Ascending Aortic and Main Pulmonary Artery Areas Derived From Cardiovascular Magnetic Resonance as Reference Values for Normal Subjects and Repaired Tetralogy of Fallot

Kutty, Shelby; Küehne, Titus; Gribben, Paul; Reed, Eric; Ling, Li; Danford, David A.; Beerbaum, Philipp; Sarikouch, Samir

doi:10.1161/circimaging.112.973073

Cited by 31 publications

(59 citation statements)

References 27 publications

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“…A symmetric MPA stenosis is clinically the most common case. The model’s anatomical dimensions correspond to a 9 year-old child’s MPA that was taken from reference values reported in a statistical clinical study 19. Model has an inner diameter of 18 mm and 1 mm uniform vessel wall thickness.…”

Section: Methodsmentioning

confidence: 99%

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

et al. 2018

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Surgical treatment of congenital heart disease (CHD) involves complex vascular reconstructions utilizing artificial and native surgical materials. A successful surgical reconstruction achieves an optimal hemodynamic profile through the graft in spite of the complex post-operative vessel growth pattern and the altered pressure loading. This paper proposes a new in silico patient-specific pre-surgical planning framework for patch reconstruction and investigates its computational feasibility. The proposed protocol is applied to the patch repair of main pulmonary artery (MPA) stenosis in the Tetralogy of Fallot CHD template. The effects of stenosis grade, the three-dimensional (3D) shape of the surgical incision and material properties of the artificial patch are investigated. The release of residual stresses due to the surgical incision and the extra opening of the incision gap for patch implantation are simulated through a quasi-static finite-element vascular model with shell elements. Implantation of different unloaded patch shapes is simulated. The patched PA configuration is pressurized to the physiological post-operative blood pressure levels of 25 and 45 mmHg and the consequent post-operative stress distributions and patched artery shapes are computed. Stress–strain data obtained in-house, through the biaxial tensile tests for the mechanical properties of common surgical patch materials, Dacron, Polytetrafluoroethylene, human pericardium and porcine xenopericardium, are employed to represent the mechanical behavior of the patch material. Finite-element model is experimentally validated through the actual patch surgery reconstructions performed on the 3D printed anatomical stenosis replicas. The post-operative recovery of the initially narrowed lumen area and post-op tortuosity are quantified for all modeled cases. A computational fluid dynamics solver is used to evaluate post-operative pressure drop through the patch-reconstructed outflow tract. According to our findings, the shorter incisions made at the throat result in relatively low local peak stress values compared to other patch design alternatives. Longer cut and double patch cases are the most effective in repairing the initial stenosis level. After the patch insertion, the pressure drop in the artery due to blood flow decreases from 9.8 to 1.35 mmHg in the conventional surgical configuration. These results are in line with the clinical experience where a pressure gradient at or above 50 mmHg through the MPA can be an indication to intervene. The main strength of the proposed pre-surgical planning framework is its capability to predict the intra-operative and post-operative 3D vascular shape changes due to intramural pressure, cut length and configuration, for both artificial and native patch materials.Electronic supplementary materialThe online version of this article (10.1007/s10439-018-2043-5) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

et al. 2018

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“…A more detailed description of this contemporary patient cohort, including details of CMR technique and results, has been published elsewhere. 13,14 To minimize any potential confounding effects of surgical era on sex impact, we limited this study to include only postrepair Fallot patients between 8 and 20 years of age. Thus, 272 ToF patients (114 women and 158 men) formed the study cohort.…”

Section: Fallot Patient Cohortmentioning

confidence: 99%

Poorer Right Ventricular Systolic Function and Exercise Capacity in Women After Repair of Tetralogy of Fallot

Sarikouch

Boethig

Peters

et al. 2013

Circ: Cardiovascular Imaging

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S ex differences in clinical presentation, procedural complications, and long-term outcomes are well known for acquired heart disease such as coronary artery disease or nonischemic cardiomyopathy. [1][2][3] There is evolving evidence that sex also influences the outcome in a range of congenital heart defects, as documented in recent registry studies. [4][5][6][7] However, although likely to be of clinical importance in the differential clinical management of female and male patients, it remains challenging to clearly demonstrate any sex effect for specific congenital heart lesions such as tetralogy of Fallot (ToF), the most common cyanotic heart defect. 8 The reasons are the heterogeneity and variability of the initial cardiovascular morphology of the defect and significant variability in the timing and mode of interventions for palliation, repair, or reoperations. Furthermore, there are differences in surgical procedures and cardiopulmonary bypass techniques between Background-In repaired congenital heart disease, there is increasing evidence of sex differences in cardiac remodeling, but there is a lack of comparable data for specific congenital heart defects such as in repaired tetralogy of Fallot.

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“…In addition to echocardiography also CMR is an inherent part of the follow-up work flow in congenital heart [11] disease and recently a number of CMR derived normative date have been published [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Dimensions of the Ascending Aorta in Children and Adolescents with Repaired Tetralogy of Fallot Obtained by Cardiac Magnetic Resonance Angiography

Mende¹,

Gräfe²,

Dähnert³

et al. 2016

Thorac cardiovasc Surg

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Introduction Dilatation of the ascending aorta is a common finding in Tetralogy of fallot (TOF). We sought to provide aortic dimensions in children and adolescents after corrected TOF obtained by contrast-enhanced cardiacmagnetic-resonance angiography (CE-CMRA) that could serve as reference values. Materials and methods We enrolled 101 children and adolescents (56 male) with a median age of 10.9 years. All patients underwent CE-CMRA imaging using a 3-dimensional spoiled gradient-echo-sequence. Aortic diameters were measured at the level of the aortic valve (AV), aortic sinus (AS), sino-tubular junction (STJ) and the ascending aorta (AA) and compared with normal values obtained from literature. Sex-specific aortic dimensions are given as percentile curves as well as z scores. Furthermore CMR volumetric and functional parameters as well as clinical and anamnestic data were analyzed to identify parameters that are associated with aortic dilatation. Results Diameters for aortic size for males were 3.6 ? 16.6*BSA 0.5 at the AV level, 7.0 ? 19.5*BSA 0.5 at the AS level, 7.0 ? 14.4*BSA 0.5 at the STJ level and 7.3 ? 15.5*BSA 0.5 at the AA level. Diameters for females were 5.8 ? 14.1*BSA 0.5 at the AV level, 7.2 ? 17.6*BSA 0.5 at the AS level, 5.2 ? 15.4*BSA 0.5 at the STJ level and 2.0 ? 17.8*BSA 0.5 at the AA level. All diameters in TOF patients were larger compared with normal values. The postoperative interval and age at examination were the only parameters associated with aortic size at all measured levels. Conclusion We provide CE-CMRA data of aortic dimensions in children and adolescents after correction of TOF. Our data might be useful for an estimation of the ''normal'' aortic size in this patient cohort and can serve as a basis for future longitudinal studies adding prognostic data.

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Ascending Aortic and Main Pulmonary Artery Areas Derived From Cardiovascular Magnetic Resonance as Reference Values for Normal Subjects and Repaired Tetralogy of Fallot

Cited by 31 publications

References 27 publications

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

Poorer Right Ventricular Systolic Function and Exercise Capacity in Women After Repair of Tetralogy of Fallot

Dimensions of the Ascending Aorta in Children and Adolescents with Repaired Tetralogy of Fallot Obtained by Cardiac Magnetic Resonance Angiography

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