A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective

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

JTCVS Open (Jun 2022)

A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndromeCentral MessagePerspective

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

Affiliations

Colton J. Ross, MS: School of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, Okla
Elizabeth J. Trimble, MD: Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Emily L. Johnson, PhD: Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Ryan Baumwart, DVM: Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Ind
Matthew A. Jolley, MD: Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Wash
Arshid Mir, MD: Departments of Anesthesiology and Critical Care and Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
Harold M. Burkhart, MD: Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Chung-Hao Lee, PhD: School 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.

Journal volume & issue: Vol. 10
pp. 324 – 339

Abstract

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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.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

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