1. REVEALING DIFFERENCES IN
ANATOMICAL REMODELLING OF
THE SYSTEMIC RIGHT VENTRICLE
E.ZACUR1, J.WONG2, R.RAZAVI2, T.GEVA3, G.GREIL2, P.LAMATA1
1 DEPT. BIOMEDICAL ENGINEERING, KINGS COLLEGE LONDON, UK
2 DIV. IMAGING SCIENCES, KINGS COLLEGE LONDON, LONDON, UK
3 BOSTON CHILDREN’S HOSPITAL, HARVARD MEDICAL SCHOOL, USA
2. TAKE HOME
MESSAGES
Models to reveal biomarkers
Shape biomarker
•Model: smooth ellipsoid
•Unveil differences in development
3. OVERVIEW
HLHS: the clinical problem and hypothesis
Coping with data
Revealing growth differences
How good is the picture?
6. HYPOPLASTIC LEFT
HEART SYNDROME (II)
Challenges:
Complex surgery - different
“schools”
Small numbers – many
factors
Opportunity: huge
impact for life
8. IMPACT OF SHUNT
CHOICE?
Outcome (transplantation free) [1]:
Early outcome: RVPA better
Mid outcome (32 months): equal
Hypothesis: scar in RVPA introduces an
adverse remodelling (growth) and impaired RV
function as compared to MBT.
[1] Frommelt et al (2014). "Impact of initial shunt type on cardiac size and function in
children with single right ventricle anomalies before the Fontan procedure: the Single
Ventricle Reconstruction Extension Trial", JACC 64(19):2026-2035.
9. Computational Anatomy is able to reveal
differences in RV growth caused by a
choice of shunt technique.
17. MESH
PERSONALIZATION
[2] Lamata P et al (2011), “An accurate, fast and robust method to generate patient-
specific cubic Hermite meshes.” Med Image Anal. 15(6):801-13”
[3] Lamata P et al (2014), “An automatic service for the personalization of ventricular
cardiac meshes.” J R Soc Interface. 11(91):20131023.
18.
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22. COMMON SHAPE
CHANGES?
Shape variation due to:
• Errors, artefacts…
• Physiological causes
Decompose shape in orthogonal
components
• Reduce dimensionality
• Get the salient modes
41. BETTER THAN
“TRADITIONAL”
Differences never revealed before
• Risk: “black box”
• Mitigation plan: map of regional changes
Function correlates with shape
(remodelling)
• Impaired contraction in RVPA [4]
[4] Wong et al (2015). "Using cardiac magnetic resonance and computational modelling
to assess the systemic right ventricle following different Norwood procedures: a dual
centre study", J Card Mag Res, 17(Suppl 1):M12.
42. STILL A BLURRY
PICTURE
Data issues: short axis stack, etc
Processing issues.
• Fitting error / LV length = 1.43/78 mm
• Adult LV: 1.28/95 mm
43. TAKE HOME
MESSAGES
Models to reveal biomarkers
Shape biomarker
• Model: smooth ellipsoid
• Unveil differences in development