Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI
Background Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry. Objective We...
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| Veröffentlicht in: | Pediatric radiology 2016-10, Vol.46 (11), p.1507-1519 |
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| creator | Jarvis, Kelly Schnell, Susanne Barker, Alex J. Garcia, Julio Lorenz, Ramona Rose, Michael Chowdhary, Varun Carr, James Robinson, Joshua D. Rigsby, Cynthia K. Markl, Michael |
| description | Background
Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry.
Objective
We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry.
Materials and methods
Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9–21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle).
Results
Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9–100], IVC to LPA: 54% ± 28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R
2
=0.50,
P
=0.02; SVC to LPA: R
2
=0.81,
P
=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values.
Conclusion
Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability. |
| doi_str_mv | 10.1007/s00247-016-3654-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5039076</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1824226463</sourcerecordid><originalsourceid>FETCH-LOGICAL-c503t-5ea2263dd931c3cb3033a4a53ed521aac1de9c79e18e4ebf9dc1609b601144a3</originalsourceid><addsrcrecordid>eNqNkt9r1TAUx4Mo23XuD_BFAr74Uj3JSdubF0H2QweTwdh7SNP0LqNNrkl7xwX_eNN1jikIPgVyPvnknORLyFsGHxlA_SkBcFEXwKoCq1IU-IKsmEBeMCnXL8kKEFgBQshD8jqlOwDAkuEBOeQ1loB1vSI_z3a6n_Togqeho00fQku7PtzT1qUxumZ6KOm0HwY7xj3VvqU7nczU60g3Niy7ztNtllg_Jnrvxlt6HvyoPTUuzuSDY0rOb6goThf_9-uLN-RVp_tkjx_XI3JzfnZz8q24vPp6cfLlsjC5y7Eorea8wraVyAyaBgFRC12ibUvOtDastdLU0rK1FbbpZGtYBbKpgDEhNB6Rz4t2OzWDbU3uMupebaMbdNyroJ36s-LdrdqEncq3S6irLPjwKIjhx2TTqAaXjO177W2YkmJrXktWc7H-H1TkYUSFGX3_F3oXpujzQ8wUYlVByTPFFsrEkFK03VPfDNScArWkQOUUqDkFaja_ez7w04nf354BvgApl_zGxmdX_9P6Cx9xvwk</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1823366052</pqid></control><display><type>article</type><title>Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Jarvis, Kelly ; Schnell, Susanne ; Barker, Alex J. ; Garcia, Julio ; Lorenz, Ramona ; Rose, Michael ; Chowdhary, Varun ; Carr, James ; Robinson, Joshua D. ; Rigsby, Cynthia K. ; Markl, Michael</creator><creatorcontrib>Jarvis, Kelly ; Schnell, Susanne ; Barker, Alex J. ; Garcia, Julio ; Lorenz, Ramona ; Rose, Michael ; Chowdhary, Varun ; Carr, James ; Robinson, Joshua D. ; Rigsby, Cynthia K. ; Markl, Michael</creatorcontrib><description>Background
Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry.
Objective
We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry.
Materials and methods
Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9–21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle).
Results
Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9–100], IVC to LPA: 54% ± 28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R
2
=0.50,
P
=0.02; SVC to LPA: R
2
=0.81,
P
=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values.
Conclusion
Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability.</description><identifier>ISSN: 0301-0449</identifier><identifier>EISSN: 1432-1998</identifier><identifier>DOI: 10.1007/s00247-016-3654-3</identifier><identifier>PMID: 27350377</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Child ; Feasibility Studies ; Female ; Fontan Procedure ; Heart Defects, Congenital - surgery ; Hemodynamics ; Humans ; Imaging ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging - methods ; Male ; Medicine ; Medicine & Public Health ; Neuroradiology ; Nuclear Medicine ; Oncology ; Original Article ; Pediatrics ; Pulmonary Artery - diagnostic imaging ; Radiology ; Ultrasound ; Vena Cava, Inferior - diagnostic imaging ; Vena Cava, Superior - growth & development ; Young Adult</subject><ispartof>Pediatric radiology, 2016-10, Vol.46 (11), p.1507-1519</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-5ea2263dd931c3cb3033a4a53ed521aac1de9c79e18e4ebf9dc1609b601144a3</citedby><cites>FETCH-LOGICAL-c503t-5ea2263dd931c3cb3033a4a53ed521aac1de9c79e18e4ebf9dc1609b601144a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00247-016-3654-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00247-016-3654-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27350377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jarvis, Kelly</creatorcontrib><creatorcontrib>Schnell, Susanne</creatorcontrib><creatorcontrib>Barker, Alex J.</creatorcontrib><creatorcontrib>Garcia, Julio</creatorcontrib><creatorcontrib>Lorenz, Ramona</creatorcontrib><creatorcontrib>Rose, Michael</creatorcontrib><creatorcontrib>Chowdhary, Varun</creatorcontrib><creatorcontrib>Carr, James</creatorcontrib><creatorcontrib>Robinson, Joshua D.</creatorcontrib><creatorcontrib>Rigsby, Cynthia K.</creatorcontrib><creatorcontrib>Markl, Michael</creatorcontrib><title>Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI</title><title>Pediatric radiology</title><addtitle>Pediatr Radiol</addtitle><addtitle>Pediatr Radiol</addtitle><description>Background
Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry.
Objective
We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry.
Materials and methods
Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9–21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle).
Results
Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9–100], IVC to LPA: 54% ± 28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R
2
=0.50,
P
=0.02; SVC to LPA: R
2
=0.81,
P
=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values.
