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. 2021 Jun 2;11:11623. doi: 10.1038/s41598-021-91125-2

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Streamline imaging flows of the pulmonary arteries of 20 patients with repaired Tetralogy of Fallot. Case 1–5 did not show a vortex in the main pulmonary arteries (MPA), however, there were vortical or helical flows in the right and left PA in some patients. Case 6–20 showed vortex formation in the MPA. Vortices typically originated posteriorly in the MPA (Type 1: Case 6–13) and formed helices. Other vortices originated from the MPA bifurcation to the right PA (Type 2: Case 16–19), at the proximal right PA (Type 3: Case 14, 15), or from the MPA bifurcation to the left PA (Type 4: Case 20). Arrows indicate vortices and arrowheads indicate the left pulmonary artery stenosis. F female, M male, RVEF right ventricular ejection fraction, PRF pulmonary regurgitant fraction, Circulation longitudinal integral circulation value. Flow visualization was performed using 4D flow postprocessor software (iT Flow; Cardioflow Design. Inc., Tokyo, Japan).