Key result
Patients with corrected atrioventricular septal defect had a significantly smaller percentage of direct left ventricular flow compared with healthy controls (30% vs 44%, P<0.001).
Why the study?
Patients with corrected atrioventricular septal defect have an abnormal left atrioventricular valve shape, but left ventricular blood flow organization in these patients had not been evaluated using 4D flow MRI particle tracing.
Does corrected atrioventricular septal defect alter left ventricular blood flow organization compared to healthy controls?
Cross-Sectional (n=62)
No
Does corrected atrioventricular septal defect alter left ventricular blood flow organization compared to healthy controls?
4D flow MRI with quantitative particle tracing demonstrates that patients with corrected AVSD have altered left ventricular flow organization, characterized by reduced direct flow and increased retained apical inflow, which may impact cardiac pumping efficiency.
Altered LV flow post-AVSD correction may reduce efficiency; extends 4D flow metrics but leaves open prognostic value and practice change.
OBJECTIVES: Four-dimensional (3 spatial directions and time) velocity-encoded flow magnetic resonance imaging with quantitative particle tracing analysis allows assessment of left ventricular (LV) blood flow organization. Corrected atrioventricular septal defect (AVSD) patients have an abnormal left atrioventricular valve shape. We aimed to analyze flow organization in corrected AVSD patients and healthy controls. METHODS: A total of 32 patients (age, 25 ± 14 years), 21 after partial AVSD correction and 11 after complete/intermediate AVSD correction, and 30 healthy volunteers (26 ± 12 years) underwent whole-heart four-dimensional velocity-encoded flow magnetic resonance imaging. Particle tracing in the 16-segment LV cavity model was used to quantitatively evaluate blood flow organization discriminating multiple components. RESULTS: Patients showed a smaller percentage of direct flow compared with controls (30% ± 9% vs 44% ± 11%; P < 0.001). In patients, more inflow was observed in the basal inferior segment (22% ± 11% vs controls, 17% ± 5%; P = 0.005), with less direct but more retained inflow (ie, part of inflow that is not ejected from LV in subsequent systole). In patients, more inflow reached the midventricular level (68% ± 13% vs controls, 58% ± 9%; P < 0.001), most notably as retained inflow in the lateral segments. Subsequently, in patients, more (mostly retained) inflow reached the apex (23% ± 13% vs 14% ± 7%; P < 0.001), which correlated with early peak filling velocity (r = 0.637, P < 0.001). Patients with a corrected complete or intermediate AVSD presented with less direct flow (24% ± 8% vs 33% ± 8%; P = 0.003) and more apical inflow (30% ± 14% vs 18% ± 12%; P = 0.014) compared with a corrected partial AVSD. CONCLUSION: Multicomponent particle tracing combined with 16-segment analysis quantitatively demonstrated altered LV flow organization after AVSD correction, with less direct and more retained inflow in apical and lateral LV cavity segments, which may contribute to decreased cardiac pumping efficiency.
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Calkoen et al. (2015) conducted a cross-sectional in Corrected atrioventricular septal defect (AVSD) (n=62). Corrected atrioventricular septal defect vs. Healthy controls was evaluated on Percentage of direct flow (p=<0.001). Patients with corrected atrioventricular septal defect had a significantly smaller percentage of direct left ventricular flow compared with healthy controls (30% vs 44%, P<0.001).
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