Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data
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Repaired tetralogy of Fallot (rTOF) patients develop right ventricular (RV) dilatation and dysfunction. To prevent their demise, pulmonary valve replacement is necessary, though appropriate timing for it is challenged by a paucity of reliable diagnostic parameters. In this pilot study, we hypothesized that stroke work (SW) and energy calculations would delineate the inefficiency of RV performance in rTOF. RV SW was calculated for both an rTOF and a normal subject by utilizing RV pressure and volume measurements obtained during cardiac catheterization and MRI studies. Energy transfer rate and ratio were computed at the main pulmonary artery (PA). Compared to the normal RV, the rTOF RV had higher operating pressure, lower computed SW (0.078 J vs. 0.115 J for normal), and higher negative energy transfer at the PA (0.044 J vs. 0.002 J for normal). Furthermore, the energy transfer ratio was nearly twice as high for the normal RV (1.06) as for the rTOF RV (0.56). RV SW and energy transfer ratio delineate important operational efficiency differences in blood flow from the RV to the PA between rTOF and normal subjects. Our pilot data suggest that the rTOF RV is significantly less efficient than normal.
- Akins, C. W., B. Travis, and A. P. Yoganathan. Energy loss for evaluating heart valve performance. J. Thorac. Cardiovasc. Surg. 136:820–833, 2008. CrossRef
- Anderson, R. H., and P. M. Weinberg. The clinical anatomy of tetralogy of fallot. Cardiol. Young 15(Suppl 1):38–47, 2005. CrossRef
- Banerjee, R. K., L. H. Back, M. R. Back, and Y. I. Cho. Physiological flow simulation in residual human stenoses after coronary angioplasty. J. Biomech. Eng. 122:310–320, 2000. CrossRef
- Bazilevs, Y., M.-C. Hsu, D. J. Benson, S. Sankaran, and A. L. Marsden. Computational fluid-structure interaction: methods and application to a total cavopulmonary connection. Comput. Mech. 45:77–89, 2009. CrossRef
- Bove, E. L., M. R. de Leval, F. Migliavacca, R. Balossino, and G. Dubini. Toward optimal hemodynamics: computer modeling of the Fontan circuit. Pediatr. Cardiol. 28:477–481, 2007. CrossRef
- Burkhoff, D., I. Mirsky, and H. Suga. Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers. Am. J. Physiol. Heart Circ. Physiol. 289:H501–H512, 2005. CrossRef
- Chatzimavroudis, G. P., J. N. Oshinski, R. H. Franch, P. G. Walker, A. P. Yoganathan, and R. I. Pettigrew. Evaluation of the precision of magnetic resonance phase velocity mapping for blood flow measurements. J. Cardiovasc. Magn. Reson. 3:11–19, 2001. CrossRef
- Chern, M. J., M. T. Wu, and H. L. Wang. Numerical investigation of regurgitation phenomena in pulmonary arteries of Tetralogy of Fallot patients after repair. J. Biomech. 41:3002–3009, 2008. CrossRef
- d’Udekem, Y., C. Ovaert, F. Grandjean, V. Gerin, M. Cailteux, P. Shango-Lody, A. Vliers, T. Sluysmans, A. Robert, and J. Rubay. Tetralogy of Fallot: transannular and right ventricular patching equally affect late functional status. Circulation 102:III116–III122, 2000.
