First name
Patrick
Last name
Dinh
Suffix
V

Title

Dynamic Annular Modeling of the Unrepaired Complete Atrioventricular Canal Annulus.

Year of Publication

2020

Number of Pages

Date Published

2020 Dec 23

ISSN Number

1552-6259

Abstract

<p><strong>BACKGROUND: </strong>Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the three-dimensional (3D) structure of the atrioventricular canal annulus prior to repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has yet to be quantified nor has it been rigorously compared to a normal mitral valve annulus.</p>

<p><strong>METHODS: </strong>The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared to the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis).</p>

<p><strong>RESULTS: </strong>The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height to valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases(p&lt;0.001).</p>

<p><strong>CONCLUSIONS: </strong>The left half of the CAVC annulus is more planar than that of a normal mitral valve with an annular height to valve width ratio similar to dysfunctional mitral valves. Given the known importance of annular shape to mitral valve function, further exploration of the association of 3D structure to valve function in CAVC is warranted.</p>

DOI

10.1016/j.athoracsur.2020.12.013

Alternate Title

Ann Thorac Surg

PMID

33359720
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Title

Toward predictive modeling of catheter-based pulmonary valve replacement into native right ventricular outflow tracts.

Year of Publication

2018

Number of Pages

Date Published

2018 Nov 15

ISSN Number

1522-726X

Abstract

<p><strong>BACKGROUND: </strong>Pulmonary insufficiency is a consequence of transannular patch repair in Tetralogy of Fallot (ToF) leading to late morbidity and mortality. Transcatheter native outflow tract pulmonary valve replacement has become a reality. However, predicting a secure, atraumatic implantation of a catheter-based device remains a significant challenge due to the complex and dynamic nature of the right ventricular outflow tract (RVOT). We sought to quantify the differences in compression and volume for actual implants, and those predicted by pre-implant modeling.</p>

<p><strong>METHODS: </strong>We used custom software to interactively place virtual transcatheter pulmonary valves (TPVs) into RVOT models created from pre-implant and post Harmony valve implant CT scans of 5 ovine surgical models of TOF to quantify and visualize device volume and compression.</p>

<p><strong>RESULTS: </strong>Virtual device placement visually mimicked actual device placement and allowed for quantification of device volume and radius. On average, simulated proximal and distal device volumes and compression did not vary statistically throughout the cardiac cycle (P = 0.11) but assessment was limited by small sample size. In comparison to actual implants, there was no significant pairwise difference in the proximal third of the device (P &gt; 0.80), but the simulated distal device volume was significantly underestimated relative to actual device implant volume (P = 0.06).</p>

<p><strong>CONCLUSIONS: </strong>This study demonstrates that pre-implant modeling which assumes a rigid vessel wall may not accurately predict the degree of distal RVOT expansion following actual device placement. We suggest the potential for virtual modeling of TPVR to be a useful adjunct to procedural planning, but further development is needed.</p>

DOI

10.1002/ccd.27962

Alternate Title

Catheter Cardiovasc Interv

PMID

30444053
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