Four-Dimensional Flow Magnetic Resonance Imaging With Wall Shear Stress Analysis Before and After Repair of Aortopulmonary Fistula

We used 4D flow magnetic resonance imaging1 to evaluate a 34-year-old man with a complicated course after aortic coarctation repair including development of an aortopulmonary fistula. Our initial 4D flow study (Figure 1) reveals abnormal vortical-type flow in the aneurysmal distal aortic arch. Evaluation of wall shear stress calculated from near-wall velocity gradients using proprietary software ( flow tool , University of Freiburg, Germany; software is experimental and not FDA approved)2 demonstrates skewing of higher shear values along the posterior and left lateral aortic arch, just upstream of a pseudoaneurysm.Figure 1. A 34-year-old man with complicated course status after aortic coarctation repair. A, 3D contrast-enhanced magnetic resonance imaging that demonstrates an aneurysm of the distal aortic arch extending …