Quantifying and visualizing abdominal hemodynamics in patients with Fontan circulation by 4D phase-contrast flow magnetic resonance imaging at 1.5 T

• Published in: International journal of cardiology 2024-10, Vol.413, p.132391, Article 132391
• Main Authors: Salehi Ravesh, Mona, Langguth, Patrick, Moritz, Joerg Detlev, Rinne, Katy, Harneit, Paul Lennard, Schulze-Nagel, Juliane, Graessner, Joachim, Uebing, Anselm, Jansen, Olav, Both, Marcus, Hansen, Jan Hinnerk
• Format: Article
• Language: English
• Subjects: Chronic liver disease; Fontan circulation; Fontan-associated liver disease; Four-dimensional phase-contrast flow magnetic resonance imaging (4D PC flow MRI); Liver magnetic resonance imaging
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2024.132391

Liver fibrosis has been recognized as a long-term morbidity associated with Fontan circulation (Fontan-associated liver disease, FALD). The pathophysiology of FALD is not completely understood and abnormal flow dynamics may be associated with this condition. Liver hemodynamics can be quantitatively evaluated with four-dimensional phase-contrast flow magnetic resonance imaging (4D PC flow MRI). The study aimed to evaluate suitability of liver 4D PC flow MRI in Fontan patients and relate flow measurements to normal values and FALD severity. Twenty-two Fontan patients were examined by 4D PC flow MRI at 1.5 Tesla to assess mesenteric, portal, splenic, and hepatic venous blood flow. Severity of FALD was graded based on routine screening, including abdominal ultrasound and laboratory tests. Median age was 18.5 (interquartile range, IQR 15.5–20.2) years. FALD was graded as “none or mild” in 16 and as “moderate to severe” in six cases. Ten patients presented at least one feature of portal hypertension (ascites, splenomegaly, or thrombocytopenia). For the entire cohort, blood flow in the superior mesenteric, splenic, and portal vein was lower than reported in the literature. No significant differences were observed in relation to FALD severity. Features of portal hypertension were associated with a higher splenic vein blood flow (0.34 ± 0.17 vs. 0.20 ± 0.07 l/min, p = 0.046). Splenic vein blood flow was negatively correlated to platelet count (r = −0.590, p = 0.005). 4D PC flow MRI appears suitable to assess liver hemodynamics in Fontan patients and integration into clinical follow-up might help to improve our understanding of FALD. [Display omitted] •Pathophysiology of Fontan-associated liver disease is not entirely clear and might be related to abnormal flow dynamics•The ability to quantitatively assess liver hemodynamics with 4D phase-contrast flow MRI was evaluated in Fontan patients•Diminished blood flow in the portal vein and its tributaries was observed in comparison to reference values•Integrating 4D phase-contrast flow MRI into Fontan follow-up might improve understanding of Fontan-associated liver disease.