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Prediction of Ventricular Mechanics After Pulmonary Valve Replacement in Tetralogy of Fallot by Biomechanical Modeling: A Step Towards Precision Healthcare

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Abstract

Clinical indicators of heart function are often limited in their ability to accurately evaluate the current mechanical state of the myocardium. Biomechanical modeling has been shown to be a promising tool in addition to clinical indicators. By providing a patient-specific measure of myocardial active stress (contractility), biomechanical modeling can enhance the precision of the description of patient’s pathophysiology at any given point in time. In this work we aim to explore the ability of biomechanical modeling to predict the response of ventricular mechanics to the progressively decreasing afterload in repaired tetralogy of Fallot (rTOF) patients undergoing pulmonary valve replacement (PVR) for significant residual right ventricular outflow tract obstruction (RVOTO). We used 19 patient-specific models of patients with rTOF prior to pulmonary valve replacement (PVR), denoted as PSMpre, and patient-specific models of the same patients created post-PVR (PSMpost)—both created in our previous published work. Using the PSMpre and assuming cessation of the pulmonary regurgitation and a progressive decrease of RVOT resistance, we built relationships between the contractility and RVOT resistance post-PVR. The predictive value of such in silico obtained relationships were tested against the PSMpost, i.e. the models created from the actual post-PVR datasets. Our results show a linear 1-dimensional relationship between the in silico predicted contractility post-PVR and the RVOT resistance. The predicted contractility was close to the contractility in the PSMpost model with a mean (± SD) difference of 6.5 (± 3.0)%. The relationships between the contractility predicted by in silico PVR vs. RVOT resistance have a potential to inform clinicians about hypothetical mechanical response of the ventricle based on the degree of pre-operative RVOTO.

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Acknowledgments

We would like to acknowledge Dr Philippe Moireau, Inria research team MΞDISIM, for the development of the cardiac simulation software CardiacLab used in this work. This work was supported by the Inria-UTSW Associated Team TOFMOD. It was also funded from by the W. B. & Ellen Gordon Stuart Trust, The Communities Foundation of Texas and by the Pogue Family Distinguished Chair (award to Dr F. Gerald Greil in February, 2015). The work was in addition supported by the Ministry of Health of the Czech Republic [NV19-08-00071]. 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

Inria, Inria-UTSW Associated Team TOFMOD, Radomír Chabiniok, Ministerstvo Zdravotnictví České Republiky, NV19-08-00071,Radomír Chabiniok, W. B. & Ellen Gordon Stuart Trust, Communities Foundation of Texas, Pogue Family, Pogue Family Distinguished Chair, Gerald Greil.

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Authors and Affiliations

  1. Inria, Palaiseau, France

    Maria Gusseva, Dominique Chapelle & Radomír Chabiniok

  2. LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France

    Maria Gusseva, Dominique Chapelle & Radomír Chabiniok

  3. Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Tarique Hussain, Gerald Greil & Radomír Chabiniok

  4. Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Nebraska, Medical Center College of Medicine, Omaha, NE, USA

    Camille Hancock Friesen

  5. Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic

    Radomír Chabiniok

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  1. Maria Gusseva
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Contributions

Conception of the study: TH, DC, RC. Statistical analysis: MG. Models formulation: DC, RC. Analyze and interpretation of the results: MG, TH, GG, CHF, RC. Design of the figures: MG. Drafting manuscript: MG, RC. Editing and revising manuscript: MG, TH, CHF, GG, DC, RC. Approving final version of manuscript: MG, TH, CHF, GG, DC, RC.

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Correspondence to Radomír Chabiniok.

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Gusseva, M., Hussain, T., Hancock Friesen, C. et al. Prediction of Ventricular Mechanics After Pulmonary Valve Replacement in Tetralogy of Fallot by Biomechanical Modeling: A Step Towards Precision Healthcare. Ann Biomed Eng 49, 3339–3348 (2021). https://doi.org/10.1007/s10439-021-02895-9

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