3D Holographic Virtual Surgical Planning for a Single Right Ventricle Fontan Patient Needing Heartmate III Placement.

A 15 year old female with hypoplastic left heart syndrome status post Norwood with Sano modification, bidirectional Glenn and extracardiac conduit Fontan developed severe right ventricular (RV) systolic dysfunction. Due to symptomatic heart failure, she underwent assessment for ventricular assist device (VAD) placement as a bridge-to-cardiac transplantation strategy. To evaluate her atypical anatomy, a chest computed tomography (CT) was uploaded into an EchoPixel True3D (Santa Clara, CA) view portal along with an accurately scaled 3D surface model of the HeartMate III (HM3) device. The surgeon then manipulated the position of the HM3 to evaluate multiple potential device positions in relation to anatomic features such as the intraventricular septum, tricuspid valve annulus, and RV muscle bundles. The patient was taken to the operating room and the HM3 device was placed just anterior to the RV apex as virtually planned. She had an uneventful postoperative course, underwent cardiac transplantation on postoperative day (POD) 63 and is doing well now 19 months post-transplantation.