Counter-clockwise vortical blood flow in the main pulmonary artery in a patient with patent ductus arteriosus with pulmonary arterial hypertension: a cardiac magnetic resonance imaging case report

BMC Med Imaging. 2016 Aug 8;16(1):45. doi: 10.1186/s12880-016-0150-z.

Abstract

Background: In patients with pulmonary hypertension (PH), duration of vortical blood flow along the main pulmonary artery enables estimation of the mean pulmonary arterial pressure (mPAP) non-invasively. It remains to date not known, if this method is applicable in patients with pulmonary arterial hypertension (PAH) and abnormal aortic-to-pulmonary shunting.

Case presentation: The present case analyzes the effect of a patent ductus arteriosus (PDA) on pulmonary artery flow patterns in PAH (mPAP from right heart catheterization, 75 mmHg). PH-associated vortical blood flow, which is typically observed rotating in a clockwise direction when viewed in right ventricular outflow tract orientation, was found nested in PDA left-to-right shunting. Even though rotating counter-clockwise, duration of vortical flow translated into correct non-invasive mPAP estimate.

Conclusions: This case indicates that PH-associated vortex rotation is not restricted to clockwise direction, and that vortex-based estimation of elevated mPAP might also be feasible in patients with PAH and PDA.

Trial registration: ClinicalTrials.gov NCT01725763.

Keywords: 4D blood flow; Cardiac magnetic resonance imaging; Patent ductus arteriosus; Pulmonary arterial hypertension.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Flow Velocity
  • Ductus Arteriosus, Patent / diagnostic imaging
  • Ductus Arteriosus, Patent / physiopathology*
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / diagnostic imaging
  • Hypertension, Pulmonary / physiopathology*
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Pulmonary Artery / physiopathology*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT01725763