- Dasi, L. P., R. Krishnankuttyrema, H. D. Kitajima, K. Pekkan, K. S. Sundareswaran, M. Fogel, S. Sharma, K. Whitehead, K. Kanter, and A. P. Yoganathan. Fontan hemodynamics: importance of pulmonary artery diameter. J. Thorac. Cardiovasc. Surg. 137:560–564, 2009. CrossRef
- Dasi, L. P., K. Pekkan, D. de Zelicourt, K. S. Sundareswaran, R. Krishnankutty, P. J. Delnido, and A. P. Yoganathan. Hemodynamic energy dissipation in the cardiovascular system: generalized theoretical analysis on disease states. Ann. Biomed. Eng. 37:661–673, 2009. CrossRef
- Dasi, L. P., K. Pekkan, H. D. Katajima, and A. P. Yoganathan. Functional analysis of Fontan energy dissipation. J. Biomech. 41:2246–2252, 2008. CrossRef
- Figueroa, C. A., I. E. Vignon-Clementel, K. C. Jansen, T. J. R. Hughes, and C. A. Taylor. A coupled momentum method for modeling blow flow in three-dimensional deformable arteries. Comput. Methods Appl. Mech. Eng. 195:5685–5706, 2006. CrossRef
- Fogel, M. A., M. T. Donofrio, C. Ramaciotti, A. M. Hubbard, and P. M. Weinberg. Magnetic resonance and echocardiographic imaging of pulmonary artery size throughout stages of Fontan reconstruction. Circulation 90:2927–2936, 1994.
- Fogel, M. A., and J. Rychik. Right ventricular function in congenital heart disease: pressure and volume overload lesions. Prog. Cardiovasc. Dis. 40:343–356, 1998. CrossRef
- Funamoto, K., Y. Suzuki, T. Hayase, T. Kosugi, and H. Isoda. Numerical validation of MR-measurement-integrated simulation of blood flow in a cerebral aneurysm. Ann. Biomed. Eng. 37:1105–1116, 2009. CrossRef
- Grigioni, M., G. D’Avenio, A. Amodeo, and R. M. Di Donato. Power dissipation associated with surgical operations’ hemodynamics: critical issues and application to the total cavopulmonary connection. J. Biomech. 39:1583–1594, 2006. CrossRef
- Harrild, D. M., C. I. Berul, F. Cecchin, T. Geva, K. Gauvreau, F. Pigula, and E. P. Walsh. Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia. Circulation 119:445–451, 2009. CrossRef
- Hazekamp, M. G., M. M. Kurvers, P. H. Schoof, H. W. Vliegen, B. M. Mulder, A. A. Roest, J. Ottenkamp, and R. A. Dion. Pulmonary valve insertion late after repair of Fallot’s tetralogy. Eur. J. Cardiothorac. Surg. 19:667–670, 2001. CrossRef
- Johansson, B., S. V. Babu-Narayan, and P. J. Kilner. The effects of breath-holding on pulmonary regurgitation measured by cardiovascular magnetic resonance velocity mapping. J. Cardiovasc. Magn. Reson. 11:1, 2009. CrossRef
- Knauth, A. L., K. Gauvreau, A. J. Powell, M. J. Landzberg, E. P. Walsh, J. E. Lock, P. J. del Nido, and T. Geva. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 94:211–216, 2008. CrossRef
- Laffon, E., V. Bernard, M. Montaudon, R. Marthan, J. L. Barat, and F. Laurent. Tuning of pulmonary arterial circulation evidenced by MR phase mapping in healthy volunteers. J. Appl. Physiol. 90:469–474, 2001.
- Liu, Y., K. Pekkan, S. C. Jones, and A. P. Yoganathan. The effects of different mesh generation methods on computational fluid dynamic analysis and power loss assessment in total cavopulmonary connection. J. Biomech. Eng. 126:594–603, 2004. CrossRef
- Marsden, A. L., V. M. Reddy, S. C. Shadden, F. P. Chan, C. A. Taylor, and J. A. Feinstein. A new multiparameter approach to computational simulation for Fontan assessment and redesign. Congenit. Heart Dis. 5:104–117, 2010. CrossRef
- Morbiducci, U., R. Ponzini, G. Rizzo, M. Cadioli, A. Esposito, F. De Cobelli, A. Del Maschio, F. M. Montevecchi, and A. Redaelli. In vivo quantification of helical blood flow in human aorta by time-resolved three-dimensional cine phase contrast magnetic resonance imaging. Ann. Biomed. Eng. 37:516–531, 2009. CrossRef
- Oechslin, E. N., D. A. Harrison, L. Harris, E. Downar, G. D. Webb, S. S. Siu, and W. G. Williams. Reoperation in adults with repair of tetralogy of fallot: indications and outcomes. J. Thorac. Cardiovasc. Surg. 118:245–251, 1999. CrossRef
- Owen, A. R., and M. A. Gatzoulis. Tetralogy of fallot: late outcome after repair and surgical implications. Semin. Thorac. Cardiovasc. Surg. Pediatr. Card. Surg. Annu. 3:216–226, 2000.
