A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective
Objective: Hypoplastic left heart syndrome (HLHS) is a congenital disease characterized by an underdevelopment of the anatomical components inside the left heart. Approximately 30% of newborns with HLHS will develop tricuspid regurgitation, and it is currently unknown how the valve annulus mechanics...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622000699 |
| _version_ | 1811333614847131648 |
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| author | Colton J. Ross, MS Elizabeth J. Trimble, MD Emily L. Johnson, PhD Ryan Baumwart, DVM Matthew A. Jolley, MD Arshid Mir, MD Harold M. Burkhart, MD Chung-Hao Lee, PhD |
| author_facet | Colton J. Ross, MS Elizabeth J. Trimble, MD Emily L. Johnson, PhD Ryan Baumwart, DVM Matthew A. Jolley, MD Arshid Mir, MD Harold M. Burkhart, MD Chung-Hao Lee, PhD |
| author_sort | Colton J. Ross, MS |
| collection | DOAJ |
| description | Objective: Hypoplastic left heart syndrome (HLHS) is a congenital disease characterized by an underdevelopment of the anatomical components inside the left heart. Approximately 30% of newborns with HLHS will develop tricuspid regurgitation, and it is currently unknown how the valve annulus mechanics and geometry are associated with regurgitation. Thus, we present an engineering mechanics-based analysis approach to quantify the mechanics and geometry of the HLHS-afflicted tricuspid valve (TV), using 4-dimensional echocardiograms. Methods: Infants born with HLHS (n = 8) and healthy newborns (n = 4) had their TVs imaged, and the data were imported to 3D Slicer. The annular curves were defined at 5 points in the cardiac cycle. The geometry and deformation (strain) of the TV annulus were calculated to elucidate the mechanics of this critical structure and to compare them between neonates with and without HLHS. Results: For the annular geometry, HLHS-afflicted newborns had significantly larger annular circumferences (20%-30%) and anteroposterior diameters (35%-45%) than the healthy patients. From a biomechanics' perspective, the HLHS patients had significantly smaller strains in the anterior segments (–0.1 ± 2.6%) during end-diastolic and end-isovolumetric relaxation (1.7 ± 3.0%) compared with the healthy counterparts (–13.3 ± 2.9% and 6.8 ± 0.9%, respectively). Conclusions: The image-based analysis presented in this study may provide novel insights into the geometric and mechanistic differences in the TV annulus between the healthy and HLHS newborns. Future longitudinal studies of the biomechanics of TV annulus and other subvalvular structures may inform our understanding of the initiation and development of tricuspid regurgitation and the design of optimal repairs in this challenging population. |
| first_indexed | 2024-04-13T16:55:32Z |
| format | Article |
| id | doaj.art-0dc16fea9f69403dbf592eb11c3853e4 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-13T16:55:32Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-0dc16fea9f69403dbf592eb11c3853e42022-12-22T02:38:49ZengElsevierJTCVS Open2666-27362022-06-0110324339A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspectiveColton J. Ross, MS0Elizabeth J. Trimble, MD1Emily L. Johnson, PhD2Ryan Baumwart, DVM3Matthew A. Jolley, MD4Arshid Mir, MD5Harold M. Burkhart, MD6Chung-Hao Lee, PhD7School of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OklaDepartment of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OklaDepartment of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OklaDepartment of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IndVeterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WashDepartments of Anesthesiology and Critical Care and Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PaDepartment of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSchool of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, Okla; Institute for Biomedical Engineering, Science and Technology, University of Oklahoma, Norman, Okla; Address for reprints: Chung-Hao Lee, PhD, School of Aerospace and Mechanical Engineering, University of Oklahoma, 865 Asp Ave, Felgar Hall 219C, Norman, OK 73019.Objective: Hypoplastic left heart syndrome (HLHS) is a congenital disease characterized by an underdevelopment of the anatomical components inside the left heart. Approximately 30% of newborns with HLHS will develop tricuspid regurgitation, and it is currently unknown how the valve annulus mechanics and geometry are associated with regurgitation. Thus, we present an engineering mechanics-based analysis approach to quantify the mechanics and geometry of the HLHS-afflicted tricuspid valve (TV), using 4-dimensional echocardiograms. Methods: Infants born with HLHS (n = 8) and healthy newborns (n = 4) had their TVs imaged, and the data were imported to 3D Slicer. The annular curves were defined at 5 points in the cardiac cycle. The geometry and deformation (strain) of the TV annulus were calculated to elucidate the mechanics of this critical structure and to compare them between neonates with and without HLHS. Results: For the annular geometry, HLHS-afflicted newborns had significantly larger annular circumferences (20%-30%) and anteroposterior diameters (35%-45%) than the healthy patients. From a biomechanics' perspective, the HLHS patients had significantly smaller strains in the anterior segments (–0.1 ± 2.6%) during end-diastolic and end-isovolumetric relaxation (1.7 ± 3.0%) compared with the healthy counterparts (–13.3 ± 2.9% and 6.8 ± 0.9%, respectively). Conclusions: The image-based analysis presented in this study may provide novel insights into the geometric and mechanistic differences in the TV annulus between the healthy and HLHS newborns. Future longitudinal studies of the biomechanics of TV annulus and other subvalvular structures may inform our understanding of the initiation and development of tricuspid regurgitation and the design of optimal repairs in this challenging population.http://www.sciencedirect.com/science/article/pii/S2666273622000699mechanical strainsimage segmentationtricuspid valve geometrycongenital heart defecttransthoracic echocardiographic imaging |
| spellingShingle | Colton J. Ross, MS Elizabeth J. Trimble, MD Emily L. Johnson, PhD Ryan Baumwart, DVM Matthew A. Jolley, MD Arshid Mir, MD Harold M. Burkhart, MD Chung-Hao Lee, PhD A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective JTCVS Open mechanical strains image segmentation tricuspid valve geometry congenital heart defect transthoracic echocardiographic imaging |
| title | A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective |
| title_full | A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective |
| title_fullStr | A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective |
| title_full_unstemmed | A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective |
| title_short | A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective |
| title_sort | pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromecentral messageperspective |
| topic | mechanical strains image segmentation tricuspid valve geometry congenital heart defect transthoracic echocardiographic imaging |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622000699 |
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