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Case Reports
. 2022 Jul 18;10(7):e6038.
doi: 10.1002/ccr3.6038. eCollection 2022 Jul.

Evaluation of pulmonary blood flow in bilateral bidirectional Glenn shunts: value of 4-D flow cardiac magnetic resonance in the evaluation of pulmonary artery confluence stenosis

Faiza Al Kindi  1 , Madan Mohan Maddali  1 , Asim Al Balushi  1 , Hamood Al Kindi  1   2
Affiliations
Case Reports

Evaluation of pulmonary blood flow in bilateral bidirectional Glenn shunts: value of 4-D flow cardiac magnetic resonance in the evaluation of pulmonary artery confluence stenosis

Faiza Al Kindi et al. Clin Case Rep. .

Abstract

Bilateral bidirectional Glenn shunts are associated with the risk of developing pulmonary artery bifurcation stenosis, resulting in variable pulmonary blood flow to either lung. This could negatively impact the subsequent stages of the single ventricle palliation pathway. This report highlights the value of 4D flow sequence from the cardiac magnetic resonance imaging in demonstrating the pulmonary blood flow characteristics following a bilateral bidirectional Glenn procedure. Mapping the blood flow pattern and its quantification to each lung provide objective insights into the possible predisposing factors for the development of pulmonary bifurcation stenosis.

Keywords: bidirectional Glenn shunt (BDG); cardiac magnetic resonance imaging (CMR); four‐dimensional (4D) flow; pulmonary artery.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
(A) Aortogram and selective angiography of the PDA (lateral view), (B) post PDA stent implantation with good flow in both RPA and LPA, (C) selective angiography of the PDA stent showing severe narrowing of the RPA and good flow to LPA
FIGURE 2
FIGURE 2
(A) Coronal 4D flow velocity map at and (B) coronal 4D flow‐based dynamic vector visualization demonstrating the direction of flow and difference in velocity between the right and left Glenn shunts. (Color coding of the velocity in cm/s). (C) Summary of the quantitative analysis of the 4D flow cardiac MRI
FIGURE 3
FIGURE 3
(A) Angiogram of the right Glenn showing good flow to RPA with good arborization. (B) angiogram of the left Glenn after crossing of segment between the two anastomoses, showing good flow to the left lung and no flow to the RPA. (C) Post‐balloon angioplasty angiogram of the narrowed segment between the right and left Glenn shunts
See this image and copyright information in PMC

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