Exploring three-dimensional right ventricular shape and function in Tetralogy of Fallot patients

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Tetralogy of Fallot (ToF) is a common congenital heart disease, often leading to right ventricular (RV) dysfunction.
• Three-dimensional echocardiography (3DE) provides enhanced accuracy in assessing RV volume and function compared to traditional methods.
• Quantifying RV geometry and deformation is crucial for understanding ToF pathophysiology and managing patients.

Purpose of the Study:

• To evaluate differences in 3DE-derived RV shape and function parameters between ToF patients and healthy controls.
• To validate a custom software tool for comprehensive RV morphology and deformation analysis using 3DE.
• To identify specific RV regions and parameters indicative of remodeling in ToF.

Main Methods:

• Acquired 3DE RV datasets from 50 ToF patients and 50 healthy controls.
• Segmented RVs using commercial software and processed with custom software for Mean Curvature (MC), Area Strain (AS), and Longitudinal Strain (LS) quantification.
• Performed global and regional measurements, analyzing curvature and strain across predefined RV segments.

Main Results:

• Curvature analysis identified the posterior boundary and apex as key regions of RV remodeling in ToF.
• Observed septal flattening and decreased concavity in ToF patients.
• Significantly reduced global RV AS in ToF, with the greatest impairment at the apex.

Conclusions:

• The custom software enables detailed RV morphology and deformation analysis from standard 3DE.
• Curvature analysis offers a novel and sensitive measure of RV remodeling in ToF.
• RV AS and LS provide valuable insights into regional RV dysfunction, potentially improving clinical decision-making for ToF management.