Noninvasive Advanced Cardiovascular Magnetic Resonance-Derived Fontan Hemodynamics Are Associated With Reduced Kidney Function But Not Albuminuria

BACKGROUND: Kidney disease is the most important predictor of death in patients with a Fontan circulation, yet its clinical and hemodynamic correlates have not been well established. METHODS AND RESULTS: A total of 53 ambulatory patients with a Fontan circulation (median age, 16.2 years, 52.8% male patients) underwent advanced cardiovascular...

Virtual surgery to predict optimized conduit size for adult Fontan patients with 16-mm conduits

Objectives: Recent evidence suggests that conduits implanted in Fontan patients at the age of 2-4 years become undersized for adulthood. The objective of this study is to use computational fluid dynamic models to evaluate the effect of virtual expansion of the Fontan conduit on haemodynamics and energetics of the total cavopulmonary...

Head-to-Head Comparison of T1 Mapping and Electroanatomical Voltage Mapping in Patients With Ventricular Arrhythmias

Background: Electroanatomical voltage mapping (EAVM) has been compared with late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR), which cannot delineate diffuse fibrosis. T1-mapping CMR overcomes the limitations of LGE-CMR, but it has not been directly compared against EAVM. Objectives: This study aims to assess the...

Haemodynamic performance of 16–20-mm extracardiac Goretex conduits in adolescent Fontan patients at rest and during simulated exercise

OBJECTIVES: To date, it is not known if 16–20-mm extracardiac conduits are outgrown during somatic growth from childhood to adolescence. This study aims to determine total cavopulmonary connection (TCPC) haemodynamics in adolescent Fontan patients at rest and during simulated exercise and to assess the relationship between conduit size and...

Influence of aortic aneurysm on the local distribution of NO and O₂ using image-based computational fluid dynamics

There is a pressing need to establish novel biomarkers to predict the progression of thoracic aortic aneurysm (TAA) dilatation. Aside from hemodynamics, the roles of oxygen (O₂) and nitric oxide (NO) in TAA pathogenesis are potentially significant. As such, it is imperative to comprehend the relationship between aneurysm presence...

E-health relationships diabetes: 50 weeks evaluation

Hybrid e-health support was given to 11 insulin-dependent type 2 diabetes mellitus (DM2) patients, with electronic support plus a multi-disciplinary health support team. Challenges were low ICT and health literacy. After 50 weeks, attractiveness and feasibility of the intervention were perceived as high: recommendation 9.5 out of 10 and...

Extracardiac conduit adequacy along the respiratory cycle in adolescent Fontan patients

OBJECTIVES: Adequacy of 16-20mm extracardiac conduits for adolescent Fontan patients remains unknown. This study aims to evaluate conduit adequacy using the inferior vena cava (IVC)-conduit velocity mismatch factor along the respiratory cycle. METHODS: Real-time 2D flow MRI was prospectively acquired in 50 extracardiac (16-20mm conduits)...

Assessment of turbulent blood flow and wall shear stress in aortic coarctation using image-based simulations

In this study, we analyzed turbulent flows through a phantom (a 180^∘ bend with narrowing) at peak systole and a patient-specific coarctation of the aorta (CoA), with a pulsating flow, using magnetic resonance imaging (MRI) and computational fluid dynamics (CFD). For MRI, a 4D-flow MRI is performed using a 3T scanner. For CFD, the...

Geometrically induced wall shear stress variability in CFD-MRI coupled simulations of blood flow in the thoracic aortas

Aortic aneurysm is associated with aberrant blood flow and wall shear stress (WSS). This can be studied by coupling magnetic resonance imaging (MRI) with computational fluid dynamics (CFD). For patient-specific simulations, extra attention should be given to the variation in segmentation of the MRI data-set and its effect on WSS. We performed...

Non-uniform mixing of hepatic venous flow and inferior vena cava flow in the Fontan conduit

Fontan patients require a balanced hepatic blood flow distribution (HFD) to prevent pulmonary arteriovenous malformations. Currently, HFD is quantified by tracking Fontan conduit flow, assuming hepatic venous (HV) flow to be uniformly distributed within the Fontan conduit. However, this assumption may be unvalid leading to inaccuracies in HFD...