A statistical model of right ventricle in tetralogy of Fallot for prediction of remodelling and therapy planning.

Patients with repaired Tetralogy of Fallot commonly suffer from chronic pulmonary valve regurgitations and extremely dilated right ventricle (RV). To reduce risk factors, new pulmonary valves must be re-implanted. However, establishing the best timing for re-intervention is a clinical challenge because of the large variability in RV shape and in pathology evolution. This study aims at quantifying the regional impacts of growth and regurgitations upon the end-diastolic RV anatomy. The ultimate goal is to determine, among clinical variables, predictors for the shape in order to build a statistical model that predicts RV remodelling. The proposed approach relies on a forward model based on currents and LDDMM algorithm to estimate an unbiased template of 18 patients and the deformations towards each individual shape. Cross-sectional multivariate analyses are carried out to assess the effects of body surface area, tricuspid and transpulmonary valve regurgitations upon the RV shape, The statistically significant deformation modes were found clinically relevant. Canonical correlation analysis yielded a generative model that was successfully tested on two new patients.