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J Thorac Cardiovasc Surg 1998;116:294-304
© 1998 Mosby, Inc.

Surgery for Congenital Heart Disease

Alterations in pulmonary artery flow patterns and shear stress determined with three-dimensional phase-contrast magnetic resonance imaging in fontan patients

This work was partially supported by the Department of Health and Human Services Public Health Service Grant HL 07411-16 and the Patricia Roberts Harris Fellowship (V.L.M.).

Received for publication June 16, 1997; revisions requested August 8, 1997; Revisions received March 5, 1998; Accepted for publication March 25, 1998. Address for reprints:
Christine H. Lorenz, PhD, Center for Cardiovascular Magnetic Resonance, Cardiovascular Division, Barnes-Jewish Hospital at Washington University Medical Center, 216 South Kingshighway Blvd., St. Louis, MO 63110.

Objective: This study compares in vivo pulmonary blood flow patterns and shear stresses in patients with either the direct atrium–pulmonary artery connection or the bicaval tunnel connection of the Fontan procedure to those in normal volunteers. Comparisons were made with the use of three-dimensional phase contrast magnetic resonance imaging.
Methods: Three-dimensional velocities, flows, and pulmonary artery cross-sectional areas were measured in both pulmonary arteries of each subject. Axial, circumferential, and radial shear stresses were calculated with the use of velocities and estimates of viscosity.
Results: The axial velocities were not significantly different between subject groups. However, the flows and cross-sectional areas were higher in the normal group than in the two patient groups in both pulmonary arteries. The group with the bicaval connection had circular swirling in the cross section of both pulmonary arteries, causing higher shear stresses than in the controls. The disorder caused by the connection of the atrium to the pulmonary artery caused an increase in some shear stresses over the controls, but not higher than those found in the group having a bicaval tunnel.
Conclusions: We found that pulmonary flow was equally reduced compared with normal flow in both patient groups. This reduction in flow can be attributed in part to the reduced size of the pulmonary arteries in both patient groups without change in axial velocity. We also found higher shear stress acting on the wall of the vessels in the patients having a bicaval tunnel, which may alter endothelial function and affect the longevity of the repair.

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