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Open Access Research

Visualization of the intracavitary blood flow in systemic ventricles of Fontan patients by contrast echocardiography using particle image velocimetry

Konstantinos Lampropoulos124*, Werner Budts14, Alexander Van de Bruaene14, Els Troost14 and Joost P van Melle134

Author Affiliations

1 Department of Cardiology, University Hospitals Leuven, Leuven, Belgium

2 Department of Cardiology, Polyclinic General Hospital of Athens, Athens, Greece

3 Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

4 Congenital and structural cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium

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Cardiovascular Ultrasound 2012, 10:5  doi:10.1186/1476-7120-10-5

Published: 20 February 2012

Abstract

Background

Flow patterns in univentricular hearts may have clinical value. Therefore, it is our objective to asses and characterize vortex flow patterns with Fontan circulation in comparison with healthy controls.

Methods

Twenty-three patients (8 Fontan and 15 normal patients) underwent echocardiography with intravenous contrast agent (Sonovue®) administration. Dedicated software was used to perform particle image velocimetry (PIV) and to visualize intracavitary flow in the systemic ventricles of the patients. Vortex parameters including vortex depth, length, width, and sphericity index were measured. Vortex pulsatility parameters including relative strength, vortex relative strength, and vortex pulsation correlation were also measured.

Results

The data from this study show that it is feasible to perform particle velocimetry in Fontan patients. Vortex length (VL) was significantly lower (0.51 ± 0.09 vs 0.65 ± 0.12, P = 0.010) and vortex width (VW) (0.32 ± 0.06 vs 0.27 ± 0.04, p = 0.014), vortex pulsation correlation (VPC) (0.26 ± 0.25 vs -0.22 ± 0.87, p = 0.05) were significantly higher in Fontan patients. Sphericity index (SI) (1.66 ± 0.48 vs 2.42 ± 0.62, p = 0.005), relative strength (RS) (0.77 ± 0.33 vs 1.90 ± 0.47, p = 0.0001), vortex relative strength (VRS) (0.18 ± 0.13 vs 0.43 ± 0.14, p = 0.0001) were significantly lower in the Fontan patients group.

Conclusions

PIV using contrast echocardiography is feasible in Fontan patients. Fontan patients had aberrant flow patterns as compared to normal hearts in terms of position, shape and sphericity of the main vortices. The vortex from the Fontan group was consistently shorter, wider and rounder than in controls. Whether vortex characteristics are related with clinical outcome is subject to further investigation.

Keywords:
Fontan patients; Vortex; Contrast echocardiography; Particle image velocimetry