Document Detail


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.
MedLine Citation:
PMID:  22487437     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Patients with repaired tetralogy of Fallot account for most cases of late-onset right ventricle failure. The current surgical approach, which includes pulmonary valve replacement/insertion, has yielded mixed results. A new surgical option of placing an elastic band in the right ventricle is proposed to improve right ventricular cardiac function as measured by the ejection fraction.
METHODS: A total of 20 computational right ventricular/left ventricular/patch/band combination models using cardiac magnetic resonance imaging from a patient with tetralogy of Fallot were constructed to investigate the effect of band material stiffness variations, band length, and active contraction. These models included 4 different band material properties, 3 band length, 3 active contracting band materials, and models with patch and scar replaced by contracting tissue.
RESULTS: Our results indicated that the band insertion, combined with active band contraction and tissue regeneration techniques that restore right ventricular myocardium, has the potential to improve right ventricular ejection fraction by 7.5% (41.63% ejection fraction from the best active band model to more than 34.10% ejection fraction from baseline passive band model) and 4.2% (41.63% from the best active band model compared with cardiac magnetic resonance imaging-measured ejection fraction of 37.45%).
CONCLUSIONS: The cardiac magnetic resonance imaging-based right ventricular/left ventricular/patch/band model provides a proof of concept for using elastic bands to improve right ventricular cardiac function. Band insertion, combined with myocardium regeneration techniques and right ventricular remodeling surgical procedures, has the potential to improve ventricular function in patients with repaired tetralogy of Fallot and other similar forms of right ventricular dysfunction after surgery. Additional investigations using in vitro experiments, animal models, and, finally, patient studies are warranted.
Authors:
Chun Yang; Dalin Tang; Tal Geva; Rahul Rathod; Haruo Yamauchi; Vasu Gooty; Alexander Tang; Glenn Gaudette; Kristen L Billiar; Mehmet H Kural; Pedro J del Nido
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-04-07
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  145     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-18     Completed Date:  2013-03-12     Revised Date:  2014-09-19    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-93, 293.e1-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Anisotropy
Biomechanical Phenomena
Cardiac Surgical Procedures* / instrumentation
Computer Simulation*
Computer-Aided Design
Constriction
Elasticity
Equipment Design
Humans
Magnetic Resonance Imaging*
Models, Cardiovascular*
Recovery of Function
Stress, Mechanical
Stroke Volume*
Tetralogy of Fallot / complications,  pathology,  physiopathology,  surgery*
Treatment Outcome
Ventricular Dysfunction, Right / etiology,  pathology,  physiopathology,  surgery*
Ventricular Function, Right*
Grant Support
ID/Acronym/Agency:
1R01-HL089269/HL/NHLBI NIH HHS; 5P50HL074734/HL/NHLBI NIH HHS; HL63095/HL/NHLBI NIH HHS; R01 HL063095/HL/NHLBI NIH HHS; R01 HL063095-07/HL/NHLBI NIH HHS; R01 HL063095-08/HL/NHLBI NIH HHS; R01 HL063095-09/HL/NHLBI NIH HHS; R01 HL089269/HL/NHLBI NIH HHS; R01 HL089269-01A2/HL/NHLBI NIH HHS; R01 HL089269-02/HL/NHLBI NIH HHS; R01 HL089269-03/HL/NHLBI NIH HHS
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