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J Thorac Cardiovasc Surg. 2016 Mar;151(3):687-694.e3. doi: 10.1016/j.jtcvs.2015.09.106. Epub 2015 Oct 3.

Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot.

Author information

1
School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China; Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, Mass. Electronic address: dtang@wpi.edu.
2
Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, Mass; China Information Technology Designing & Consulting Institute Co, Ltd, Beijing, China.
3
Department of Cardiac Surgery, Boston Children's Hospital, Department of Surgery, Harvard Medical School, Boston, Mass.
4
Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, Mass.
5
Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Mass.
6
Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, Mass; School of Mathematical Sciences, Xiamen University, Xiamen, Fujian, China.
7
Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Mass; Department of Surgery, University of Massachusetts Medical School, Worcester, Mass.

Abstract

OBJECTIVE:

Patients with repaired tetralogy of Fallot account for a substantial proportion of cases with late-onset right ventricular failure. The current surgical approach, which includes pulmonary valve replacement/insertion, has yielded mixed results. Therefore, it may be clinically useful to identify parameters that can be used to predict right ventricular function response to pulmonary valve replacement.

METHODS:

Cardiac magnetic resonance data before and 6 months after pulmonary valve replacement were obtained from 16 patients with repaired tetralogy of Fallot (8 male, 8 female; median age, 42.75 years). Right ventricular ejection fraction change from pre- to postpulmonary valve replacement was used as the outcome. The patients were divided into group 1 (n = 8, better outcome) and group 2 (n = 8, worst outcome). Cardiac magnetic resonance-based patient-specific computational right ventricular/left ventricular models were constructed, and right ventricular mechanical stress and strain, wall thickness, curvature, and volumes were obtained for analysis.

RESULTS:

Our results indicated that right ventricular wall stress was the best single predictor for postpulmonary valve replacement outcome with an area under the receiver operating characteristic curve of 0.819. Mean values of stress, strain, wall thickness, and longitudinal curvature differed significantly between the 2 groups with right ventricular wall stress showing the largest difference. Mean right ventricular stress in group 2 was 103% higher than in group 1.

CONCLUSIONS:

Computational modeling and right ventricular stress may be used as tools to identify right ventricular function response to pulmonary valve replacement. Large-scale clinical studies are needed to validate these preliminary findings.

KEYWORDS:

computational modeling; congenital heart disease; pulmonary valve replacement; right ventricle; tetralogy of Fallot

PMID:
26548998
PMCID:
PMC4761474
[Available on 2017-03-01]
DOI:
10.1016/j.jtcvs.2015.09.106
[Indexed for MEDLINE]
Free PMC Article

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