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Computed Tomography-Derived Normative Values of Right Ventricular Outflow Tract Structures in the Pediatric Population

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Abstract

Recent advances in available percutaneous device technology require accurate measurements and quantification of relationships between right ventricular outflow tract (RVOT) structures in children with and without congenital heart disease to determine device suitability. To date, no population study has described normal reference ranges of these measurements by computed tomography (CT). We aimed to establish normative values for four CT-derived measurements between RVOT structures from a heterogeneous population without heart disease and develop z scores useful for clinical practice. Patients without heart disease who underwent cardiac CT between April 2014 and February 2021 at Children’s Hospital Colorado were included. Distance between the right ventricular (RV) apex to pulmonary valve (PV), PV to pulmonary trunk bifurcation, and bifurcation to the right and left pulmonary artery was measured. Previously validated models were used to normalize the measurements and calculate Z scores. Each measurement was plotted against BSA and Z scores distributions were used as reference lines. Three-hundred and sixty-four healthy patients with a mean age of 8.8 years (range 1–21), 58% male, and BSA of 1 m2 (range 0.4–2.1) were analyzed. The Haycock formula was used to present data as predicted values for a given BSA and within equations relating each measurement to BSA. Predicted values and Z-score boundaries for all measurements are presented.We report CT-derived normative data for four measurements between RVOT structures from a heterogeneous cohort of healthy children. Knowledge of this normative data will be useful in both determining device fit and customizing future devices to accommodate the diverse pediatric size range.

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Abbreviations

BiVAD:

Biventricular assist device

BSA:

Body surface area

CT:

Computed tomography

LPA:

Left pulmonary artery

PT:

Pulmonary trunk

PV:

Pulmonary valve

RPA:

Right pulmonary artery

RV:

Right ventricle

RVOT:

Right ventricular outflow tract

SD:

Standard deviation

VAD:

Ventricular assist device

References

  1. Knobel Z, Kellenberger CJ, Kaiser T, Albisetti M, Bergsträsser E, Valsangiacomo Buechel ER (2011) Geometry and dimensions of the pulmonary artery bifurcation in children and adolescents: assessment in vivo by contrast-enhanced MR-angiography. Int J Cardiovasc Imaging 27(3):385–396

    Article  PubMed  Google Scholar 

  2. Gutgesell HP, French M (1991) Echocardiographic determination of aortic and pulmonary valve areas in subjects with normal hearts. Am J Cardiol 68(8):773–776

    Article  CAS  PubMed  Google Scholar 

  3. Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21(8):922–934

    Article  PubMed  Google Scholar 

  4. Snider AR, Enderlein MA, Teitel DF, Juster RP (1984) Two-dimensional echocardiographic determination of aortic and pulmonary artery sizes from infancy to adulthood in normal subjects. Am J Cardiol 53(1):218–224

    Article  CAS  PubMed  Google Scholar 

  5. VanderPluym CJ, Fynn-Thompson F, Blume ED (2014) Ventricular assist devices in children. Circulation 129(14):1530–1537

    Article  PubMed  Google Scholar 

  6. Baez Hernandez N, Kirk R, Sutcliffe D, Davies R, Jaquiss R, Gao A et al (2020) Utilization and outcomes in biventricular assist device support in pediatrics. J Thorac Cardiovasc Surg 160(5):1301–8.e2

    Article  PubMed  Google Scholar 

  7. Morgan GJ, Sadeghi S, Salem MM, Wilson N, Kay J, Rothman A et al (2019) SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without “pre-stenting”: a multi-institutional experience. Catheter Cardiovasc Interv 93(2):324–329

    Article  PubMed  Google Scholar 

  8. Alkashkari W, Albugami S, Abbadi M, Niyazi A, Alsubei A, Hijazi ZM (2020) Transcatheter pulmonary valve replacement in pediatric patients. Expert Rev Med Devices 17(6):541–554

    Article  CAS  PubMed  Google Scholar 

  9. Holzer RJ, Hijazi ZM (2016) Transcatheter pulmonary valve replacement: State of the art. Catheter Cardiovasc Interv 87(1):117–128

    Article  PubMed  Google Scholar 

  10. Chung R, Taylor AM (2014) Imaging for preintervention planning: transcatheter pulmonary valve therapy. Circ Cardiovasc Imaging 7(1):182–189

    Article  PubMed  Google Scholar 

  11. Curran L, Agrawal H, Kallianos K, Kheiwa A, Lin S, Ordovas K et al (2020) Computed tomography guided sizing for transcatheter pulmonary valve replacement. Int J Cardiol Heart Vasc 29:100523

    PubMed  PubMed Central  Google Scholar 

  12. Revels JW, Wang SS, Gharai LR, Febbo J, Fadl S, Bastawrous S (2021) The role of CT in planning percutaneous structural heart interventions: Where to measure and why. Clin Imaging 76:247–264

    Article  PubMed  Google Scholar 

  13. Sun X, Hao Y, Sebastian Kiekenap JF, Emeis J, Steitz M, Breitenstein-Attach A et al (2022) Four-dimensional computed tomography-guided valve sizing for transcatheter pulmonary valve replacement. J Vis Exp. https://doi.org/10.3791/63367

    Article  PubMed  Google Scholar 

  14. Schievano S, Coats L, Migliavacca F, Norman W, Frigiola A, Deanfield J et al (2007) Variations in right ventricular outflow tract morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation. J Cardiovasc Magn Reson 9(4):687–695

    Article  PubMed  Google Scholar 

  15. Lasa JJ, Castellanos DA, Denfield SW, Dreyer WJ, Tume SC, Justino H et al (2018) First report of biventricular percutaneous impella ventricular assist device use in pediatric patients. Asaio J 64(5):e134–e137

    Article  PubMed  Google Scholar 

  16. Qureshi AM, Turner ME, O’Neill W, Denfield SW, Aghili N, Badiye A et al (2020) Percutaneous Impella RP use for refractory right heart failure in adolescents and young adults-a multicenter US experience. Catheter Cardiovasc Interv 96(2):376–81

    Article  PubMed  Google Scholar 

  17. Zilberman MV, Khoury PR, Kimball RT (2005) Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. Pediatr Cardiol 26(4):356–360

    Article  CAS  PubMed  Google Scholar 

  18. Lu MT, Cai T, Ersoy H, Whitmore AG, Levit NA, Goldhaber SZ, Rybicki FJ (2009) Comparison of ECG-gated versus non-gated CT ventricular measurements in thirty patients with acute pulmonary embolism. Int J Cardiovasc Imaging 25(1):101–107. https://doi.org/10.1007/s10554-008-9342-0

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Heart Institute, Children’s Hospital Colorado, School of Medicine, University of Colorado Denver Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, 80045-2560, USA

    Natalie Soszyn, Justin Schweigert, Salvador R. Franco, Gareth J. Morgan, Max Mitchell & Jenny E. Zablah

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  1. Natalie Soszyn
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  2. Justin Schweigert
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  3. Salvador R. Franco
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  4. Gareth J. Morgan
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  5. Max Mitchell
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  6. Jenny E. Zablah
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Contributions

JZ, MM and GM conceived the idea of developing normative values between RVOT structures. JS was responsible for data collection. NS and SR conducted the data analysis. NS wrote the manuscript in discussion with JZ. GM and JZ revised the manuscript for quality. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Jenny E. Zablah.

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Competing interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Children’s Hospital Colorado approved this study.

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Soszyn, N., Schweigert, J., Franco, S.R. et al. Computed Tomography-Derived Normative Values of Right Ventricular Outflow Tract Structures in the Pediatric Population. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03456-2

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