Vector Flow Mapping for Hemodynamic Assessment Before and After Percutaneous Pulmonary Valve Implantation: A Case Report

Vector Flow Mapping for Hemodynamic Assessment Before and After Percutaneous Pulmonary Valve Implantation: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Vector Flow Mapping for Hemodynamic Assessment Before and After Percutaneous Pulmonary Valve Implantation: A Case Report Yuyan Cai¹, Xi Li¹, Hong Tang¹, Zhengang Zhao¹, Yuan Feng¹, Xin Wei¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8193337/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Severe pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair leads to right ventricular (RV) dilation and dysfunction. Early postoperative assessment after percutaneous pulmonary valve implantation (PPVI) may be insufficient using conventional echocardiographic indices. Case presentation: A 10-year-old girl with repaired TOF presented with severe PR and RV dilation. Vector flow mapping (VFM) was used before and after PPVI to assess RV and right ventricular outflow tract–pulmonary artery (RVOT–PA) flow fields. Pre-procedural VFM revealed abnormal RV vortices, elevated diastolic energy loss (EL), and pronounced reverse flow in RVOT–PA. Immediately after PPVI, RV flow normalized, reverse flow disappeared, and EL decreased markedly, despite minimal early improvement in standard RV functional indices. Conclusions VFM sensitively demonstrated early hemodynamic improvement after PPVI, offering additional value beyond conventional echocardiographic indices. Flow-field–based metrics may aid postoperative assessment in congenital heart disease. Tetralogy of Fallot Pulmonary regurgitation Percutaneous pulmonary valve implantation Vector flow mapping Energy loss Echocardiography Figures Figure 1 Figure 2 Figure 3 Background Severe pulmonary regurgitation (PR) is a common late complication after surgical repair of tetralogy of Fallot (TOF), often resulting in progressive right ventricular (RV) dilation and dysfunction. Percutaneous pulmonary valve implantation (PPVI) restores pulmonary valve competence, yet early postoperative improvements may not be detectable using conventional echocardiographic indices. Vector flow mapping (VFM) provides visualization of flow vectors and quantification of energy loss (EL), offering insight into intracardiac flow dynamics. This case report describes VFM-derived changes before and after PPVI. Case Presentation A 10-year-old girl with repaired TOF (8 years post-surgery) presented with exertional intolerance. Transthoracic echocardiography (TTE) revealed severe PR with a forward velocity of 2.9 m/s and mean pressure gradient of 19 mmHg. Right atrial and RV enlargement were present (39 mm and 29 mm, respectively), with reduced systolic function: systolic excursion (TAPSE) 13 mm, tissue Doppler imaging-derived systolic velocity (TDI-S′) 8 cm/s and fractional area change (FAC) 34% (Fig. 1A1-A4). A 23-mm Med-Zenith PT-Valve was successfully deployed during PPVI. Post-procedure TTE showed excellent valve function, reduced antegrade velocity (1.7 m/s), mean gradient of 7 mmHg, and trace regurgitation. RV size improved mildly, but functional indices showed minimal immediate change (Fig. 1B1-B4). Vector Flow Mapping Analysis Pre-procedural VFM demonstrated mid-systolic RV vortices, late-diastolic vortices beneath the tricuspid valve, and elevated diastolic EL (5.7 W/m, Fig. 2A1-A3). In the RVOT–PA region, severe PR caused reverse flow and multiple vortices, with diastolic EL reaching 77.3 W/m (Fig. 3A1-A3). Immediately after PPVI, RV flow became laminar with disappearance of abnormal vortices (Fig. 2B1-B3). Reverse flow in the RVOT–PA was abolished, and diastolic EL decreased to 13.7 W/m. A small localized vortex near the stent frame represented benign flow disturbance (Fig. 3B1-B3). Discussion Chronic PR after TOF repair contributes to progressive RV dilation and dysfunction. PPVI corrects PR-induced volume overload, but early functional changes may not be captured by routine echocardiographic parameters (1, 2). In this case, VFM identified abnormal intracardiac flow patterns and elevated energy loss prior to PPVI and demonstrated rapid normalization immediately afterward. These findings show that VFM can complement standard echocardiography by providing direct visualization of flow efficiency. It may therefore serve as a sensitive tool for postoperative assessment in congenital heart disease(3, 4). Conclusions VFM demonstrated early hemodynamic improvement following PPVI in a child with repaired TOF. Restoration of physiologic flow fields and reduced energy loss preceded measurable changes in conventional RV functional indices. VFM may aid in early postoperative evaluation. Abbreviations EL Energy loss FAC Fractional area change PA Pulmonary artery PPVI Percutaneous pulmonary valve implantation PR Pulmonary regurgitation RV Right ventricle RVOT Right ventricular outflow tract TAPSE Tricuspid annular plane