Using contracting band to improve right ventricle ejection fraction for patients with repaired tetralogy of Fallot: A modeling study using patient-specific.

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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 Chun Yang, MS, Dalin Tang, PhD, FAHA, Tal Geva, MD, Rahul Rathod, MD, Haruo Yamauchi, MD, PhD, Vasu Gooty, MD, Alexander Tang, Glenn Gaudette, PhD, Kristen L. Billiar, PhD, Mehmet H. Kural, MS, Pedro J. del Nido, MD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 1, Pages 285-293.e2 (January 2013) DOI: 10.1016/j.jtcvs.2012.03.009 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Hypothesis that smaller patch and removal of RV scar might lead to improved surgical outcome after surgery. A, Repaired tetralogy of Fallot (ToF) heart with right ventricular (RV) outflow patch and scar on anterior RV wall. B, Right ventricular after pulmonary valve insertion (PVR) and reduction of RV outflow patch (current practice). C, Right ventricle after pulmonary valve insertion (PVR), reduction of RV outflow patch, and removal of RV scar (RV remodeling, proposed new surgical procedure). The Journal of Thoracic and Cardiovascular Surgery 2013 145, 285-293.e2DOI: (10.1016/j.jtcvs.2012.03.009) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A-C, Cardiac magnetic resonance (CMR) images of patient, segmented contours, and reconstructed 3-dimensional (3D) geometry with and without a band. RV-LV, Right ventricle-left ventricle; RVOT, right ventricular outflow track. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 285-293.e2DOI: (10.1016/j.jtcvs.2012.03.009) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Fiber orientation and 2-layer model construction. Fiber orientations from pig model on (A) epicardium and (B) endocardial surface. Left ventricular (LV) fiber orientation was approximately −60° (relative to circumferential direction) at the epicardium and +80° at the endocardium. C, Human ventricular fiber orientation from a patient: C, font view; D, back view. E and F, Fiber orientation from our proposed right ventricular (RV)/left ventricular (LV) model based on patient-specific RV/LV morphologies. RV fiber orientation was set at −45° at the epicardium and +40° at the endocardium. Angles can be adjusted to fit patient-specific data. G, Two-layer model construction illustration using 2 slices. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 285-293.e2DOI: (10.1016/j.jtcvs.2012.03.009) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Material stress-stretch curves, pressure conditions used in report and computational right ventricular (RV) volume curve matching cardiac magnetic resonance (CMR)–measured data. A, Stress-stretch curves from Mooney-Rivlin isotropic patch, scar, and anisotropic RV tissue models. Model parameter values (c2 = 0 for all models). Anisotropic RV model (out-layer given in plot): c1 = 5.746 kPa, c2 = 0, D1 = 1.479 kPa, D2 = 3.0, K1 = 23.413 kPa, K2 = 3.2; scar, c1 = 19.227 kPa, c2 = 0, D1 = 19.227 kPa, D2 = 9.0; patch, c1 = 38.454 KPa, c2 = 0, D1 = 38.454 kPa, D2 = 9.0. Tff, stress in the fiber direction; Tcc, stress in fiber circumferential direction. B, Stress-stretch curves from Mooney-Rivlin isotropic models for passive band materials. 1 stiff, c1 = 12,000 kPa, D1 = 6000 kPa, D2 = 1.4; 0.5 stiff: c1 = 6000 kPa, D1 = 3000 kPa, D2 = 1.4; 0.25 stiff, c1 = 3000 kPa, D1 = 1500 kPa, D2 = 1.4; 0.05 stiff, c1 = 600 kPa, D1 = 300 kPa, D2 = 1.4; curve fitting mechanical engineering testing data, c1 = 1510 kPa, D1 = −221.9 kPa, D2 = 2.0; 900 kPa band, c1 = 900 kPa, D1 = 0 kPa, D2 = 0. C, Imposed inner RV pressure. D, Model validation, computational RV volume from baseline no-band model matching CMR-measured RV volume data. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 285-293.e2DOI: (10.1016/j.jtcvs.2012.03.009) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Stress and strain plots from 3 models corresponding to maximum pressure condition showing complex stress/strain behaviors. A, Model with patch and scan, no band. B, Model with patch and scan, with band. C, Model with viable tissue for patch and scan, with band. D, Stress-P1, Pmax, model with patch and scan, no band. E, Stress-P1, Pmax, model with patch, scar, and band. F, Stress-P1, Pmax, model with viable tissue for patch and scan, with band. G, Strain-P1, Pmax, model with patch and scan, no band. H, Strain-P1, Pmax, model with patch, scar, and band. I, Strain-P1, Pmax, model with viable tissue for patch and scan, with band. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 285-293.e2DOI: (10.1016/j.jtcvs.2012.03.009) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions