Characterizing single ventricle hemodynamics using phase contrast magnetic resonance imaging
Sundareswaran, Kartik Sivaram
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Single ventricle congenital heart defects afflict 2 per every 1000 births. They are characterized by cyanotic mixing between the de-oxygenated blood coming back from the systemic circulation and the oxygenated blood from the pulmonary circulation. Prior to introduction of the Fontan procedure in 1971, surgical options for single ventricle patients were limited. The Fontan operation involves a series of three palliative procedures aimed at the separation of systemic and pulmonary circulations and reducing the long term effects of chronic hypoxia and ventricular volume overload. The total cavopulmonary connection (TCPC) is completed in the final stage of the surgery with the anastomosis of the inferior vena cava (IVC) and superior vena cava to the pulmonary arteries. Improved quantification and visualization of flow structures within the TCPC has the potential to aid in the planning and design of the Fontan operation. Despite significant development of phase contrast magnetic resonance imaging (PC MRI) for in vivo flow measurements, it is not routinely applied in children with single ventricle congenital heart disease. Limited technologies available for post-processing of PC MRI data has prevented clinicians and scientists from conducting the detailed hemodynamic analyses necessary to better understand the physiology of the single ventricle circulation. This thesis attempts to bridge the gap between PC MRI and fluid dynamics, by developing the necessary post-processing technologies for PC MRI, and then applying these techniques for characterizing single ventricle hemodynamics.