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Preoperative Morphological Prediction of Early Reoperation Risk After Primary Repair in Tetralogy of Fallot: A Contemporary Analysis of 83 Cases

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Abstract

This study was conducted to investigate the pulmonary artery (PA) variations in tetralogy of Fallot (TOF) and preoperative morphological predictors for early reoperation. Eighty-three TOF patients and 20 children with normal PA were included. The TOF group was divided into two subsets according to whether or not reoperation was performed within 3 years postoperatively. Clinical information was obtained, along with computed tomography (CT)-based three-dimensional geometry of the PA. Morphological measurements of the length of the main PA branches, the angles between them, and the cross-sectional area of each segment of the PAs were acquired using computer software. Logistic regression and receiver operating characteristic curves were applied to analysis. The TOF group showed a significantly smaller PA size and irregular PA shape, with lower Nakata and McGoon indices, than the control group. The median bifurcation angle (angle-γ) was greater than 100° in the TOF group, as compared to 66.70° in the control group (P < 0.000). Residual obstruction of the infundibulum or PAs was the main reason for early reoperation in this series. The development of the main PA and left PA was poorer in the reoperation subset than in the non-reoperation subset (P ≤ 0.01). The preoperative angle-γ in the reoperation subset was larger than that in the non-reoperation subset (median, 117.8° vs. 112.0°, P = 0.026). Higher weight (OR = 0.372) and McGoon index (OR = 0.122) were protective factors, while larger angle-γ (> 114.8°, OR = 5.040) and angle-γ normalized by body surface area (BSA) (γ/BSA > 297.9, OR = 18.860) were risk factors. This study provides an intuitive perspective of PA anatomical variations in TOF. Larger preoperative PA bifurcation angle and γ/BSA were morphological risk predictors of postoperative reoperation in patients with TOF.

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Data Availability

The data transparency was available.

Code Availability

Not applicable.

Abbreviations

TOF:

Tetralogy of Fallot

RVOT:

Right ventricular outflow tract

PA:

Pulmonary artery

MPA:

Main PA

LPA:

Left PA

RPA:

Right PA

PVR:

Pulmonary valve region

VSD:

Ventricular septal defect

PR:

Primary repair

Re-opx.:

Reoperation subset

Un-reo.:

Non-reoperation subset

CTFU:

CT scan at follow-up

weight_pre:

Preoperative body weight

BSA:

Body surface area

Nakata:

PA index

α :

The intersection angle between MPA and LPA (angle-LPA)

β :

The intersection angle between MPA and RPA (angle-RPA)

γ :

Bifurcation angle

γ/BSA:

Bifurcation angle normalized by BSA

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Acknowledgements

We express our great gratitude for the financial support of the National Key R&D Program of China (Grant No. 2017YFC1308103) and Shanghai Municipal Science and Technology Commission (Grant No. 19411963700), and the genuine software support and technical guidance of the Biomechanics Research Office of the Institute of Congenital Heart Disease of Shanghai Children’s Medical Center.

Funding

This study was supported by the National Key R&D Program of China (Grant No. 2017YFC1308103) and Shanghai Municipal Science and Technology Commission (Grant No. 19411963700).

Author information

Author notes

  1. Qiancheng Luo and Xiaomin He contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai, 200127, China

    Qiancheng Luo, Xiaomin He, Zhiying Song, Xiaoyang Zhang, Zhirong Tong, Juanya Shen, Jinlong Liu & Jinghao Zheng

  2. Pediatric Translational Medicine Institute, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai, 200127, China

    Zhirong Tong, Juanya Shen & Jinlong Liu

  3. Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai, 200127, China

    Zhirong Tong, Juanya Shen & Jinlong Liu

  4. Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai, 200127, China

    Liwei Hu & Yumin Zhong

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  1. Qiancheng Luo
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Contributions

QL and XH performed the experiments, analyzed the data, and drafted the manuscript. ZS and XZ collected clinical data and followed up with the patients. YZ and LH were responsible for imaging diagnosis and preparation of imaging data. ZT and JS provided guidance and support for software use. JL and YZ revised the manuscript. JL and JZ designed and supervised the research. All authors read, approved, and contributed to the final manuscript.

Corresponding authors

Correspondence to Yumin Zhong, Jinlong Liu or Jinghao Zheng.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The retrospective study protocol was reviewed and approved by the Ethics Committee of Shanghai Children’s Medical Center, and ethical approval was obtained for the usage of image data for research, and all datasets were anonymized.

Informed Consent

Not applicable. This was a review of the clinical data of 103 patients with congenital heart diseases (CHD) between January 2015 and December 2019 at Shanghai Children’s Medical Center. Data on sex, age, weight, CHD, treatments, and follow-up outcomes were collected from our database.

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Luo, Q., He, X., Song, Z. et al. Preoperative Morphological Prediction of Early Reoperation Risk After Primary Repair in Tetralogy of Fallot: A Contemporary Analysis of 83 Cases. Pediatr Cardiol 42, 1512–1525 (2021). https://doi.org/10.1007/s00246-021-02635-9

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  • DOI: https://doi.org/10.1007/s00246-021-02635-9

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