Conclusion
Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability.</description><subject>Adolescent</subject><subject>Child</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fontan Procedure</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Imaging</subject><subject>Imaging, Three-Dimensional</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroradiology</subject><subject>Nuclear Medicine</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Pediatrics</subject><subject>Pulmonary Artery - diagnostic imaging</subject><subject>Radiology</subject><subject>Ultrasound</subject><subject>Vena Cava, Inferior - diagnostic imaging</subject><subject>Vena Cava, Superior - growth & development</subject><subject>Young Adult</subject><issn>0301-0449</issn><issn>1432-1998</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkt9r1TAUx4Mo23XuD_BFAr74Uj3JSdubF0H2QweTwdh7SNP0LqNNrkl7xwX_eNN1jikIPgVyPvnknORLyFsGHxlA_SkBcFEXwKoCq1IU-IKsmEBeMCnXL8kKEFgBQshD8jqlOwDAkuEBOeQ1loB1vSI_z3a6n_Togqeho00fQku7PtzT1qUxumZ6KOm0HwY7xj3VvqU7nczU60g3Niy7ztNtllg_Jnrvxlt6HvyoPTUuzuSDY0rOb6goThf_9-uLN-RVp_tkjx_XI3JzfnZz8q24vPp6cfLlsjC5y7Eorea8wraVyAyaBgFRC12ibUvOtDastdLU0rK1FbbpZGtYBbKpgDEhNB6Rz4t2OzWDbU3uMupebaMbdNyroJ36s-LdrdqEncq3S6irLPjwKIjhx2TTqAaXjO177W2YkmJrXktWc7H-H1TkYUSFGX3_F3oXpujzQ8wUYlVByTPFFsrEkFK03VPfDNScArWkQOUUqDkFaja_ez7w04nf354BvgApl_zGxmdX_9P6Cx9xvwk</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Jarvis, Kelly</creator><creator>Schnell, Susanne</creator><creator>Barker, Alex J.</creator><creator>Garcia, Julio</creator><creator>Lorenz, Ramona</creator><creator>Rose, Michael</creator><creator>Chowdhary, Varun</creator><creator>Carr, James</creator><creator>Robinson, Joshua D.</creator><creator>Rigsby, Cynthia K.</creator><creator>Markl, Michael</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>5PM</scope></search><sort><creationdate>20161001</creationdate><title>Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI</title><author>Jarvis, Kelly ; Schnell, Susanne ; Barker, Alex J. ; Garcia, Julio ; Lorenz, Ramona ; Rose, Michael ; Chowdhary, Varun ; Carr, James ; Robinson, Joshua D. ; Rigsby, Cynthia K. ; Markl, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-5ea2263dd931c3cb3033a4a53ed521aac1de9c79e18e4ebf9dc1609b601144a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Fontan Procedure</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Imaging</topic><topic>Imaging, Three-Dimensional</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroradiology</topic><topic>Nuclear Medicine</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Pediatrics</topic><topic>Pulmonary Artery - diagnostic imaging</topic><topic>Radiology</topic><topic>Ultrasound</topic><topic>Vena Cava, Inferior - diagnostic imaging</topic><topic>Vena Cava, Superior - growth & development</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jarvis, Kelly</creatorcontrib><creatorcontrib>Schnell, Susanne</creatorcontrib><creatorcontrib>Barker, Alex J.</creatorcontrib><creatorcontrib>Garcia, Julio</creatorcontrib><creatorcontrib>Lorenz, Ramona</creatorcontrib><creatorcontrib>Rose, Michael</creatorcontrib><creatorcontrib>Chowdhary, Varun</creatorcontrib><creatorcontrib>Carr, James</creatorcontrib><creatorcontrib>Robinson, Joshua D.</creatorcontrib><creatorcontrib>Rigsby, Cynthia K.</creatorcontrib><creatorcontrib>Markl, Michael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jarvis, Kelly</au><au>Schnell, Susanne</au><au>Barker, Alex J.</au><au>Garcia, Julio</au><au>Lorenz, Ramona</au><au>Rose, Michael</au><au>Chowdhary, Varun</au><au>Carr, James</au><au>Robinson, Joshua D.</au><au>Rigsby, Cynthia K.</au><au>Markl, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI</atitle><jtitle>Pediatric radiology</jtitle><stitle>Pediatr Radiol</stitle><addtitle>Pediatr Radiol</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>46</volume><issue>11</issue><spage>1507</spage><epage>1519</epage><pages>1507-1519</pages><issn>0301-0449</issn><eissn>1432-1998</eissn><abstract>Background
Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry.
Objective
We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry.
Materials and methods
Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9–21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle).
Results
Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9–100], IVC to LPA: 54% ± 28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R
2
=0.50,
P
=0.02; SVC to LPA: R
2
=0.81,
P
=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values.
Conclusion
Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27350377</pmid><doi>10.1007/s00247-016-3654-3</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0301-0449 |
| ispartof | Pediatric radiology, 2016-10, Vol.46 (11), p.1507-1519 |
| issn | 0301-0449 1432-1998 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5039076 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Child Feasibility Studies Female Fontan Procedure Heart Defects, Congenital - surgery Hemodynamics Humans Imaging Imaging, Three-Dimensional Magnetic Resonance Imaging - methods Male Medicine Medicine & Public Health Neuroradiology Nuclear Medicine Oncology Original Article Pediatrics Pulmonary Artery - diagnostic imaging Radiology Ultrasound Vena Cava, Inferior - diagnostic imaging Vena Cava, Superior - growth & development Young Adult |
| title | Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI |
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