TY - JOUR
T1 - Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients After Complete Repair
AU - Gusseva, Maria
AU - Hussain, Tarique
AU - Friesen, Camille Hancock
AU - Moireau, Philippe
AU - Tandon, Animesh
AU - Patte, Cécile
AU - Genet, Martin
AU - Hasbani, Keren
AU - Greil, Gerald
AU - Chapelle, Dominique
AU - Chabiniok, Radomír
N1 - Funding Information:
This work was supported by the Inria?UT Southwestern Associated Team Tetralogy of Fallot and Modeling of Diseases (TOFMOD), Wellcome/Engineering and Physical Sciences Research Council Centre for Medical Engineering (WT 203148/Z/16/Z), and the Ministry of Health of the Czech Republic (NV19-08-00071) to Dr Chabiniok. It was also funded in part from by the W.B. & Ellen Gordon Stuart Trust, The Communities Foundation of Texas, and a Pogue Family Distinguished Chair (awarded to Dr Greil in February 2015). Research reported in this publication was supported by Children's HealthSM, but the content is solely the responsibility of the authors and does not necessarily represent the official views of Children's HealthSM.
Funding Information:
This work was supported by the Inria–UT Southwestern Associated Team Tetralogy of Fallot and Modeling of Diseases (TOFMOD), Wellcome/Engineering and Physical Sciences Research Council Centre for Medical Engineering (WT 203148/Z/16/Z), and the Ministry of Health of the Czech Republic (NV19-08-00071) to Dr Chabiniok. It was also funded in part from by the W.B. & Ellen Gordon Stuart Trust, The Communities Foundation of Texas , and a Pogue Family Distinguished Chair (awarded to Dr Greil in February 2015). Research reported in this publication was supported by Children’s Health SM , but the content is solely the responsibility of the authors and does not necessarily represent the official views of Children’s Health SM .
Publisher Copyright:
© 2021 Canadian Cardiovascular Society
PY - 2021/11
Y1 - 2021/11
N2 - Background: A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. Methods: Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. Results: RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff—both in line with published data. Conclusions: This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.
AB - Background: A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. Methods: Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. Results: RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff—both in line with published data. Conclusions: This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.
UR - http://www.scopus.com/inward/record.url?scp=85117807895&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2021.06.018
DO - 10.1016/j.cjca.2021.06.018
M3 - Article
C2 - 34216743
AN - SCOPUS:85117807895
SN - 0828-282X
VL - 37
SP - 1798
EP - 1807
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 11
ER -
