Jan L Bruse1, Elena Cervi1, Kristin McLeod2, Giovanni Biglino1, Maxime Sermesant3, Xavier Pennec3, Andrew M Taylor1, Silvia Schievano1, Tain-Yen Hsia4. 1. Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom. 2. Cardiac Modeling Department, Simula Research Laboratory, Oslo, Norway; Inria, Asclepios Team, Sophia Antipolis, France. 3. Inria, Asclepios Team, Sophia Antipolis, France. 4. Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom. Electronic address: hsiat@gosh.nhs.uk.
Abstract
BACKGROUND: Aortic arch reconstruction after hypoplastic left heart syndrome (HLHS) palliation can vary widely in shape and dimensions between patients. Arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch three-dimensional shape features with functional and short-term outcome data after total cavopulmonary connection (TCPC). METHODS: Aortic arch shape models of 37 patients with HLHS (age, 2.89 ± 0.99 years) were reconstructed from magnetic resonance data before TCPC completion. A novel, validated statistical shape analysis method was used to compute a three-dimensional anatomic mean shape from the cohort and calculate the deformation vectors of the mean shape toward each patient's specific anatomy. From these deformations, three-dimensional shape features most related to ventricular ejection fraction, indexed end-diastolic volume, and superior cavopulmonary pressure were extracted by partial least-square regression analysis. Shape patterns relating to intensive care unit and hospital lengths of stay after TCPC were assessed. RESULTS: Distinct deformation patterns, which result in an acutely mismatched aortic root and ascending aorta, and a gothic-like transverse arch, correlated with increased indexed end-diastolic volume and higher superior cavopulmonary pressure but not with ejection fraction. Specific arch morphology with pronounced transverse arch and descending aorta mismatch also correlated with longer intensive care unit and hospital lengths of stay after TCPC completion. CONCLUSIONS: Independent of hemodynamically important arch obstruction, altered aortic morphology in HLHS patients appears to have important associations with higher superior cavopulmonary pressure and with short-term outcomes after TCPC completion as highlighted by statistical shape analysis, which could act as adjunct to risk assessment in HLHS.
BACKGROUND: Aortic arch reconstruction after hypoplastic left heart syndrome (HLHS) palliation can vary widely in shape and dimensions between patients. Arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch three-dimensional shape features with functional and short-term outcome data after total cavopulmonary connection (TCPC). METHODS: Aortic arch shape models of 37 patients with HLHS (age, 2.89 ± 0.99 years) were reconstructed from magnetic resonance data before TCPC completion. A novel, validated statistical shape analysis method was used to compute a three-dimensional anatomic mean shape from the cohort and calculate the deformation vectors of the mean shape toward each patient's specific anatomy. From these deformations, three-dimensional shape features most related to ventricular ejection fraction, indexed end-diastolic volume, and superior cavopulmonary pressure were extracted by partial least-square regression analysis. Shape patterns relating to intensive care unit and hospital lengths of stay after TCPC were assessed. RESULTS: Distinct deformation patterns, which result in an acutely mismatched aortic root and ascending aorta, and a gothic-like transverse arch, correlated with increased indexed end-diastolic volume and higher superior cavopulmonary pressure but not with ejection fraction. Specific arch morphology with pronounced transverse arch and descending aorta mismatch also correlated with longer intensive care unit and hospital lengths of stay after TCPC completion. CONCLUSIONS: Independent of hemodynamically important arch obstruction, altered aortic morphology in HLHSpatients appears to have important associations with higher superior cavopulmonary pressure and with short-term outcomes after TCPC completion as highlighted by statistical shape analysis, which could act as adjunct to risk assessment in HLHS.
Authors: Avan Suinesiaputra; Pierre Ablin; Xenia Alba; Martino Alessandrini; Jack Allen; Wenjia Bai; Serkan Cimen; Peter Claes; Brett R Cowan; Jan D'hooge; Nicolas Duchateau; Jan Ehrhardt; Alejandro F Frangi; Ali Gooya; Vicente Grau; Karim Lekadir; Allen Lu; Anirban Mukhopadhyay; Ilkay Oksuz; Nripesh Parajali; Xavier Pennec; Marco Pereanez; Catarina Pinto; Paolo Piras; Marc-Michel Rohe; Daniel Rueckert; Dennis Saring; Maxime Sermesant; Kaleem Siddiqi; Mahdi Tabassian; Luciano Teresi; Sotirios A Tsaftaris; Matthias Wilms; Alistair A Young; Xingyu Zhang; Pau Medrano-Gracia Journal: IEEE J Biomed Health Inform Date: 2017-01-17 Impact factor: 5.772
Authors: Jan L Bruse; Giuliano Giusti; Catriona Baker; Elena Cervi; Tain-Yen Hsia; Andrew M Taylor; Silvia Schievano Journal: J Med Device Date: 2017-05-03 Impact factor: 0.582
Authors: Benedetta Biffi; Jan L Bruse; Maria A Zuluaga; Hopewell N Ntsinjana; Andrew M Taylor; Silvia Schievano Journal: Front Pediatr Date: 2017-03-08 Impact factor: 3.418
Authors: Dhananjay Radhakrishnan Subramaniam; William A Stoddard; Kristian H Mortensen; Steffen Ringgaard; Christian Trolle; Claus H Gravholt; Ephraim J Gutmark; Goutham Mylavarapu; Philippe F Backeljauw; Iris Gutmark-Little Journal: J Cardiovasc Magn Reson Date: 2017-02-24 Impact factor: 5.364