Impaired continuity of flow in congenital heart disease with single ventricle physiology.

We report the comprehensive evaluation of cardiac morphology, valve function, and three-dimensional (3D) blood flow in a pediatric patient with congenital heart disease. 3D visualization of cardiovascular flow paths and quantitative flow analysis based on flow-sensitive 4D magnetic resonance imaging (MRI) provided detailed insight into hemodynamic changes associated with valve insufficiency and the complex single ventricle physiology. Despite only moderate atrio-ventricular regurgitation (fraction=28%) a marked redirection of atrial flow and pronounced vortex flow in the entire atrium was observed. Disturbed retrograde flow was even found upstream within the left pulmonary veins (regurgitant fraction=27%) indicating interrupted continuity of flow directed through the single atrium and ventricle. Such findings indicate the potential of flow-sensitive 4D MRI to detect and quantify complex 3D flow alterations.