Article Text

Download PDFPDF
Three-dimensional and four-dimensional flow assessment in congenital heart disease
  1. Evangeline Warmerdam1,2,
  2. Gregor J Krings2,
  3. Tim Leiner3,
  4. Heynric B Grotenhuis2,4
  1. 1 Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Pediatric Cardiology, Wilhelmina Children's Hospital University Medical Center, Utrecht, The Netherlands
  3. 3 Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4 Pediatric Cardiology, Universitair Medisch Centrum Utrecht - Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
  1. Correspondence to Dr Heynric B Grotenhuis, Pediatric Cardiology, Universitair Medisch Centrum Utrecht - Locatie Wilhelmina Kinderziekenhuis, Utrecht 3584 EA, The Netherlands; H.B.Grotenhuis{at}


Congenital heart disease (CHD) is the most common form of congenital defects, with an incidence of 8 per 1000 births. Due to major advances in diagnostics, perioperative care and surgical techniques, the survival rate of patients with CHD has improved dramatically. Conversely, although 70%–95% of infants with CHD survive into adulthood, the rate of long-term morbidity, which often requires (repeat) intervention, has increased. Recently, the role of altered haemodynamics in cardiac development and CHD has become a subject of interest. Patients with CHD often have abnormal blood flow patterns, either due to the primary cardiac defect or as a consequence of the surgical intervention(s). Research suggests that these abnormal blood flow patterns may contribute to diminished cardiac and vascular function. Serial assessment of haemodynamic parameters in patients with CHD may allow for improved understanding of the often complex haemodynamics in these patients and thereby potentially guide the timing and nature of interventions with the aim of preventing progression of cardiovascular deterioration. In this article we will discuss two novel non-invasive four-dimensional (4D) techniques to evaluate cardiovascular haemodynamics: 4D-flow cardiac magnetic resonance and computational fluid dynamics. This review focuses on the additional value of these two modalities in the evaluation of patients with CHD with abnormal flow patterns, who could benefit from advanced haemodynamic evaluation: patients with coarctation of the aorta, bicuspid aortic valve, tetralogy of Fallot and patients after Fontan palliation.

  • congenital heart disease
  • advanced cardiac imaging
  • cardiac magnetic resonance imaging

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Conception of the article: EW and HBG. Drafting the manuscript and critical appraisal: EW, GJK, TL and HBG. Approval of the final version: EW, GJK, TL and HBG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.