Prospective, single-center studyInclusion criteria: patients undergoing surgical repair of ventricular septal defect, double outlet right ventricle, or atrioventricular valve repair (or other diagnoses by surgeon’s request) from June – December 2018, with 3D echo, CT or MRI dataSoftware platforms

An imager prepared the images and presented the data to the surgeonSurgeons completed preop and postop surveys: adequacy of imaging, relative utility of the platforms, and change in management/ approach

Echo: QLab (Philips, Amsterdam, The Netherlands)CT and MRI: cvi42 (Circle Cardiovascular Imaging, Calgary, Canada)Virtual reality: True 3D (EchoPixel, Santa Clara, CA)

University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI

Jimmy C Lu, Gregory J Ensing, Richard G Ohye, Jennifer C Romano, Peter Sassalos, Sonal T Owens, Thor Thorsson, Sunkyung Yu, Ray Lowery, Ming-Sing Si

RESULTSBACKGROUND

VIRTUAL REALITY THREE-DIMENSIONAL MODELING FOR CONGENITAL HEART SURGERY PLANNING

CONCLUSIONS

20 patients were included (median 0.8 years old, interquartile range [IQR] 0.3-3.2, median weight 7.9 kg, IQR 5.4-14.3)Cases described in the Table

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3D echocardiography, CT and MRI are commonly used for preoperative planning in congenital heart diseaseStandard methods of presentation may not be effective in communicating with surgeonsPrinted models require significant cost and infrastructure

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Virtual reality 3D modeling shows promise for sharing valuable anatomic details with surgeons.This technology may be additive for pre-operative planning, and may change the operative approach.Further study is needed to improve case selection and to evaluate impact on patient outcomes.

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To evaluate the impact of virtual reality 3D modeling on congenital heart surgery

AIM

Table 1. Cases

Figure 1: Time spent with each platform, and percent of cases in which surgeons felt each platform was worth their time.

Figure 2: Surgeons felt that True 3D provided additional information in most cases.

Figure 3: TAPVC to the left SVC. (A) MRA viewed from posteriorly. Intracardiac anatomy from 3D SSFP sequence viewed from inferiorly (B) shows confluence predominantly posterior to left-sided atrium, but right-sided LV. The anastomosis was continued along the RLPV to facilitate subsequent 2-ventricle repair.

Figure 4: TAPVC (supracardiac with left-sided vertical vein) s/p repair, s/p revision (with augmentation of anastomosis with left atrial appendage). Chest CT, viewed from posteriorly (aorta and LPA removed). The anastomosis was from the proximal left vertical vein to the LA, but the apparent narrowing was between the remnant of the left vertical vein and the remainder of the confluence. The anastomosis needed to be revised to extend to the true confluence.

Figure 5: Surgeons would like to review similar cases with True 3D in the future.

METHODS••

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In all cases, surgeons felt they had adequate information to operate, using either platform.Surgeons spent more time reviewing with the True 3D platform (Figure 1).In most cases, True 3D provided additional information (Figure 2)In 2 cases, viewing data on True 3D led to a change in surgical plan (Figures 3-4).Discrepancies between True 3D data and intraoperative findings in 2 cases:

The azygos vein could not be differentiated from a pulmonary veinEvaluating VSD margins in a case with multiple VSDsIn neither case did traditional 3D imaging more clearly delineate the anatomy

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Case Age (yrs)

Weight (kg)

Diagnosis Imaging Modali�es

Surgery

1 0.1 3.7 Congenital mitral regurgita�on Echo Mitral valve repair

2 2.3 14.7 VSD, double chamber RV Echo VSD closure, DCRV repair

3 10.3 13.7 Incomplete AVSD Echo Incomplete AVSD repair

4 0.8 8.3 DORV with straddling papillary muscle Echo, MRI Stage II pallia�on

5 0.3 4.2 Perimembranous VSD Echo VSD closure

6 1.3 8.2 Incomplete AVSD Echo Incomplete AVSD repair

7 11.6 39.8 Incomplete AVSD Echo Incomplete AVSD repair

8 3.4 13.9 TOF with pulm atresia, MAPCAs s/p mBT shunt and par�al unifocaliza�on

CMR Unifocaliza�on and PA plasty

9 3.8 15.1 AVSD s/p repair, recurrent subaor�c stenosis

Echo Subaor�c resec�on

10 0.3 4.3 Complete AVSD Echo AVSD repair

11 0.4 6.2 AVSD with malposed atrial septum, double outlet right atrium

Echo AVSD repair

12 0.8 7.8 DORV, criss-cross AV valves with straddling a�achments

Echo Stage II pallia�on

13 0.6 8.0 DORV, pulmonary atresia, TAPVC, s/p central shunt

MRI TAPVC repair, upsize central shunt

14 2.8 11.6 Mul�ple VSDs s/p PA band Echo VSD closures

15 0.5 6.05 DORV, subvalvar PS, straddling MV Echo, MRI DORV repair with arterial switch

16 0.2 0.27 Unbalanced AVSD with PS, TAPVC s/p TAPVC repair x2 and central shunt

CT TAPVC revision

17 29.4 58 TOF s/p repair with intramural VSD Echo, MRI VSD closure

18 0.02 2.8 TAPVC CT TAPVC repair

19 0.8 7.0 TOF with AVSD s/p RVOT stent Echo TOF and AVSD repair

20 0.3 6.1 HLHS s/p Norwood and central shunt, with tricuspid regurgita�on

Echo Stage II pallia�on, TV repair

The authors have no signi�cant relationships to disclose.

Strongly DisagreeNeutralAgreeStrongly Agree

55% 30%

10%

5%

A.

B.DisagreeNeutralStrongly Agree

90%

5% 5%

0

5

10

15

20

0

20

40

60

80

100

Min

utes

%Strongly

Agree

Traditional

Time spent (min)

True 3D

Worth my time

p= 0.16p= 0.0003