Noninvasive assessment of myocardial perfusion using ultrafast ultrasound: clinical study for congenital heart disease

Figures

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  Figure 1. The acquisition workflow for ultrafast PD myocardial perfusion approximation. (A) HV, TGA with intact ventricular septum, and HLHS were recruited. (B) An ultrafast ultrasound-enabled research scanner was used in all acquisitions. (C) Three acquisitions were acquired in the short and long-axis views at the RV free wall and interventricular septum. (D) Ultrafast acquisitions were taken at 2000 frames per second, with coherent compounding of 5 diverging waves (top row), covering a sector of 60°, with an imaging depth of 60 mm. (E) After tissue signals were suppressed, ultrafast ultrasound PD signals were extracted to quantify blood volumes of the coronary microvasculature. (F) PD signals were plotted over time and, for visualization purposes, scaled by peak PD throughout the cardiac cycle and by maximal time duration. HV, healthy volunteer; TGA, transposition of the great arteries; HLHS, hypoplastic left heart syndrome; LAD, left anterior descending artery; RCA, right coronary artery; Cx, circumflex; IVS, interventricular septum; RV, right ventricle; PD, power Doppler.

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  Figure 2. Temporal blood volume patterns of healthy volunteers. The right ventricular blood volume peaks slightly in systole compared with diastole. Meanwhile, the left ventricular blood volume pattern has a tall peak in diastole relative to systole. When compared with epicardial coronary perfusion data, the temporal patterns appear similar. The reference coronary perfusion pattern was scaled and superimposed onto the healthy volunteer blood volumes to assist with comparison. P-value derived from t-test comparing the difference of percentage of the integral of the PD values of systole compared with diastole. Adapted from Chatzizisis et al.7

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  Figure 3. Temporal blood volume patterns in transposition of the great arteries. The mean blood volume patterns of TGA patients are presented. The blood volume patterns of HV are superimposed. Of note, all TGA patients pre-operatively had a patent ductus arteriosus, thus exposing the LV to systemic pressures. P-value derived from t-test comparing the difference of percentage of the integral of the PD signals of systole compared with diastole.

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  Figure 4. Temporal blood volume patterns in HLHS. The mean blood volume patterns of HLHS patients are presented. The blood volume patterns of HV are superimposed. P-value derived from t-test comparing the difference of percentage of the integral of the PD signals of systole compared with diastole.