Skip to main content
  • Oral presentation
  • Open access
  • Published:

Disturbed diastolic left ventricular inflow vortex ring formation in patients with corrected atrioventricular septal defect: quantitative three-dimensional vortex core analysis from 4DFlow MRI


Vortex formation in the left ventricle (LV) is suggested to contribute to efficient blood pumping and altered vortex formation is associated with diastolic dysfunction. Patients after atrioventricular septal defect (AVSD) correction present abnormalities in valve morphology and subsequently develop altered inflow patterns (Calkoen et al. JMRI 2014), which may disturb normal vortex formation. We aimed to analyze vortex ring formation in AVSD-corrected patients compared to healthy controls and to evaluate association with inflow angle.


23 patients (age 20±8 years) and 23 healthy controls (age 19±8 years) were included. Whole-heart 4DFlow MRI was performed on 3T MRI with free breathing, three-directional velocity encoding of 150cm/s in all directions, spatial resolution 2.3×2.3×3.0-4.2mm3 and 30 phases reconstructed over one cardiac cycle. The Lambda2 method was used to depict the cores of three-dimensional (3D) vortex ring structures in the velocity field in the LV at the phases of peak early filling (E-peak) and peak late filling (A-peak) (2). Subsequently, the 3D location of the vortex ring center was defined using the circumferential (C), longitudinal (L) and radial (R) coordinates as well as vortex orientation relative to the LV long-axis (Elbaz et al. JCMR 2014). The circularity index (CI) was calculated to quantify the shape of the vortex ring. Measured parameters of controls and patients were compared using chi-square tests and non-parametric t-tests. In patients, Pearson's correlation between vortex orientation and previously described inflow angle (Calkoen et al. JMRI 2014) was analyzed.


A distinct vortex ring core at E-peak was observed in all controls and in 18 (78%) patients (p=0.025). An A-peak vortex ring core was detected in 20 (87%) controls and 11 (49%) patients (p=0.014). Quantitative characteristics of detected vortex ring cores at E-peak and A-peak are presented in Table 1. The larger value in R-coordinate observed in patients indicates a more lateral position of the vortex core center in patients during E-peak and A-peak. In patients a less circular shape of the vortex core was observed compared to controls. Orientation of the vortex core in patients showed a wide range (13 - 125 degrees). In patients the correlation between vortex orientation and inflow angle was r=0.5 (p=0.06) at E-peak and r= 0.7 (p=0.01) at A-peak.

Table 1 Quantitative vortex core characteristics at E-peak and A-peak in controls and patients.


Presence and formation of vortex ring core is aberrant in patients with corrected AVSD compared to healthy controls. Different position and circularity of the vortex cores are possibly due to abnormalities in the left atrioventricular valve. Altered vortex orientation is correlated with patients' lateral inflow. Future studies are required to investigate the effect of absence or altered vortex ring formation on energy loss.


E.E. Calkoen is financially supported by a grant from the Willem-Alexander Kinder- en Jeugdfonds, M.S. ElBaz and J.J.M. Westenberg are financially supported by a grant from the Dutch Technology Foundation (STW).

Figure 1
figure 1

Vortex ring core in a control and a patient during E-peak. In the patient a more tilted (orientation 37 degrees) and more lateral positioned (R = 0.39) vortex was observed. RA = right atrium, RV = right ventricle, LA = left atrium, LV = left ventricle.

Author information

Authors and Affiliations


Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

ElBaz, M.S., Calkoen, E., Roest, A. et al. Disturbed diastolic left ventricular inflow vortex ring formation in patients with corrected atrioventricular septal defect: quantitative three-dimensional vortex core analysis from 4DFlow MRI. J Cardiovasc Magn Reson 17 (Suppl 1), O4 (2015).

Download citation

  • Published:

  • DOI: