Comparing Flow And Pulmonary Artery Growth Post PDA Stenting In Patients With Ductal-Dependent Pulmonary Flow Using Four-Dimensional Magnetic Resonance Imaging (4D Flow MRI)

Abstract

The Four-Dimensional Magnetic Resonance Imaging (4D Flow MRI) provides a qualitative and quantitative assessment of cardiovascular structures and processes. 4D flow MRI was used to study pulmonary flow in post-patent ductus arteriosus (PDA) stent insertion in duct-dependent pulmonary flow neonates at baseline (PDA stent insertion) and after 6 months. Also, to evaluate effect of flow dynamics on growth of pulmonary arteries. This prospective observational study included neonates with ductus arteriosus-dependent pulmonary circulation who underwent ductal stenting between June 2021 and November 2022.Cardiac 4D flow MRI and magnetic resonance angiography (MRA) were conducted in 2 phases; after the deployment of the PDA stent during the neonatal period and after 6 months from stent deployment. Eight neonates were recruited, but only five completed both scans. A total of 10 pulmonary arteries were evaluated during each phase. The median LPA and RPA diameters and indexed flow for LPA and RPAwere evaluated. The growth rate of LPA was observed to be lower than that of RPA [percentage diameter increase: 74% vs 153%]. LPA Z score was lower than RPA. Indexed flow in both LPA and RPA showed a reduction in the 6-month scan, which was consistent with reduced stent patency. 4D flow cardiac MRI showed different growth rates and reduced flow between LPA and RPA post-PDA stent. These insights can aid in future management decisions.