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This study evaluates the accuracy of 4D flow AVVR quantification in post-Fontan patients by comparing 4D flow to conventional echocardiographic (AVVR\n                    <jats:sub>Echo<\/jats:sub>\n                    ) and CMR assessments. Patients in the multi-institutional FORCE registry with high-quality 4D flow CMR were included. Regurgitant fractions (RFs) were calculated using two 4D-flow based methods: AVVR\n                    <jats:sub>AVV\u2212Ao (4D)<\/jats:sub>\n                    , calculated from atrioventricular valve and aortic flows, and AVVR\n                    <jats:sub>Jet<\/jats:sub>\n                    , which directly measures AVVR jet volume. 4D flow RFs and severity classifications were compared with AVVR\n                    <jats:sub>Echo<\/jats:sub>\n                    and CMR-reported AVVR severity (AVVR\n                    <jats:sub>Report\u2212Cat<\/jats:sub>\n                    ), and examiner-reported RFs (AVVR\n                    <jats:sub>Report\u2212RF<\/jats:sub>\n                    ). Statistical tests included Pearson correlation, Cohen\u2019s kappa, and Bland-Altman analysis. The study included 218 post-Fontan patients (median age: 16.2 years, IQR: 12.8\u201322.5) and 36.2% were female. Both 4D flow methods displayed excellent interobserver reproducibility (interclass correlation\u2009&gt;\u20090.95) and RFs approximately 7% lower than AVVR\n                    <jats:sub>Report\u2212RF<\/jats:sub>\n                    . AVVR\n                    <jats:sub>AVV\u2212Ao (4D)<\/jats:sub>\n                    showed stronger agreement with AVVR\n                    <jats:sub>Report\u2212RF<\/jats:sub>\n                    (\u03ba\u2009=\u20090.50 [95% CI: 0.25\u20130.75];\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.49,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). AVVR\n                    <jats:sub>Jet<\/jats:sub>\n                    \u200b demonstrated better concordance with AVVR\n                    <jats:sub>Report\u2212Cat<\/jats:sub>\n                    (\u03ba\u2009=\u20090.31 [95% CI: 0.17\u20130.45]). Both AVVR\n                    <jats:sub>AVV\u2212Ao (4D)<\/jats:sub>\n                    (OR\u2009=\u20091.53,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004; AUC\u2009=\u20090.71) and AVVR\n                    <jats:sub>Jet<\/jats:sub>\n                    (OR\u2009=\u20091.74,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002; AUC\u2009=\u20090.65) were associated significantly with the composite outcome of death and heart transplantation listing. This is the first study analyzing the accuracy of 4D flow AVVR quantification in post-Fontan patients, demonstrating reproducibility, prognostic value, and good concordance with conventional methods. These findings suggest that 4D flow AVVR quantification may serve as a complementary method for assessing AVVR in post-Fontan patients.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04243-x","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T08:56:00Z","timestamp":1775552160000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Measuring Atrioventricular Valve Regurgitation Using 4D Flow Cardiovascular Magnetic Resonance Post-Fontan"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2307-4797","authenticated-orcid":false,"given":"Husayn M.","family":"Ladha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9190-3842","authenticated-orcid":false,"given":"Justin C.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7814-2813","authenticated-orcid":false,"given":"Yu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5561-9973","authenticated-orcid":false,"given":"Adam B.","family":"Christopher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4663-6720","authenticated-orcid":false,"given":"Jacqueline","family":"Kreutzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9137-642X","authenticated-orcid":false,"given":"Rajesh","family":"Krishnamurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2580-151X","authenticated-orcid":false,"given":"Francesca","family":"Raimondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2129-5501","authenticated-orcid":false,"given":"Joshua D.","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1003-1903","authenticated-orcid":false,"given":"Yue-Hin","family":"Loke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3783-0783","authenticated-orcid":false,"given":"Laura J.","family":"Olivieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7490-3702","authenticated-orcid":false,"given":"Mark A.","family":"Fogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3715-9627","authenticated-orcid":false,"given":"Rafael","family":"Ceschin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7149-5421","authenticated-orcid":false,"given":"Rahul H.","family":"Rathod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3777-4822","authenticated-orcid":false,"given":"Tarek","family":"Alsaied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"FORCE Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Alsaied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Detterich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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