3D Velocity-Encoded Magnetic Resonance Imaging: a new tool for the assessment of right ventricular diastolic function in children with pulmonary regurgitation after corrected Tetralogy of Fallot

  • Annelies van der Hulst, Division of Pediatric Cardiology, department of Pediatrics, Leiden University Medical Center, The Netherlands
  • Jos Westenberg, Division of image processing, department of Radiology, Leiden University Medical Center, The Netherlands
  • Lucia Kroft, Department of Radiology, Leiden University Medical Center, The Netherlands
  • Jeroen Bax, Department of Cardiology, Leiden University Medical Center, The Netherlands
  • Albert de Roos, Department of Radiology, Leiden University Medical Center, The Netherlands
  • Nico Blom, Division of Pediatric Cardiology, department of Pediatrics, Leiden University Medical Center, The Netherlands
  • Arno Roest, Division of Pediatric Cardiology, department of Pediatrics, Leiden University Medical Center, The Netherlands

    • Background: In patients with corrected Tetralogy of Fallot (cToF) assessment of diastolic function of the right ventricle (RV) is complicated by pulmonary regurgitation (PR). Two-dimensional one-directional velocity-encoded MRI (2D VE-MRI) can assess diastolic function by summation of flow through the tricuspid (TV) and pulmonary valve (PV) during diastole. However, 2D VE-MRI of the TV is hampered by heart motion. Furthermore, heartrate variability influences accurate summation of 2D MRI TV and PV flow. Three-dimensional (3D) three directional VE-MRI overcomes these problems with velocity-encoding in three orthogonal directions of all valves during one acquisition and retrospective valve tracking. This study evaluates 3D VE-MRI for assessing PV and TV flow in children with cToF. Methods: 12 children (mean age 13.7±2.7 year) with cToF and PR underwent MRI with 2D and 3D VE-MRI flow mapping of the PV and TV. Summation of the 3D VE-MRI curves yielded RV time-volume curves. RV dimensions were calculated from transversal cine planimetry images. Results: A good correlation was found between planimetry stroke volume and 3D pulmonary forward flow (Pearson’s correlation coefficient 0.84, p 0.001), and between 2D and 3D pulmonary forward flow (0.86, p<0.0001) PR (0.95, p<0.0001). 3D VE-MRI peak early filling rate was 483±171 ml/s, peak atrial filling rate 254±99 ml/s, E/A 2.3±1.5, and deceleration time 271±88 ms. Conclusion: 3D VE-MRI is a reliable new tool for the assessment of PV flow and PR in patients with cToF. 3D VE-MRI could be a new tool for the assessment of diastolic function in cToF patients with PR.