Quantitative assessment of right ventricular structure and flow dynamics in pulmonary homograft obstruction

The insertion of cryopreserved homograft conduit into the pulmonary outflow tract is an effective method of relieving severe pulmonary valve dysfunction. A certain proportion of the inserted homografts undergo late degeneration resulting in progressive right ventricular outflow obstruction. When severe, this obstruction needs repeat intervention. The timing of this intervention is critical and depends on a thorough assessment of symptoms, coupled with detailed evaluation of right ventricular structure and function as well as flow dynamics in the right ventricular outflow. We report a patient who illustrates many of the issues related to management of these patients with particular reference to the use of modern imaging followed by detailed image processing.