Anushka Agarwal

The presence of mitral valve prolapse in congenital heart disease patients is not well described. Tetralogy of Fallot is the most common cyanotic CHD associated with overall good long-term survival after palliation. Since MVP is more often identified in adults and TOF patients are now surviving longer, we thus sought to perform this cohort study with a case-control design to determine the prevalence of MVP and systolic displacement of mitral leaflets in adult TOF patients, and describe their clinical and imaging characteristics.Retrospective interrogation of our echocardiography database identified 328 consecutive TOF patients ≥18 years from 1 January 2000 to 31 December 2014. All images were reviewed to identify patients with concomitant MVP or SDML.26 TOF patients fulfilled criteria for systolic mitral valve abnormality. 2 had moderate to severe mitral regurgitation requiring repair. When compared with 52 TOF patients without SMVA, those with SMVA were more likely to be females, less likely to have transannular patch, had lower right ventricular ejection fraction and a trend towards increased risk of atrial and ventricular arrhythmias. On multivariate logistic regression, SMVA was independently associated with the absence of transannular patch and atrial arrhythmias.In this series of adult TOF patients, we describe a novel finding of a high prevalence of systolic mitral valve abnormalities.

Tissue remodeling is a complex process that can occur in response to a wound or injury. In lung tissue, abnormal remodeling can lead to permanent structural changes that are characteristic of important lung diseases such as interstitial pulmonary fibrosis and bronchial asthma. Fibroblast-mediated contraction of three-dimensional collagen gels is considered an in vitro model of tissue contraction and remodeling, and the epithelium is one factor thought to modulate this process. We studied the effects of epithelium on collagen density and contraction using two-photon laser scanning microscopy. TPLSM was used to image autofluorescence of collagen fibers in an engineered tissue model of the human respiratory mucosa-a three-dimensional co-culture of human lung fibroblasts, denatured type I collagen, and a monolayer of human alveolar epithelial cell line or human bronchial epithelial cell line. Tissues were imaged at days 1, 8, and 15 at 10 depths within the tissue. Gel contraction was measured concurrently with TPLSM imaging. Image analysis shows that gels without an epithelium had the fastest rate of decay of fluorescent signal, corresponding to highest collagen density. Results of the gel contraction assay show that gels without an epithelium also had the highest degree of contraction. We conclude that epithelial cells modulate collagen density and contraction of engineered human lung tissue, and TPLSM is an effective tool to investigate this phenomenon.