systolic excursion TDI-S′ Tissue Doppler imaging-deprived systolic velocity TOF Tetralogy of Fallot TTE Transthoracic echocardiography VFM Vector flow mapping Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of West China Hospital, Sichuan University (Approval No.2019-277). Written informed consent to participate in the study was obtained from the patient’s parent. The study was registered at the Chinese Clinical Trial Registry (ChiCTR1900023258) on May 19, 2019. Consent for publication Written informed consent for publication of clinical data and images was obtained from the parent of the patient. Availability of data and materials All material and images used in this report are available from the corresponding author by request. Competing interests The authors declare no competing interests. Funding None. Authors’ contributions All authors contributed to clinical management, data interpretation, and manuscript writing. All authors approved the final manuscript. Acknowledgements None. References Boudjemline Y. Percutaneous pulmonary valve implantation: what have we learned over the years? EuroIntervention. 2017;13(AA):AA60–AA7. Ansari MM, Cardoso R, Garcia D et al. Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future. J Am Coll Cardiol. 2015;66(20):2246–55. Honda T, Itatani K, Takanashi M et al. Exploring energy loss by vector flow mapping in children with ventricular septal defect: Pathophysiologic significance. Int J Cardiol. 2017;244:143–50. Chen Z, Li Y, Li C et al. Right Ventricular Dissipative Energy Loss Detected by Vector Flow Mapping in Children: Characteristics of Normal Values. J Ultrasound Med. 2019;38(1):131–40. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 May, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers invited by journal 08 Feb, 2026 Editor assigned by journal 18 Dec, 2025 Submission checks completed at journal 17 Dec, 2025 First submitted to journal 17 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8193337","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":587617812,"identity":"8f12fcb3-eb15-4212-ab39-35e734fe7535","order_by":0,"name":"Yuyan Cai¹","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yuyan","middleName":"","lastName":"Cai¹","suffix":""},{"id":587617813,"identity":"b4cad35a-5034-40a0-953d-0086b6cec2e3","order_by":1,"name":"Xi Li¹","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xi","middleName":"","lastName":"Li¹","suffix":""},{"id":587617814,"identity":"66d8743b-49bc-4337-a25a-9f1cd4a076bb","order_by":2,"name":"Hong Tang¹","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Tang¹","suffix":""},{"id":587617815,"identity":"96e67b8f-a5b0-4b50-8853-3b21721df9b9","order_by":3,"name":"Zhengang Zhao¹","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Zhengang","middleName":"","lastName":"Zhao¹","suffix":""},{"id":587617816,"identity":"76755aa6-39e9-41e1-82c1-9b17b5420e51","order_by":4,"name":"Yuan Feng¹","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Feng¹","suffix":""},{"id":587617817,"identity":"8e4e66d3-c4a1-42b8-a712-ef71ca21d5f0","order_by":5,"name":"Xin Wei¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie2Qv0vDQBTHLzw5l4tZrxTEP+Hk4HAo7R/ikhDoJtQtQ9CTg3Sza/4MoX+ADQ/a5cC1g2Ak4FwoSCcxVgSXJB0F77M8Hnw/vB+EOBx/Ek/DvgIU1S7hpwEAlocpxzSWxF7I3pSORdecbyVgqu9lSfTwxM54W1ysjNlO0uehBiblxHJvjowIkg4uGxVbaJkv32IN9LrKEw4K/UVJluMr3aCodaRjRjGuz58LZjlVeBIKT2Oz8vKqkX18KURxP+NMGiZ4q7L27oyf4ZDAkerXChfQoYxsZMC/x5AAjc9zywXH+slhyy296arasncckQCLcpPc3M5miOUmHTQqP0SPi99t2BHfL3hAxuFwOP4rn9WtWo3ut996AAAAAElFTkSuQmCC","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Wei¹","suffix":""}],"badges":[],"createdAt":"2025-11-24 12:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8193337/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8193337/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102747278,"identity":"ca9a03a0-be43-4807-a05c-314ee2e92647","added_by":"auto","created_at":"2026-02-16 09:04:23","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":309978,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of right heart morphology and pulmonary regurgitation (PR) before and after PPVI on TTE. A1-A4: Severe PR and RV enlargement before intervention; B1-B4: Restored pulmonary valve function after PPVI.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8193337/v1/677b76aef02eead19c19417d.jpeg"},{"id":102599582,"identity":"ba6808ab-8638-48de-b0a0-b6f8f4c6e554","added_by":"auto","created_at":"2026-02-13 12:41:55","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":366444,"visible":true,"origin":"","legend":"\u003cp\u003eVFM analysis of RV flow fields before and after PPVI, illustrating changes in vortex formation and energy loss. A1-A3: Pre-procedural vortex patterns and elevated EL; B1-B3 Resolution of vortices and improved flow efficiency after PPVI.