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1 Cover Page The handle holds various files of this Leiden University dissertation. Author: Elbaz M.S.M.M. Title: Three-dimensional in-vivo intra-cardiac vortex flow from 4D Flow MRI : quantification, automatic identification and association with energy loss Issue Date:

2 Three-dimensional in-vivo intra-cardiac vortex flow from 4D Flow MRI Quantification, automatic identification and association with energy loss Mohammed S.M. Elbaz

3 Colophon About the cover: For the printed copy of this thesis, move the thesis vertically around the horizontal axis to see the animation. The animated printed cover shows the time evolution of 3D vortex ring (in brown) within left ventricular blood flow of a healthy human heart during early diastolic filling (from the moment of peak inflow to end diastasis) as derived from in-vivo 4D flow MRI velocity field. The structures in brown are 3D vortex cores (based on Lambda2 definition) superimposed on a streamline visualization of a cross-sectional view of LV blood flow color coded from blue to red according to velocity magnitude. Time (t), placed at the bottom of the cover, is the relative time of each phase/frame presented as a fraction of the RR interval starting from the time of peak inflow (0.43RR) to the time of the end of diastasis (0.73RR). More details can be found in Chapter 2 and online movie 2 referred therein. Online cover shows the 3D vortex ring core superimposed on streamlines in the left ventricle at the moment of peak early filling. Copyright Mohammed S.M. Elbaz. This work was carried out in the ASCI graduate school. ASCI dissertation series number 356 This research is supported by the Dutch Technology Foundation STW, which is part of the Netherlands Organisation for Scientific Research (NWO) and partly funded by the Ministry of Economic Affairs (project number 11626). Three-dimensional in-vivo intra-cardiac vortex flow from 4D Flow MRI: Quantification, automatic identification and association with energy loss Ph.D. thesis with a summary in Dutch. ISBN Thesis layout by Mohammed S.M. Elbaz Cover designed by Mohammed S. M. Elbaz and Rahil Shahzad Printed by GVO Drukkers en Vormgevers BV 2016 Mohammed S.M. Elbaz, Leiden, the Netherlands All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the copyright owner.

4 Three-dimensional in-vivo intra-cardiac vortex flow from 4D Flow MRI Quantification, automatic identification and association with energy loss Proefschrift ter verkrijging van de graad van Doctor aan de Universiteit Leiden, op gezag van Rector Magnificus Prof. mr. C. J. J. M. Stolker, volgens besluit van het College voor Promoties te verdedigen op dinsdag 6 september 2016 klokke 16:15 uur door Mohammed Samir Mohammed Mohammed Elbaz geboren te Dakahliya (Egypte) in 1985

5 Promotiecommissie promotor: co-promotor: leden promotie commissie: Prof.dr.ir. B.P.F. Lelieveldt Dr.ir. R.J. van der Geest Prof.dr.ir. T. Ebbers Linköping University, Linköping (Sweden) Prof.dr. H.J. Lamb Dr.ir. J. Wentzel Erasmus Medical Center, Rotterdam

6 To my parents Hoda and Samir, and my wife Simin

7

8 Contents Chapter 1 Introduction 9 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Vortex flow during early and late left ventricular filling in normal subjects: quantitative characterization using retrospectively-gated 4D flow cardiovascular magnetic resonance and three-dimensional vortex core analysis Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects Assessment of viscous energy loss and the association with 3D vortex ring formation in left ventricular inflow: in vivo evaluation using 4D Flow MRI Abnormal left atrial flow patterns in patients after atrioventricular septal defect correction and regurgitation: evaluation with 4D Flow Magnetic Resonance Imaging and particle tracing Automatic extraction of the 3D left ventricular diastolic transmitral vortex ring from 3D whole-heart phase contrast MRI using Laplace-Beltrami signatures Hierarchical Shape Distributions for Automatic Identification of 3D Diastolic Vortex Rings from 4D Flow MRI Chapter 8 Summary, Discussion and Future Perspectives 131 Samenvatting en conclusies 139 List of publications Acknowledgements Curriculum vitae

9 8

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