Left ventricular blood flow patterns in normal subjects: a quantitative analysis by three-dimensional magnetic resonance velocity mapping

Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark.

OBJECTIVES. Magnetic resonance velocity mapping was used to investigate the hypothesis of a vortex motion within the left ventricle interacting with mitral valve motion and inflow velocity. BACKGROUND. In vitro flow visualization studies have suggested the presence of a large anterior vortex inside the left ventricle during mitral inflow. However, to our knowledge the occurrence of this phenomenon has not been demonstrated in the human left ventricle. METHODS. Magnetic resonance velocity mapping was performed in 26 healthy volunteers using a flow-adjusted gradient sequence for three-dimensional flow velocity acquisition in the long-axis plane of the left ventricle. By computer processing, the flow vectors in the left ventricle were visualized and animated dynamically. RESULTS. The early diastolic mitral inflow was apically directed, and a large counterclockwise anterior vortex was created within the left ventricle shortly after the onset of the mid-diastolic semiclosure of the anterior mitral leaflet. During mid-diastolic diastasis, mitral inflow ceased until the flow accelerated again at atrial systole. The final closure of the mitral valve was preceded by a smaller vortex seen at the tips of the mitral leaflets. At systolic ejection, all flow vectors were directed toward the left ventricular outflow tract. The anterior vortex had a radius of 1.62 +/- 0.24 cm (mean +/- SD), and the average angular velocity (i.e., the rotation of an element about the center of the vortex within the central core) was 30.08 +/- 9.98 radians/s. The maximal kinetic energy of the anterior vortex was 4.3 x 10(-4) +/- 7.1 x 10(-5) J. CONCLUSIONS. The hypothesis of a diastolic vortex formation in the human left ventricle was confirmed, and its close temporal relation to the motion of the anterior mitral leaflet was demonstrated.

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