Abstract
Remodeling in adults with repaired tetralogy of Fallot (rToF) may occur due to chronic pulmonary regurgitation, but may also be related to altered flow patterns, including vortices. We aimed to correlate and quantify relationships between vorticity and ventricular shape derived from atlas-based analysis of biventricular shape. Adult rToF (n = 12) patients underwent 4D flow and cine MRI imaging. Vorticity in the RV was computed after noise reduction using a neural network. A biventricular shape atlas built from 95 rToF patients was used to derive principal component modes, which were associated with vorticity and pulmonary regurgitant volume (PRV) using univariate and multivariate linear regression. Univariate analysis showed that indexed PRV correlated with 3 modes (r = −0.55,−0.50, and 0.6, all p < 0.05) associated with RV dilatation and an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV and paradoxical movement of the septum. RV outflow and inflow vorticity were also correlated with these modes. However, total vorticity over the whole RV was correlated with two different modes (r = −0.62,−0.69, both p < 0.05). Higher vorticity was associated with both RV and LV shape changes including longer ventricular length, a larger bulge beside the tricuspid valve, and distinct tricuspid tilting. RV flow vorticity was associated with changes in biventricular geometry, distinct from associations with PRV. Flow vorticity may provide additional mechanistic information in rToF remodeling. Both LV and RV shapes are important in rToF RV flow patterns.
Highlights
Many patients with repaired Tetralogy of Fallot survive to adulthood due to successful primary repair [1]
We aimed to examine relationships between biventricular geometry and flow vortices in the right ventricle (RV) and the right ventricular outflow tract using a processing pipeline including enhancement of velocity vectors using a deep neural network, quantification of vorticity using numerical differentiation, and correlation with morphological scores calculated by projection onto an atlas of repaired Tetralogy of Fallot (rToF) patients
12 rToF Patients and 10 Volunteers Were Included in the Study
Summary
Many patients with repaired Tetralogy of Fallot (rToF) survive to adulthood due to successful primary repair [1]. Chronic pulmonary regurgitation is often a consequence, leading to shape, hemodynamic and electrophysiological changes in the right ventricle (RV) [2, 3]. Previous studies analyzed the regional three-dimensional (3D) alterations of the RV anatomy in rToF [2,3,4]. RV shape changes have been associated with common clinical metrics such as pulmonary regurgitant volume (PRV), indicating links between PRV and RV dilatation, with. RV Vorticity and Shape in rTOF outflow tract bulging and apical dilation [3, 5]. Remodeling patterns have been shown to be different in rToF patients compared with pulmonary hypertension patients [6] and quantification of these patterns has been facilitated by shape modeling [7]
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