Visualisation of cardiac magnetic resonance-based anatomic models in virtual reality to evaluate candidacy for transcatheter pulmonary valve replacement in surgically palliated right ventricular outflow tracts.

Cardiovascular MRI with magnetic resonance angiography supports clinical indication for transcatheter pulmonary valve replacement. We aimed to: (1) assess the feasibility of generating virtual right ventricular outflow tract models directly from magnetic resonance angiography datasets and (2) compare transcatheter pulmonary valve replacement candidacy based on visualisation of anatomic and valve models in virtual reality to outcomes and dispositions suggested by industry fit analysis derived from cardiac CT. Patients with native or surgically palliated right ventricular outflow tracts considered for transcatheter pulmonary valve replacement with temporally related magnetic resonance angiography and cardiac CT were included. Magnetic resonance angiography models were generated using commercial software; virtual valves were created using industry dimensions. A blinded interventional cardiologist determined pulmonary valve replacement candidacy using virtual reality review. A total of 16 patients (N = 7 males, 44%) with a median age 15.5 years (interquartile range [IQR] 13.9, 17.8) were identified. Median time for model generation was 20.6 minutes (IQR 18.5, 22.0). 11/16 (69%) patients passed industry screening fit analysis; 14/16 (88%) ultimately underwent transcatheter pulmonary valve replacement. Four patients who passed virtual reality screening failed industry screening but underwent successful transcatheter pulmonary valve replacement. One patient passed virtual reality and industry screening but did not undergo transcatheter pulmonary valve replacement. One patient passed virtual reality screening but failed industry screening and was not offered transcatheter pulmonary valve replacement. In conclusion, generating virtual models from clinical magnetic resonance angiography datasets is feasible. Modelling may help evaluate transcatheter pulmonary valve replacement candidacy, but must be used in conjunction with other data.