- Pohost, G. M., L. Hung, and M. Doyle. Clinical use of cardiovascular magnetic resonance. Circulation 108:647–653, 2003. CrossRef
- Redington, A. N., H. H. Gray, M. E. Hodson, M. L. Rigby, and P. J. Oldershaw. Characterisation of the normal right ventricular pressure-volume relation by biplane angiography and simultaneous micromanometer pressure measurements. Br. Heart J. 59:23–30, 1988. CrossRef
- Redington, A. N., M. L. Rigby, E. A. Shinebourne, and P. J. Oldershaw. Changes in the pressure-volume relation of the right ventricle when its loading conditions are modified. Br. Heart J. 63:45–49, 1990. CrossRef
- Rosenthal, A. Adults with tetralogy of fallot—repaired, yes; cured, no. N. Engl. J. Med. 329:655–656, 1993. CrossRef
- Schipke, J. D., J. Alexander, Jr., Y. Harasawa, R. Schulz, and D. Burkhoff. Interrelation between end-systolic pressure-volume and pressure-wall thickness relations. Am. J. Physiol. 255:H679–H684, 1988.
- Sievers, B., B. Brandts, J. C. Moon, D. J. Pennell, and H. J. Trappe. Cardiovascular magnetic resonance of asymptomatic myocardial infarction. Int. J. Cardiol. 93:79–80, 2004. CrossRef
- Soerensen, D. D., K. Pekkan, K. S. Sundareswaran, and A. P. Yoganathan. New power loss optimized Fontan connection evaluated by calculation of power loss using high resolution PC-MRI and CFD. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2:1144–1147, 2004.
- Spilker, R. L., J. A. Feinstein, D. W. Parker, V. M. Reddy, and C. A. Taylor. Morphometry-based impedance boundary conditions for patient-specific modeling of blood flow in pulmonary arteries. Ann. Biomed. Eng. 35:546–559, 2007. CrossRef
- Sundareswaran, K. S., K. R. Kanter, H. D. Kitajima, R. Krishnankutty, J. F. Sabatier, W. J. Parks, S. Sharma, A. P. Yoganathan, and M. Fogel. Impaired power output and cardiac index with hypoplastic left heart syndrome: a magnetic resonance imaging study. Ann. Thorac. Surg. 82:1267–1275, 2006; (discussion 1275–1267). CrossRef
- Therrien, J., S. C. Siu, P. R. McLaughlin, P. P. Liu, W. G. Williams, and G. D. Webb. Pulmonary valve replacement in adults late after repair of tetralogy of fallot: are we operating too late? J. Am. Coll. Cardiol. 36:1670–1675, 2000. CrossRef
- Whitehead, K. K., K. Pekkan, H. D. Kitajima, S. M. Paridon, A. P. Yoganathan, and M. A. Fogel. Nonlinear power loss during exercise in single-ventricle patients after the Fontan: insights from computational fluid dynamics. Circulation 116:I165–I171, 2007. CrossRef
- Wong, K. K., R. M. Kelso, S. G. Worthley, P. Sanders, J. Mazumdar, and D. Abbott. Cardiac flow analysis applied to phase contrast magnetic resonance imaging of the heart. Ann. Biomed. Eng. 37:1495–1515, 2009. CrossRef
- Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data
Annals of Biomedical Engineering
Volume 38, Issue 12 , pp 3674-3687
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Right ventricular stroke work
- Tetralogy of Fallot
- Pulmonary insufficiency
- Phase contrast MRI
- Industry Sectors
- Author Affiliations
- 1. Department of Mechanical Engineering, University of Cincinnati, Cincinnati, OH, USA
- 2. Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- 3. The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC #2003, Cincinnati, OH, 45229, USA