Patients after surgical repair of Tetralogy of Fallot (rTOF) may suffer a decrease in left ventricular (LV) function. The aim of our study is to evaluate a novel method of assessing LV torsion in patients with rTOF, as an early indicator of systolic LV dysfunction. Motion tracking based on image registration regularized by the equilibrium gap principle, known as equilibrated warping, was employed to assess LV torsion. Seventy-six cases of rTOF and ten normal controls were included. The group of controls was assessed for reproducibility using both equilibrated warping and standard clinical tissue tracking software (CVI42, version 5.10.1, Calgary, Canada). Patients were dichotomized into two groups: normal vs. loss of torsion. Torsion by equilibrated warping was successfully obtained in 68 of 76 (89%) patients and 9 of 10 (90%) controls. For equilibrated warping, the intra- and interobserver coefficients of variation were 0.095 and 0.117, respectively, compared to 0.260 and 0.831 for tissue tracking by standard clinical software. The intra- and inter-observer intraclass correlation coefficients for equilibrated warping were 0.862 and 0.831, respectively, compared to 0.992 and 0.648 for tissue tracking. Loss of torsion was noted in 32 of the 68 (47%) patients with rTOF. There was no difference in LV or RV volumes or ejection fraction between these groups. The assessment of LV torsion by equilibrated warping is feasible and shows good reliability. Loss of torsion is common in patients with rTOF and its robust assessment might contribute into uncovering heart failure in an earlier stage.

Department of Cardiology Boston Children's Hospital 300 Longwood Avenue BCH 3215 Boston MA 02115 USA

Department of Mathematics Faculty of Nuclear Sciences and Physical Engineering Czech Technical University Prague Prague Czech Republic

Division of Pediatric Cardiology Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX USA

Division of Pediatric Radiology Department of Radiology University of Texas Southwestern Medical Center Dallas TX USA

Inria Le Chesnay Rocquencourt France

Institute for Biomedical Engineering Swiss Federal Institute of Technology Zurich Switzerland

Pediatric Heart Center University Children's Hospital Zürich Zurich Switzerland

School of Biomedical Engineering and Imaging Sciences St Thomas' Hospital King's College London London UK

Solid Mechanics Laboratory École Polytechnique CNRS Polytechnic Institute of Paris Paris France

The College of New Jersey Ewing NJ USA

Pediatr Cardiol. 2022 Jan;43(1):248. doi: 10.1007/s00246-021-02766-z. PubMed

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Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients After Complete Repair