A Modelling Study of Right Ventricular Function in Fallot's Tetralogy
A Computational Modelling Study of Repaired Tetralogy of Fallot: To develop novel biomechanical parameters of right ventricular function and determine their change following Pulmonary Valve Replacement.
Golden Jubilee National Hospital Research Institute
Duration of Study in the UK
3 years, 0 months, 0 days
Tetralogy of Fallot (TOF) is a common congenital heart malformation comprising a defect of ventricular septation with underdevelopment of the right ventricular outflow. TOF is surgically corrected in infancy with typically excellent mid to long-term outcomes. However, late morbidity related to right ventricle (RV) dysfunction comprising heart failure, arrhythmia and death, may occur in adulthood which accrues with increasing age. The causation of RV dysfunction relates to various mechanisms including myocardial injury/scarring related to previous surgery, abnormal RV pressure/volume loading related to Pulmonary valve dysfunction, and conduction abnormalities. Prosthetic pulmonary valve replacement (PVR) has been strongly promoted to reduce pulmonary regurgitation and remodel the RV in the hope to improve clinical outcomes. However, the indications and timing of PVR, currently based on symptomatology, increased RV volumes and reduced function, have been insufficient to consistently improve patient outcomes.
Computational heart models have the potential to investigate RV mechanics of TOF and predict the ventricular response of PVR intervention. This study proposes an interdisciplinary collaboration between clinicians, imaging specialists and applied mathematicians with the aim to establish a high-fidelity computational simulated cardiac model for TOF based on patient MRI data. Subsequently, the patient-specific model will be used to characterise RV mechanics in TOF without PVR and TOF patients pre and post-PVR. A comparison will be made with healthy age/gender-matched controls. We propose that personalized cardiac models will identify relevant RV biomarkers that can potentially predict the benefit, or otherwise, of PVR in patients with TOF. RV mechanics and their relationship to patient well-being will be determined by cardiopulmonary exercise testing and clinical follow-up. Adult patients with repaired TOF will be invited to recruit including those under consideration, or who have had PVR. This research has transferable potential to inform other heart diseases in which RV failure is a principal determinant of the outcome.
East of Scotland Research Ethics Service REC 2
Date of REC Opinion
9 Feb 2023
Further Information Favourable Opinion