Computer Modeling of the Tricuspid Valve in Hypoplastic Left Heart Syndrome

左心发育不全综合征三尖瓣的计算机建模

• 批准号: 10029738
• 负责人: Matthew Jolley
• 金额: $ 84.29万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-20 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10029738
• 关键词: 3-Dimensional; Adult; Affect; Anatomy; Automobile Driving; Biological Markers; Blood Circulation; Cessation of life; Child; Complex; Computer Models; Custom; Decision Making; Development; Disease; Functional disorder; Future; Goals; Heart; Heart failure; Hypoplastic Left Heart Syndrome; Image; Individual; Infant; Infrastructure; Investigation; Knowledge; Left; Methodology; Methods; Mitral Valve; Modality; Modeling; Operative Surgical Procedures; Patient-Focused Outcomes; Patients; Pediatric Hospitals; Philadelphia; Population; Quality of life; Retrospective cohort study; Right ventricular structure; Shapes; Structural defect; Structure; Surgical Valves; Three-Dimensional Echocardiography; Tricuspid Valve Insufficiency; Tricuspid valve structure; United States; Universities; Visualization; Vulnerable Populations; Work; base; cohort; congenital heart disorder; design; experience; flexibility; image processing; improved; indexing; individual patient; innovative technologies; novel; open source; repaired; shape analysis; structural heart disease; three dimensional structure; three-dimensional modeling; tool

PROJECT SUMMARY/ABSTRACT Hypoplastic left heart syndrome (HLHS) is characterized by incomplete development of the left heart and affects over 1,000 live born infants in the United States per year. Staged surgical treatment allows children with HLHS to survive and flourish, but the right ventricle (RV) remains the sole functioning ventricle and the tricuspid valve (TV) is their only functional atrioventricular valve. Tricuspid regurgitation is thus highly associated with heart failure and death. Thirty percent of HLHS patients require surgical intervention to treat tricuspid regurgitation. Despite incremental progress, understanding of the relationship between TV structure and tricuspid regurgitation in HLHS is limited, and results of surgical repair are suboptimal. 3D echocardiography and quantitative 3D echocardiography based analysis have dramatically improved adult mitral valve surgical planning and repair. However, despite preliminary work with basic tools suggesting relationships between the 3D structure of the TV and patient survival, and the unmet need for precise structural information to guide TV repair, there is no commercial or readily available method sufficiently adaptable to model and quantify the unique and highly variable TV anatomy in HLHS. As a result, the information in 3D echocardiography images remains latent, limiting understanding of the relationship between TV structure and tricuspid regurgitation, as well as the design of patient-specific repairs informed by 3D structural analysis. This proposal builds upon Dr. Jolley’s experience with modeling of atrioventricular valves in congenital heart disease and the development of flexible open-source modeling tools. The specific goals are to 1) investigate methods for quantifying TV structure from 3D echocardiography images using metric based tools as well as novel shape parameterization and statistical shape analysis; and 2) use these tools to identify TV structural correlates of TV dysfunction in 100 HLHS patients who have completed staged surgical repair. The methods developed will be incorporated into the open-source 3D Slicer imaging processing platform to catalyze future studies of congenital and adult structural heart disease, particularly those not possibly using current modalities. These studies are the first step toward individualized surgical repair of the TV informed by 3D structural analysis, and a detailed understanding of structural features of TV dysfunction in HLHS. The proposal leverages the existing infrastructure and extensive expertise at the Children’s Hospital of Philadelphia, Queen’s University, and Kitware Inc. Overall, this study represents a significant advance in the understanding of tricuspid valve disease in HLHS, as well as a flexible, and extensible armamentarium of tools for the future image-based investigation of congenital and adult structural heart disease.

项目概要/摘要 左心发育不全综合征（HLHS）的特点是左心发育不完全，影响 美国每年有超过 1,000 名活产婴儿。分阶段手术治疗让 HLHS 儿童得以生存 生存和繁荣，但右心室 (RV) 仍然是唯一具有功能的心室和三尖瓣 （TV）是他们唯一有功能的房室瓣。因此，三尖瓣反流与心脏高度相关 失败和死亡。百分之三十的 HLHS 患者需要手术干预来治疗三尖瓣反流。 尽管取得了渐进的进展，但对 TV 结构和三尖瓣反流之间关系的了解 HLHS 的治疗效果有限，手术修复效果欠佳。 3D 超声心动图和定量 3D 基于超声心动图的分析极大地改善了成人二尖瓣手术计划和修复。 然而，尽管初步工作表明电视 3D 结构之间的关系 和患者的生存率，以及对指导电视修复的精确结构信息的未满足的需求，没有 商业或现成的方法足以适应建模和量化独特且高度 HLHS 中的可变电视解剖结构。因此，3D 超声心动图图像中的信息仍然是潜在的，限制了 了解 TV 结构与三尖瓣反流之间的关系，以及 TV 结构的设计 通过 3D 结构分析进行针对患者的修复。该建议建立在乔利博士的经验之上 先天性心脏病房室瓣建模和灵活开源的开发 建模工具。具体目标是 1) 研究量化 3D 电视结构的方法 使用基于度量的工具以及新颖的形状参数化和统计形状的超声心动图图像 分析; 2) 使用这些工具来识别 100 名 HLHS 患者中电视功能障碍的电视结构相关性 已完成分期手术修复。开发的方法将被纳入开源 3D Slicer 成像处理平台可促进先天性和成人结构性心脏病的未来研究， 特别是那些不可能使用当前模式的人。这些研究是迈向个体化的第一步 通过 3D 结构分析以及对结构特征的详细了解对电视进行手术修复 HLHS 中的电视功能障碍。该提案利用了现有的基础设施和广泛的专业知识 费城儿童医院、女王大学和 Kitware Inc. 总体而言，这项研究代表了 在 HLHS 中对三尖瓣疾病的理解方面取得了重大进展，并且灵活、可扩展 用于未来基于图像的先天性和成人结构性心脏病研究的工具库。