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

Autor: Joseph H. Gorman, Yoav Dori, Anna Ilina, Andrew C. Glatz, Andras Lasso, Robert C. Gorman, Adam B. Scanlan, Gabor Fichtinger, Matthew J. Gillespie, Brian H. Morray, Matthew A. Jolley, Kevin K. Whitehead, Patrick V. Dinh, Alex V. Nguyen, Francis X. McGowan, Hannah H. Nam
Rok vydání: 2018
Předmět:
Patient-Specific Modeling
medicine.medical_specialty
Cardiac Catheterization
Pulmonary insufficiency
030204 cardiovascular system & hematology
Prosthesis Design
Article
03 medical and health sciences
0302 clinical medicine
Internal medicine
Pulmonary Valve Replacement
medicine
Ventricular outflow tract
Animals
Humans
Radiology
Nuclear Medicine and imaging
030212 general & internal medicine
Cardiac Surgical Procedures
Sheep
Domestic
Tetralogy of Fallot
Heart Valve Prosthesis Implantation
Pulmonary Valve
Cardiac cycle
business.industry
Hemodynamics
Models
Cardiovascular
General Medicine
medicine.disease
Pulmonary Valve Insufficiency
Catheter
Treatment Outcome
Heart Valve Prosthesis
Models
Animal
Cardiology
Implant
Cardiology and Cardiovascular Medicine
business
Tomography
X-Ray Computed
Volume (compression)
Zdroj: Catheter Cardiovasc Interv
ISSN: 1522-726X
Popis: Background 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. Methods 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. Results 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 > 0.80), but the simulated distal device volume was significantly underestimated relative to actual device implant volume (P = 0.06). Conclusions 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.
Databáze: OpenAIRE
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