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

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 activ...

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Bibliographic Details
Published in:Annals of biomedical engineering 2021-12, Vol.49 (12), p.3339-3348
Main Authors: Gusseva, Maria, Hussain, Tarique, Hancock Friesen, Camille, Greil, Gerald, Chapelle, Dominique, Chabiniok, Radomír
Format: Article
Language:English
Subjects:
Biochemistry
Bioengineering
Biological and Medical Physics
Biomechanics
Biomedical and Life Sciences
Biomedical Engineering and Bioengineering
Biomedicine
Biophysics
Cardiology and cardiovascular system
Cardiovascular disease
Classical Mechanics
Congenital diseases
Heart
Heart function
Human health and pathology
Indicators
Life Sciences
Mechanical analysis
Modelling
Muscle contraction
Myocardium
Original Article
Patients
Regurgitation
Tetralogy of Fallot
Ventricle
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Summary: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 PSM pre , and patient-specific models of the same patients created post-PVR (PSM post )—both created in our previous published work. Using the PSM pre 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 PSM post , 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 PSM post 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.
ISSN:0090-6964
1573-9686
DOI:10.1007/s10439-021-02895-9