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J Thorac Cardiovasc Surg 2007;133:260-262
© 2007 The American Association for Thoracic Surgery

Brief Communication

Ascending–descending aortic bypass surgery in aortic arch coarctation: Four-dimensional magnetic resonance flow analysis

^a Departments of Diagnostic Radiology and Medical Physics, University Hospital Freiburg, Freiburg, Germany
^b Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany.

Received for publication August 9, 2006; accepted for publication August 25, 2006.

^_* Address for reprints: Alex P. Frydrychowicz, MD, University Hospital Freiburg, Department of Diagnostic Radiology, Hugstetter Str. 55, 79106 Freiburg, Germany. (Email: alex.frydrychowicz@uniklinik-freiburg.de).

The first 20% of the full text of this article appears below.

In light of the current discussion about the effect of blood flow on arterial wall remodeling,^1-3 the investigation of vascular hemodynamics within the aorta is of great interest. It has the potential to greatly enhance the understanding of the pathogenesis and progression of vascular diseases and to aid in the decision of whether treatment is warranted. Noninvasive magnetic resonance imaging (MRI), with its intrinsic sensitivity to blood flow, offers the unique possibility to simultaneously acquire morphology and spatially coregistered hemodynamic information noninvasively.⁴

Electrocardiography-synchronized and respiration-controlled 3-dimensional magnetic resonance (MR) velocity mapping (flow-sensitive 4-dimensional MRI), a state-of-the-art MRI technique, was used to acquire time-resolved, 3-dimensional, morphologic, and 3-directional blood flow data. Visualization was performed with a commercially available software tool initially developed for engineering applications, which allowed for several 3-dimensional visualization modes for a detailed visual inspection of local hemodynamic features associated with complex vascular geometries (Appendix E1).⁵ A homemade software tool was used to quantify blood flow information at multiple locations along the vascular tree.

Based on an exemplary patient measurement, the possibilities of time-resolved 3-dimensional flow visualization and MR-based quantitative flow analysis are demonstrated, which might influence therapeutic strategies in individual patients in addition to standard clinical diagnostic testing.

Anatomic Findings and Clinical Summary

In this symptomatic patient MR angiography depicted a moderate coarctation of the aortic arch (Figure 1). However, in addition to the stenosis, unusual origins of the supra-aortic branches were diagnosed. A large right common carotid artery was directly followed by the left internal carotid artery. At the height of the coarctation, both the . . . [Full Text of this Article]

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