# Right Ventricular Remodeling in Tetralogy of Fallot

> **NIH NIH F30** · UNIVERSITY OF PENNSYLVANIA · 2022 · $54,252

## Abstract

Project Summary/Abstract
Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, affecting 0.3% of children.
Before correction, its four defects lead to increased right heart pressures and mixing of oxygenated and
deoxygenated blood. Even after surgical repair, patients may experience elevated right heart pressures and
volumes due to residual pulmonary stenosis, pulmonary regurgitation, scar formation, and conduction
abnormalities. These changes in geometry, wall thickness, and pressure-volume relationships all contribute to
right ventricular (RV) remodeling, which can eventually lead to adverse events such as ventricular arrhythmias,
RV dysfunction, and the need for pulmonic valve repair, affecting up to 44% of patients overall. Despite the great
advances that have been made in medical and surgical care of ToF patients, there is still limited understanding
of which patients will experience adverse RV remodeling and subsequent clinical events. ToF patients’ cardiac
function is normally assessed annually using cardiovascular magnetic resonance (CMR) imaging, which provides
excellent views of the right heart and its valves. However, manual analysis of these images is time-consuming
and subject to inter- and intra-user variability. Additionally, CMR provides anatomic and flow data enabling
quantification of pulmonary artery hemodynamics, but has not yet been investigated in post-repair ToF patients.
Detailed characterization of pulmonary artery stresses and pressures, through the application of computational
fluid dynamics (CFD) simulations, could provide insight into factors affecting RV remodeling. There remains an
unmet need to comprehensively identify features that characterize and predict progression from primary ToF
repair to adverse RV remodeling and poor outcomes. My objectives in this proposal are to identify the structural
and hemodynamic parameters of ToF that are associated with RV remodeling in order to improve both clinical
care and quality of life. I plan to approach these objectives using two specific aims. In Aim 1, I will develop a
supervised machine learning algorithm to accurately and automatically segment 3D cardiac volumes using CMR
images. This algorithm will enable robust and repeatable measurements of cardiac structure and function for
both cross-sectional and longitudinal analyses. I hypothesize that this algorithm will achieve accurate and precise
segmentation results as assessed by Dice scores and intraclass correlation coefficients. In Aim 2, I will study
patient-specific pulmonary artery hemodynamics and determine associations with adverse RV remodeling.
Specifically, I will generate 3D and 1D CFD models based upon CMR-derived geometries and phase-contrast
flow data. I hypothesize that hemodynamic parameters such as wall shear stress and total pathway resistance
will be associated with and provide mechanistic insight into RV remodeling. Overall, I anticipate that this project
will provide me with...

## Key facts

- **NIH application ID:** 10387064
- **Project number:** 1F30HL162429-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Elizabeth Walker Thompson
- **Activity code:** F30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $54,252
- **Award type:** 1
- **Project period:** 2022-08-01 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10387064

## Citation

> US National Institutes of Health, RePORTER application 10387064, Right Ventricular Remodeling in Tetralogy of Fallot (1F30HL162429-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10387064. Licensed CC0.

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