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8193337/v1/c48d700a3e398397a11e4d28.jpeg"},{"id":102599584,"identity":"8a916634-61c2-4e0a-bb4d-3c3fa4ba88bf","added_by":"auto","created_at":"2026-02-13 12:41:55","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":317390,"visible":true,"origin":"","legend":"\u003cp\u003eVFM assessment of RVOT–PA before and after PPVI. A1-A3: Reverse flow and multiple vortices caused by severe PR; B1-B3 Abolition of reverse flow and marked reduction in EL following PPVI.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8193337/v1/0f6197e93900362d566b9cc8.jpeg"},{"id":102750847,"identity":"8f08eea5-3e09-4c10-a56b-120015132fa5","added_by":"auto","created_at":"2026-02-16 09:22:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1368630,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8193337/v1/8be7b431-5dff-4780-a457-bf29bcdbfcda.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Vector Flow Mapping for Hemodynamic Assessment Before and After Percutaneous Pulmonary Valve Implantation: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eSevere pulmonary regurgitation (PR) is a common late complication after surgical repair of tetralogy of Fallot (TOF), often resulting in progressive right ventricular (RV) dilation and dysfunction. Percutaneous pulmonary valve implantation (PPVI) restores pulmonary valve competence, yet early postoperative improvements may not be detectable using conventional echocardiographic indices. Vector flow mapping (VFM) provides visualization of flow vectors and quantification of energy loss (EL), offering insight into intracardiac flow dynamics. This case report describes VFM-derived changes before and after PPVI.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 10-year-old girl with repaired TOF (8 years post-surgery) presented with exertional intolerance. Transthoracic echocardiography (TTE) revealed severe PR with a forward velocity of 2.9 m/s and mean pressure gradient of 19 mmHg. Right atrial and RV enlargement were present (39 mm and 29 mm, respectively), with reduced systolic function: systolic excursion (TAPSE) 13 mm, tissue Doppler imaging-derived systolic velocity (TDI-S\u0026prime;) 8 cm/s and fractional area change (FAC) 34% (Fig.\u0026nbsp;1A1-A4). A 23-mm Med-Zenith PT-Valve was successfully deployed during PPVI. Post-procedure TTE showed excellent valve function, reduced antegrade velocity (1.7 m/s), mean gradient of 7 mmHg, and trace regurgitation. RV size improved mildly, but functional indices showed minimal immediate change (Fig.\u0026nbsp;1B1-B4).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eVector Flow Mapping Analysis\u003c/h2\u003e \u003cp\u003ePre-procedural VFM demonstrated mid-systolic RV vortices, late-diastolic vortices beneath the tricuspid valve, and elevated diastolic EL (5.7 W/m, Fig.\u0026nbsp;2A1-A3). In the RVOT\u0026ndash;PA region, severe PR caused reverse flow and multiple vortices, with diastolic EL reaching 77.3 W/m (Fig.\u0026nbsp;3A1-A3). Immediately after PPVI, RV flow became laminar with disappearance of abnormal vortices (Fig.\u0026nbsp;2B1-B3). Reverse flow in the RVOT\u0026ndash;PA was abolished, and diastolic EL decreased to 13.7 W/m. A small localized vortex near the stent frame represented benign flow disturbance (Fig.\u0026nbsp;3B1-B3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eChronic PR after TOF repair contributes to progressive RV dilation and dysfunction. PPVI corrects PR-induced volume overload, but early functional changes may not be captured by routine echocardiographic parameters (1, 2). In this case, VFM identified abnormal intracardiac flow patterns and elevated energy loss prior to PPVI and demonstrated rapid normalization immediately afterward.\u003c/p\u003e \u003cp\u003eThese findings show that VFM can complement standard echocardiography by providing direct visualization of flow efficiency. It may therefore serve as a sensitive tool for postoperative assessment in congenital heart disease(3, 4).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eVFM demonstrated early hemodynamic improvement following PPVI in a child with repaired TOF. Restoration of physiologic flow fields and reduced energy loss preceded measurable changes in conventional RV functional indices. VFM may aid in early postoperative evaluation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eEL\u0026nbsp;\u003c/strong\u003eEnergy loss\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFAC\u0026nbsp;\u003c/strong\u003eFractional area change\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePA\u0026nbsp;\u003c/strong\u003ePulmonary artery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPVI\u0026nbsp;\u003c/strong\u003ePercutaneous pulmonary valve implantation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePR\u0026nbsp;\u003c/strong\u003ePulmonary regurgitation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRV\u0026nbsp;\u003c/strong\u003eRight ventricle\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRVOT\u0026nbsp;\u003c/strong\u003eRight ventricular outflow tract\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTAPSE\u0026nbsp;\u003c/strong\u003eTricuspid