Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair

Abstract

Objectives: To investigate how virtual reality (VR) imaging impacts decision-making in atrioventricular valve surgery.Methods: This was a single-center retrospective study involving 15 children and adolescents, median age 6 years (range, 0.33-16) requiring surgical repair of the atrioventricular valves between the years 2016 and 2019. The patients' preoperative 3-dimesnional (3D) echocardiographic data were used to create 3D visualization in a VR application. Five pediatric cardiothoracic surgeons completed a questionnaire formulated to compare their surgical decisions regarding the cases after reviewing conventionally presented 2-dimesnional and 3D echocardiographic images and again after visualization of 3D echocardiograms using the VR platform. Finally, intraoperative findings were shared with surgeons to confirm assessment of the pathology.Results: In 67% of cases presented with VR, surgeons reported having "more" or "much more" confidence in their understanding of each patient's pathology and their surgical approach. In all but one case, surgeons were at least as confident after reviewing the VR compared with standard imaging. The case where surgeons reported to be least confident on VR had the worst technical quality of data used. After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases. Conclusions:The main impact of viewing imaging on VR is the improved clarity of the anatomical structures. Surgeons reported that this would have impacted the surgical approach in the majority of cases. Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization; thus. quality assessment of imaging is necessary before projecting in a VR format. (JTCVS Techniques 2021;7:269-77)Virtual reality imaging for 3D echocardiography in use. CENTRAL MESSAGEVirtual reality dynamic 3-dimensional echocardiographic imaging improves surgical insight for atrioventricular valve repair planning in congenital heart disease for clinical use. PERSPECTIVEThis study demonstrates the potential clinical benefits and value of virtual reality in surgical planning for congenital heart disease and other structural heart defects. The observed benefits are improved user interaction and visualization of valve apparatus in a beating heart compared with image visualization using standard techniques.See Commentary on page 278.

A Virtual Reality System for Improved Image-Based Planning of Complex Cardiac Procedures

“…This evaluation focused on assessing whether the proposed system was of clinical benefit in planning surgery for CHD patients [33]:…”

Non-invasive Imaging in the Evaluation of Cardiac Shunts for Interventional Closure

“…Early benefits are already being seen in the VR application of surgical planning for atrioventricular valve surgery in CHD (39).…”

A Virtual Reality System for Improved Image-based Planning of Complex Cardiac Procedures

“…This evaluation focused on assessing whether the proposed system was of clinical benefit in planning surgery for CHD patients [33]. Benchmark: Philips QLAB 10.8 (Philips).…”

“…Our experiment provided evidence that our system can improve surgery planning by facilitating understanding of complex anatomy to surgeons before the procedure. A more detailed description of the study and discussion of the results has been published [33].…”