Right ventricular dysfunction developing late after congenital cardiac surgery is one of the most common causes of heart failure in adults with congenital heart disease. In tetra logy of Fallot (ToF), the most common cyanotic heart defect, initial repair in infancy involves an incision and patch in the RV outflow, including the pulmonary valve, which often results in late development of severe RV dilatation and dysfunction due to chronic pulmonary regurgitation and RV scarring/patch dilatation. Current surgical management of late RV dysfunction, consisting of pulmonary valve insertion and reduction of the RV outflow patch, reduces RV volume but does not result in a predictable improvement in RV function. A more radical procedure, which includes extensive removal of scar and outflow patch, is being evaluated in an NHLBI sponsored randomized prospective trial. However, there is no currently available method for predicting outcome after either procedure or what the optimal procedure is for a given pt., i.e. no clinically useful tools for determining patient-specific therapy. In this project, we propose to develop a computational modeling approach to determine the efficacy and suitability of the various reconstructive options to treat failing RV in ToF pts. We will use non-invasive cardiac magnetic resonance imaging (CMR) to provide patient-specific RV/LV morphology, deformation, and flow data for the construction and validation of computational models. 3D CMR-based RV/LV combination models will be constructed, which include fluid-structure interactions (RV/LV and RV patch), two-layer RV/LV structure, anisotropic material properties, fiber orientation, and active contraction to simulate blood flow, heart motion, and stress/strain distribution to evaluate the effect of different remodeling procedures on RV function, and to seek an optimal RV volume and patch design to improve post-operative RV function. Clinical imaging and hemodynamic data from an ongoing NHLBI-funded clinical trial will be used to build and validate the model. Our ultimate goal is to apply this methodology in patient- specific computer-aided cardiac surgery planning to reach optimal surgical procedure design and outcome in patients with RV dysfunction from congenital heart defects. A multidisciplinary group of experienced investigators in congenital cardiac surgery, cardiology and computational mathematics will conduct this project.

Public Health Relevance

This project aims to use MRI images obtained from patients with repair tetralogy of Fallot that are being evaluated for surgery to develop computational models of right ventricular function. The ultimate goal is to develop models that will predict outcomes and optimize right ventricular function after surgery. The MRI's to be used for this study are clinically indicated studies as part of the care of these patients and are currently obtained under an approved protocol where Dr. Tal Geva is the principal investigator.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL089269-04
Application #
8277919
Study Section
Bioengineering, Technology and Surgical Sciences Study Section (BTSS)
Program Officer
Evans, Frank
Project Start
2009-06-01
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
4
Fiscal Year
2012
Total Cost
$409,068
Indirect Cost
$109,890
Name
Children's Hospital Boston
Department
Type
DUNS #
076593722
City
Boston
State
MA
Country
United States
Zip Code
02115
Valente, Anne Marie; Gauvreau, Kimberlee; Assenza, Gabriele Egidy et al. (2014) Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart 100:247-53
Geva, Tal (2014) Is MRI the preferred method for evaluating right ventricular size and function in patients with congenital heart disease?: MRI is the preferred method for evaluating right ventricular size and function in patients with congenital heart disease. Circ Cardiovasc Imaging 7:190-7
Tang, Dalin; Yang, Chun; Geva, Tal et al. (2014) Right ventricular local longitudinal curvature as a marker and predictor for pulmonary valve replacement surgery outcome: an initial study based on preoperative and postoperative cardiac magnetic resonance data from patients with repaired tetralogy of Fal J Thorac Cardiovasc Surg 147:537-8
Geva, Tal (2013) Indications for pulmonary valve replacement in repaired tetralogy of fallot: the quest continues. Circulation 128:1855-7
Yang, Chun; Tang, Dalin; Geva, Tal et al. (2013) Using contracting band to improve right ventricle ejection fraction for patients with repaired tetralogy of Fallot: a modeling study using patient-specific CMR-based 2-layer anisotropic models of human right and left ventricles. J Thorac Cardiovasc Surg 145:285-93, 293.e1-2
Yamauchi, Haruo; Feins, Eric N; Vasilyev, Nikolay V et al. (2013) Creation of nonischemic functional mitral regurgitation by annular dilatation and nonplanar modification in a chronic in vivo swine model. Circulation 128:S263-70
Tang, Dalin; Yang, Chun; Geva, Tal et al. (2013) A Multiphysics Modeling Approach to Develop Right Ventricle Pulmonary Valve Replacement Surgical Procedures with a Contracting Band to Improve Ventricle Ejection Fraction. Comput Struct 122:78-87
Yamauchi, Haruo; Vasilyev, Nikolay V; Marx, Gerald R et al. (2012) Right ventricular papillary muscle approximation as a novel technique of valve repair for functional tricuspid regurgitation in an ex vivo porcine model. J Thorac Cardiovasc Surg 144:235-42
Tang, Dalin; Yang, Chun; Geva, Tal et al. (2011) Multi-Physics MRI-Based Two-Layer Fluid-Structure Interaction Anisotropic Models of Human Right and Left Ventricles with Different Patch Materials: Cardiac Function Assessment and Mechanical Stress Analysis. Comput Struct 89:1059-1068
Geva, Tal (2011) Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 13:9

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