annular plane systolic excursion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTDI-S\u0026prime;\u0026nbsp;\u003c/strong\u003eTissue Doppler imaging-deprived systolic velocity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTOF\u0026nbsp;\u003c/strong\u003eTetralogy of Fallot\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTTE\u0026nbsp;\u003c/strong\u003eTransthoracic echocardiography\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVFM\u0026nbsp;\u003c/strong\u003eVector flow mapping\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of West China Hospital, Sichuan University (Approval No.2019-277). Written informed consent to participate in the study was obtained from the patient\u0026rsquo;s parent. The study was registered at the Chinese Clinical Trial Registry (ChiCTR1900023258) on May 19, 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of clinical data and images was obtained from the parent of the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll material and images used in this report are available from the corresponding author by request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to clinical management, data interpretation, and manuscript writing. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoudjemline Y. Percutaneous pulmonary valve implantation: what have we learned over the years? EuroIntervention. 2017;13(AA):AA60\u0026ndash;AA7.\u003c/li\u003e\n\u003cli\u003eAnsari MM, Cardoso R, Garcia D et al. Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future. J Am Coll Cardiol. 2015;66(20):2246\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eHonda T, Itatani K, Takanashi M et al. Exploring energy loss by vector flow mapping in children with ventricular septal defect: Pathophysiologic significance. Int J Cardiol. 2017;244:143\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eChen Z, Li Y, Li C et al. Right Ventricular Dissipative Energy Loss Detected by Vector Flow Mapping in Children: Characteristics of Normal Values. J Ultrasound Med. 2019;38(1):131\u0026ndash;40.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tetralogy of Fallot, Pulmonary regurgitation, Percutaneous pulmonary valve implantation, Vector flow mapping, Energy loss, Echocardiography","lastPublishedDoi":"10.21203/rs.3.rs-8193337/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8193337/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSevere pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair leads to right ventricular (RV) dilation and dysfunction. Early postoperative assessment after percutaneous pulmonary valve implantation (PPVI) may be insufficient using conventional echocardiographic indices.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003eA 10-year-old girl with repaired TOF presented with severe PR and RV dilation. Vector flow mapping (VFM) was used before and after PPVI to assess RV and right ventricular outflow tract\u0026ndash;pulmonary artery (RVOT\u0026ndash;PA) flow fields. Pre-procedural VFM revealed abnormal RV vortices, elevated diastolic energy loss (EL), and pronounced reverse flow in RVOT\u0026ndash;PA. Immediately after PPVI, RV flow normalized, reverse flow disappeared, and EL decreased markedly, despite minimal early improvement in standard RV functional indices.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eVFM sensitively demonstrated early hemodynamic improvement after PPVI, offering additional value beyond conventional echocardiographic indices. Flow-field\u0026ndash;based metrics may aid postoperative assessment in congenital heart disease.\u003c/p\u003e","manuscriptTitle":"Vector Flow Mapping for Hemodynamic Assessment Before and After Percutaneous Pulmonary Valve Implantation: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 12:41:50","doi":"10.21203/rs.3.rs-8193337/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-19T04:39:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69445700138526611974355701037233158232","date":"2026-04-27T17:03:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T10:51:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293396158784462738454370324699842531882","date":"2026-02-13T08:33:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-08T05:22:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-18T05:41:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T15:15:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-12-17T15:08:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0345d090-2845-4334-9a96-29e98a688ad8","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-19T04:39:47+00:00","index":71,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T12:41:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 12:41:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8193337","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8193337","identity":"rs-8193337","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}