Hemodynamic assessment of self-expandable pulmonary valve in treating surgically repaired tetralogy of Fallot using 3D printed models

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, accounting for 7% of all live births with congenital heart defects. TOF is characterized by four primary anomalies: a ventricular septal defect (VSD), an overriding aorta, right ventricular hypertrophy, and right ventricular outflow tract obstruction (RVOTO). The standard surgical intervention, typically performed within the first year of life, involves VSD closure and relief of RVOTO. Despite the initial success of these surgeries, long-term complications such as right heart failure, arrhythmias, and sudden cardiac death frequently occur. These complications are often attributed to pulmonary regurgitation (PR), which results from the transannular patch used during repair, leading to right ventricular (RV) enlargement and dysfunction over time. Pulmonary valve replacement (PVR) has become essential for managing PR and restoring RV function. Traditional options, including homografts, xenografts, and various bioprosthetic valves, are associated with limited durability and potential for reoperation due to calcification, degeneration, and somatic outgrowth, particularly in younger patients. These limitations have prompted the development of less invasive alternatives, such as percutaneous pulmonary valve implantation (PPVI), which offers the advantages of reduced procedural risk and shorter recovery times. This dissertation focuses on the hemodynamic assessment of self-expandable pulmonary valves, specifically the Pulsta® valve , in treating surgically repaired TOF. The Pulsta® valve, a significant advancement in the field, consists of a nitinol wire stent frame and decellularized porcine pericardium leaflets designed for deployment in the native RVOT without a rigid supporting frame, allowing for a more flexible adaptation to the patient's anatomy. The A key innovation in this study is the utilization of 3D-printed models to simulate patient-specific anatomies. These models, a testament to the rapid advancements in technology, enable precise pre-procedural planning and optimization of valve selection and implantation techniques. By creating accurate replicas of the patient's heart, 3D printing technology allows for detailed assessment of the valves' anatomical fit and functional performance under various physiological conditions. Hemodynamic assessments include evaluating pressure gradients, valve function, and the absence of obstruction or regurgitation, which are crucial for determining the success and durability of the implanted valves. This approach, with its precision and risk reduction, provides a sense of security and confidence in the procedure, enhancing the overall quality of care. The research aims to provide comprehensive insights into the long-term outcomes of self-expandable valves in the native RVOT. By leveraging advanced imaging and 3D printing technologies, this study significantly enhances our understanding of TOF management, potentially reducing the need for repeated interventions and improving patient outcomes. The findings contribute significantly to biomedical engineering and bioinformatics, offering promising directions for future research and clinical practice in congenital heart disease treatment and, ultimately, improving the quality of life for TOF patients.