Korean J Radiol.  2019 Sep;20(9):1334-1341. 10.3348/kjr.2019.0096.

Evaluation of Flow Pattern in the Ascending Aorta in Patients with Repaired Tetralogy of Fallot Using Four-Dimensional Flow Magnetic Resonance Imaging

• Lee S
• Kim YJ
• Jung JW
• Choi JY
• Park HK
• Shin YR
• Choi BW

• KMID: 2455762
• DOI: http://doi.org/10.3348/kjr.2019.0096

Abstract

OBJECTIVE
To evaluate flow pattern characteristics in the ascending aorta (AA) with four-dimensional (4D)-flow MRI and to determine predictors of aortic dilatation late after tetralogy of Fallot (TOF) repair.
MATERIALS AND METHODS
This study included 44 patients with repaired TOF (25 males and 19 females; mean age, 28.9 ± 8.4 years) and 11 volunteers (10 males and 1 female, mean age, 33.7 ± 8.8 years) who had undergone 4D-flow MRI. The aortic diameters, velocity, wall shear stress (WSS), flow jet angle (FJA), and flow displacement (FD) at the level of the sinotubular junction (STJ) and mid-AA were compared between the repaired TOF and volunteer groups. The hemodynamic and clinical parameters were also compared between the aortic dilatation and non-dilatation subgroups in the repaired TOF group.
RESULTS
The diameters of the sinus of Valsalva, STJ, and AA were significantly higher in the repaired TOF group than in the volunteer group (p = 0.002, p < 0.001, and p = 0.013, respectively). The FJAs at the STJ and AA were significantly greater in the repaired TOF group (p < 0.001 and p = 0.003, respectively), while velocities and WSS parameters were significantly lower. FD showed no statistically significant difference (p = 0.817). In subgroup analysis, age at TOF repair was significantly higher (p = 0.039) and FJA at the level of the AA significantly greater (p = 0.003) and mean WSS were significantly lower (p = 0.039) in the aortic dilatation group. FD were higher in the aortic dilatation group without statistical significance (p = 0.217).
CONCLUSION
Patients with repaired TOF have an increased FJA, dilated AA, and secondarily decreased WSS. In addition to known risk factors, flow eccentricity may affect aortic dilatation in patients with repaired TOF.

Keyword

Corrected tetralogy of Fallot; Aorta dilatation; Four-dimensional flow magnetic resonance imaging

MeSH Terms

Aorta*
Dilatation
Female
Hemodynamics
Humans
Magnetic Resonance Imaging*
Male
Risk Factors
Sinus of Valsalva
Tetralogy of Fallot*
Volunteers

Figure

• 

  Fig. 1 Differences in aortic dimensions between patients with rTOF and healthy volunteers.AA = ascending aorta, DA = descending aorta, rTOF = repaired tetralogy of Fallot, STJ = sinotubular junction

• 

  Fig. 2 Representative maximal WSS maps of volunteers and patients with rTOF.A. Volunteer. B. Aortic dilatation with high WSS group. C. Aortic dilatation with low WSS group. D. Non-aortic dilatation with low WSS group. E. Non-aortic dilatation with high WSS group. WSS = wall shear stress

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