Right Ventricular Flow Vorticity Relationships With Biventricular Shape in Adult Tetralogy of Fallot

Abstract

Remodeling in adults with repaired tetralogy of Fallot (rToF) may occur due to chronic pulmonary regurgitation, but may also be related to altered flow patterns, including vortices. We aimed to correlate and quantify relationships between vorticity and ventricular shape derived from atlas-based analysis of biventricular shape. Adult rToF (n = 12) patients underwent 4D flow and cine MRI imaging. Vorticity in the RV was computed after noise reduction using a neural network. A biventricular shape atlas built from 95 rToF patients was used to derive principal component modes, which were associated with vorticity and pulmonary regurgitant volume (PRV) using univariate and multivariate linear regression. Univariate analysis showed that indexed PRV correlated with 3 modes (r = −0.55,−0.50, and 0.6, all p < 0.05) associated with RV dilatation and an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV and paradoxical movement of the septum. RV outflow and inflow vorticity were also correlated with these modes. However, total vorticity over the whole RV was correlated with two different modes (r = −0.62,−0.69, both p < 0.05). Higher vorticity was associated with both RV and LV shape changes including longer ventricular length, a larger bulge beside the tricuspid valve, and distinct tricuspid tilting. RV flow vorticity was associated with changes in biventricular geometry, distinct from associations with PRV. Flow vorticity may provide additional mechanistic information in rToF remodeling. Both LV and RV shapes are important in rToF RV flow patterns.

3D modeling and printing for complex biventricular repair of double outlet right ventricle

“…Furthermore, additional quantitative measures describing the complex anatomy, such as the orientation of intracardiac structures as well as the orientation of structures in relation to each other might be feasible. Here, parameters such as the angles between the valve annulus planes and the VSD, but also more complex and abstract measurements based on statistical shape analysis ( 24 ) can be thought of. Such parameters might allow to objectify the mostly qualitative nature of the additional information provided by either 3D reconstructions or 3D printing.…”

Abnormal Diastolic Hemodynamic Forces: A Link Between Right Ventricular Wall Motion, Intracardiac Flow, and Pulmonary Regurgitation in Repaired Tetralogy of Fallot

“…The intraventricular and deformation parameters not traditionally considered in pressure-volume analysis are pertinent to the pathophysiology of RTOF. 4D flow studies of RTOF have demonstrated unique flow and deformation patterns that are related to PR, independent of RV size ( 5 , 6 , 27 ). Abnormalities in global longitudinal strain and circumferential strain, including biventricular dis-synchrony in RTOF have been well-documented ( 25 , 28 ).…”

Roadmap for an imaging and modelling paediatric study in rural NZ

“…RV and LV endocardial and epicardial surfaces were fitted, while the papillary muscles were excluded from the myocardial mass. Cardiac indices, such as end diastolic, end systolic and stroke volumes, as well as ventricular mass were calculated using numerical integration (Dyverfeldt et al, 2015;Mauger et al, 2019;Mauger et al, 2021;Elsayed et al, 2022).…”

“…Personalized biventricular models have paved the path to advanced and in-depth cardiac analysis. In addition to the routine cardiac indices that are now easier and more robust in the way they are measured; new predictive indices are gaining interest such as strain measurements (Elsayed et al, 2022). Ultimately, our research will lead to the development of paediatric cardiac atlases.…”