Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot Dalin Tang,

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Presentation transcript:

Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot Dalin Tang, PhD, FAHA, Chun Yang, MS, Pedro J. del Nido, MD, Heng Zuo, MS, Rahul H. Rathod, MD, Xueying Huang, PhD, Vasu Gooty, MD, Alexander Tang, BA, Kristen L. Billiar, PhD, FASME, Zheyang Wu, PhD, Tal Geva, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 3, Pages 687-694.e3 (March 2016) DOI: 10.1016/j.jtcvs.2015.09.106 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 CMR-based model construction process. A, CMR image of a patient, end of systole. B, Segmented contours. C, Reconstructed 3-dimensional geometry. D and E, Fiber orientation. F, 2-layer construction. RV, Right ventricle; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 687-694.e3DOI: (10.1016/j.jtcvs.2015.09.106) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Biaxial mechanical testing and initial results. A, Biaxial testing apparatus. B, Human RV tissue sample. C, Tissue sample mounted for biaxial test. D, Anisotropic data from the human RV sample. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 687-694.e3DOI: (10.1016/j.jtcvs.2015.09.106) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Material stress-stretch curves, pressure conditions used in the article, and computational RV volume curve matching CMR-measured data. A, Stress-stretch curves from Mooney–Rivlin anisotropic RV tissue models used in this article. Model parameter values in Equations (6) and (7) for a patient: beginning filling: C = 72.16 kPa, b1 = 8.7875; b2 = 1.7005; b3 = 0.7743; beginning ejection: C = 9.922 kPa, b1 = 8.7875; b2 = 1.7005; b3 = 0.7743. Tff: stress in the fiber direction; Tcc: stress in fiber circumferential direction. B, Imposed inner RV pressure. C, Model validation: computational RV volume from the fluid-structure interaction model matching CMR-measured RV volume data (error=∑ |CMR(i)−num(i)|∑ |CMR(i)|=0.0167.<2%). BF, Beginning filling; BE, beginning ejection; RV, right ventricular; CMR, cardiac magnetic resonance. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 687-694.e3DOI: (10.1016/j.jtcvs.2015.09.106) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Selected cut surface, maximum principal stress and strain corresponding to end of diastole and end of systole pressure conditions. A, Position of the cut surface. B, Maximum principal stress, end of diastole. C, Maximum principal strain, end of diastole. D, Maximum principal stress, end of systole. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 687-694.e3DOI: (10.1016/j.jtcvs.2015.09.106) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 RVEF change correlated negatively with stress (r = −0.56, P = .025) and pre-PVR RV volume (r = −0.60, P = .015). A, Stress versus EF change. B, Pre-PVR RV volume versus EF change. RVEF, Right ventricular ejection fraction; RV, right ventricular. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 687-694.e3DOI: (10.1016/j.jtcvs.2015.09.106) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

CMR-based model construction process: image, segmentation, 3-dimensional geometry, and fiber orientation. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 687-694.e3DOI: (10.1016/j.jtcvs.2015.09.106) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions