Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients after Complete Repair

International audienceBackground: A biomechanical model of the heart can be used to incorporate multiple data sources (ECG, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of tetralogy of Fallot patients after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. Methods: 20 rTOF patients who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance (CMR) were included in this retrospective study. Biomechanical models specific to individual patient and physiology (pre- and post-PVR) were created and utilized to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of RV end-diastolic volume (EDV) and effective flow in pulmonary artery (Qeff) was also compared to expected values. Results: RV contractility pre-PVR (65±17 kPa, mean ± SD) was increased in rTOF patients in comparison to normal RV (39-45 kPa) (p<0.05). The contractility decreased significantly in all patients post-PVR (p