, kinetic energy; SCPC, superior cavopulmonary connection; SV, single ventricle; SVEDVi, single‐ventricle end‐diastolic volume index; and VEL, viscous energy loss.

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  Figure 5. Associations of intracardiac flow with APCs. A, Representative streamline representation of a patient with an SV with APC burden >50% of pulmonary flow versus less APC burden (represented example has bilateral superior vena cavae). Select streamlines were visualized using Paraview 5.13 StreamTracer function to isolate relevant streamlines in the vector field. B, Kinetic energy measurements of the representative patients. C, Correlation between SCER and APC burden. APC indicates aortopulmonary collateral; SCER, superior cavopulmonary circulation energy ratio; and SV, single ventricle.

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  Figure 6. Associations of intracardiac flow with AVVR. A, Representative streamline representation of a patient with an SV with significant AVVR vs no AVVR. Select streamlines were visualized using Paraview 5.13 StreamTracer function to isolate relevant streamlines in the vector field. B, Atrial VEL measurements of the representative patients. AVVR indicates atrioventricular valve regurgitation; SV, single ventricle; and VEL, viscous energy loss.