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Respiration may have an increased impact on pulmonary flow in these patients that cannot be assessed by standard tools including 4D flow MRI. This study uses 5D flow MRI to assess respiratory\u2010cycle variations in flow energetics in patients with CHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      5D flow was acquired with four respiratory states in 14 Fontan patients (21\u2009\u00b1\u20098\u2009years, 8 female), 10 intracardiac shunt patients (19\u2009\u00b1\u200913\u2009years, 8 female), and 9 controls (26\u2009\u00b1\u20096\u2009years, 1 female). Blood kinetic energy (KE\n                      <jats:sub>mean<\/jats:sub>\n                      ), viscous energy loss (EL\n                      <jats:sub>total<\/jats:sub>\n                      ), and EL fraction (EL\n                      <jats:sub>total<\/jats:sub>\n                      \/KE\n                      <jats:sub>mean<\/jats:sub>\n                      ) as a measure of flow inefficiency were calculated in inferior and superior caval veins (IVC, SVC), pulmonary arteries (PA), and aorta. Correlations were assessed with clinical markers of altered cardiac flow function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      5D flow was acquired with acceleration factor\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u200937\u201393 varying between respiratory states. Fontan and shunt patients demonstrated significant respiratory\u2010driven changes in pulmonary flow energetics compared to controls. Fontan IVC and PA KE\n                      <jats:sub>mean<\/jats:sub>\n                      were increased during inspiration (+43%, +37%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and decreased during expiration (\u221240%, \u221235%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), resulting in increased expiratory EL fraction (+34%, +30%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Shunt patients showed a similar effect in IVC KE\n                      <jats:sub>mean<\/jats:sub>\n                      (+28%, \u221225%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Decreased expiratory IVC KE\n                      <jats:sub>mean<\/jats:sub>\n                      was associated with increased Fontan left\u2013right PA flow differential (\u03c1\u2009=\u2009\u22120.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and increased shunt Qp\/Qs (\u03c1\u2009=\u2009\u22120.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings of this study show that CHD flow energetics and efficiency are modulated by respiration. Respiratory\u2010resolved imaging is needed to identify these dynamics and their relationships to overall cardiac function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mrm.70403","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T03:57:38Z","timestamp":1777262258000},"page":"1342-1354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>5D<\/scp>\n                    Flow\n                    <scp>MRI<\/scp>\n                    Reveals Respiration\u2010Driven Changes in Blood Flow Energetics in Congenital Heart Disease"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6466-2711","authenticated-orcid":false,"given":"Thara","family":"Nallamothu","sequence":"first","affiliation":[{"name":"Radiology, Feinberg School of Medicine, Northwestern Medicine  Chicago Illinois USA"},{"name":"Biomedical Engineering, Northwestern University  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