Modeling Physiological Flow in Fontan Models With Four-Dimensional Flow Magnetic Resonance Imaging, Particle Image Velocimetry, and Arterial Spin Labeling

The Fontan procedure is a successful palliation for single ventricle defect. Yet, a number of complications still occur in Fontan patients due to abnormal blood flow dynamics, necessitating improved flow analysis and treatment methods. Phase-contrast magnetic resonance imaging (MRI) has emerged as a suitable method for such flow analysis. However, limitations on altering physiological blood flow conditions in the patient while in the MRI bore inhibit experimental investigation of a variety of factors that contribute to impaired cardiovascular health in these patients. Furthermore, resolution and flow regime limitations in phase contrast (PC) MRI pose a challenge for accurate and consistent flow characterization. In this study, patient-specific physical models were created based on nine Fontan geometries and MRI experiments mimicking low- and high-flow conditions, as well as steady and pulsatile flow, were conducted. Additionally, a particle image velocimetry (PIV)-compatible Fontan model was created and flow was analyzed with PIV, arterial spin labeling (ASL), and four-dimensional (4D) flow MRI. Differences, though nonstatistically significant, were observed between flow conditions and between patient-specific models. Large between-model variation supported the need for further improvement for patient-specific modeling on each unique Fontan anatomical configuration. Furthermore, high-resolution PIV and flow-tracking ASL data provided flow information that was not obtainable with 4D flow MRI alone.