Image Segmentation and Modeling of the Pediatric Tricuspid Valve in Hypoplastic Left Heart Syndrome

Hypoplastic left heart syndrome (HLHS) is a single-ventricle congen‐ ital heart disease that is fatal if left unpalliated. In HLHS patients, the tricuspid valve is the only functioning atrioventricular valve, and its competence is there‐ fore critical. This work demonstrates the first automated strategy for segmenta‐ tion, modeling, and morphometry of the tricuspid valve in transthoracic 3D echo‐ cardiographic (3DE) images of pediatric patients with HLHS. After initial land‐ mark placement, the automated segmentation step uses multi-atlas label fusion and the modeling approach uses deformable modeling with medial axis repre‐ sentation to produce patient-specific models of the tricuspid valve that can be comprehensively and quantitatively assessed. In a group of 16 pediatric patients, valve segmentation and modeling attains an accuracy (mean boundary displace‐ ment) of 0.8 ± 0.2 mm relative to manual tracing and shows consistency in annular and leaflet measurements. In the future, such image-based tools have the potential to improve understanding and evaluation of tricuspid valve morphology in HLHS and guide strategies for patient care.