Abstract

During surgical repair of tetralogy of Fallot (TOF), pulmonary valve preservation (preservative repair) has demonstrated improved long-term outcomes compared to repairs which incise into the valve annulus (non-preservative repair). Given the influence of geometry on hemodynamics, the success of preservative repair may be linked to the suitability of the preoperative patient geometry. However, the specific patient anatomies that may be predisposed to successful preservative repair are unknown due to significant interpatient variability in right ventricular outflow tract and pulmonary artery geometries, as well as the limitations in current methods of sub-regional geometric analysis. As a first step towards understanding the link between geometry and hemodynamics in TOF patients at a sub-region level, we characterize the TOF geometry from the right ventricular infundibulum to the left and right pulmonary arteries. Our process consists of segmentation of magnetic resonance images and analysis of cross-sectional slices of the geometries along the centerlines. For the infundibulum, main, left, and right pulmonary arteries individually, we quantify geometric parameters important in determining hemodynamic characteristics such as flow separation and recirculation, which can influence the degree of regurgitation. Specifically, we calculate the diameter along the sub-region length, the average diameter, length, and tortuosity for each segment, as well as the bifurcation, LPA and RPA branch angles. This approach enables direct geometric comparisons within and among patients and allows for observation of the range in anatomic presentation. We have applied this approach to a dataset of 11 postoperative TOF patients, repaired with both preservative and non-preservative surgical techniques.

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