Histologic alterations in tetralogy of Fallot

Alpat, Şafak; Yılmaz, M.; Önder, Sevgen; Sargon, Mustafa F.; Güvener, Murat; Doğan, Rıza; Demircin, Metin; Paşaoğlu, İlhan

doi:10.1111/jocs.12873

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…Indeed SHG signal is of big interest for the characterization of myocardial pathologies especially fibrotic remodeling. SHG very sufficiently visualizes disorganized collagen-rich structures characteristic for progressing fibrosis in the transmural images and also in the cross sections where anincrease of extra cellular matrix between myocyte bundlesis observed as reported for myocardial disease [26] .…”

Section: Resultssupporting

confidence: 54%

Label-free Imaging of Myocardial Remodeling in Atrial Fibrillation Using Nonlinear Optical Microscopy: A Feasibility Study.

Büttner

Galli

Husser

et al. 2018

Journal of Atrial Fibrillation

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Atrial fibrillation, characterized by rapid disorganized electrical activation of myocardium, is caused by and accompanied by remodeling of myocardial tissue. We applied nonlinear optical microscopy (NLOM) to visualize typical myocardial features and atrial fibrillation effects in order to test anon-destructive imaging technology that in principle can be applied in vivo.Coherent anti-Stokes Raman scattering, endogenous two-photon excited fluorescence, and second harmonic generation were used to inspect unstained human atrial myocardium from three patients who underwent surgical Cox-MAZE procedure with amputation of left atrial appendage. Using NLOM techniques, we collected detailrich pictures of unstained tissue that enable comprehensive characterization of myocardial characteristics like myocyte structure, collagen and lipofuscin deposition, intercalating disc width, and fatty degradation. Development of in vivo application of the NLOM technique may represent a revolutionary approach in characterizing atrial fibrillation associated myocardial remodeling with important implications for therapy individualization and monitoring.

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Section: Resultssupporting

confidence: 54%

Label-free Imaging of Myocardial Remodeling in Atrial Fibrillation Using Nonlinear Optical Microscopy: A Feasibility Study.

Büttner

Galli

Husser

et al. 2018

Journal of Atrial Fibrillation

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“…In terms of evolution of myocardial fibrosis, the finding of severe fibrosis in patients with long aortic cross-clamp time during primary repair points to the vulnerability of the myocardium to irreversible damage during cardiopulmonary bypass and is consistent with previous reports 20–22. Although exposure to chronic hypoxia is known to be associated with severe myocardial fibrosis,23 in our population, collagen volume fraction was not associated with prior aortopulmonary shunt or age at primary repair.…”

Section: Discussioncontrasting

confidence: 58%

Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement

Yamamura

Yuen

Hickey

et al. 2018

Heart

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ObjectiveThe relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR.MethodsAdults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure.ResultsFifty-three patients (male 58%, 38±11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m2, p=0.044), decreased RVESVi change (Δ29 vs Δ45 mL/m2, p=0.005), increased RV mass (34 vs 25 g/m2, p=0.023) and larger right atrial (RA) area (21 vs 17 cm2, p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057).ConclusionsSevere RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes.

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“…Hypoxia and RVOT obstruction lead to pathological changes such as RV hypertrophy and myocardial interstitial fibrosis ( 16 ). Chronic hypoxia is a major stimulus for myocardial remodelling and causes detrimental histopathological alterations in cardiac myocytes and fibrosis ( 13 , 17 ). Previous studies have shown varying degrees of histopathological changes and mild fibrosis in muscle specimens from TOF patients ( 11 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Adverse events after repair of tetralogy of Fallot: prediction models by machine learning of a retrospective cohort study in western China

Xi¹,

Xiang²,

Wu³

et al. 2023

Transl Pediatr

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Background The incidence of clinical adverse events after tetralogy of Fallot (TOF) repair remains high. This study was performed to explore risk factors for adverse events and develop a prediction model through machine learning (ML) to forecast the incidence of clinical adverse events after TOF repair. Methods A total of 281 participants who were treated with cardiopulmonary bypass (CPB) at our hospital from January 2002 to January 2022 were included in the study. Risk factors for adverse events were explored by composite and comprehensive analyses. Five artificial intelligence (AI) models were used for ML to build prediction models and screen out the model with the best performance in predicting adverse events. Results CPB time, differential pressure of the right ventricular outflow tract (RVOTDP or DP), and transannular patch repair were identified as the main risk factors for adverse events. The reference point for CPB time was 116.5 minutes and that for right ventricular (RV) outflow tract differential pressure was 70 mmHg. SPO 2 was a protective factor, with a reference point of 88%. By integrating the results for the training and validation cohorts, we confirmed that, among all models, the logistic regression (LR) model and Gaussian Naive Bayes (GNB) model were stable, showing good discrimination, calibration and clinical practicability. The dynamic nomogram can be used as a predictive tool for clinical application. Conclusions Differential pressure of the RV outflow tract, CPB time, and transannular patch repair are risk factors, and SPO 2 is a protective factor for adverse events after complete TOF repair. In this study, models developed by ML were established to predict the incidence of adverse events.

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Histologic alterations in tetralogy of Fallot

Abstract: Pre-existing cardiomyocyte injury accompanied by mitochondrial damage and fibrosis were more pronounced in cyanotic TOF patients. Early repair may prevent the development of histopathologic alterations in these patients.

Cited by 11 publications

References 26 publications

Label-free Imaging of Myocardial Remodeling in Atrial Fibrillation Using Nonlinear Optical Microscopy: A Feasibility Study.

Label-free Imaging of Myocardial Remodeling in Atrial Fibrillation Using Nonlinear Optical Microscopy: A Feasibility Study.

Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement

Adverse events after repair of tetralogy of Fallot: prediction models by machine learning of a retrospective cohort study in western China

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