3D Virtual reality assessment of right ventricle-pulmonary artery conduit dilation and coronary compression risk: a retrospective bi-center feasibility study.

BACKGROUND

Right ventricle-to-pulmonary artery (RV-PA) conduits are crucial to establishing or restoring RV-PA continuity in children with complex congenital heart disease. Progressive conduit obstruction is common, particularly in growing patients, and may necessitate transcatheter dilation and stenting. One of the major procedural concerns in these cases is the risk of coronary artery compression during stent implantation. This study evaluated the technical feasibility and clinical utility of patient-specific three-dimensional (3D) reconstruction and virtual reality (VR) modeling to enhance pre-procedural planning and coronary risk assessment.

METHODS

This retrospective bi-center feasibility analysis of pediatric patients who underwent evaluation for RV-PA conduit dilation and stenting was conducted at the Sheba and Wolfson Medical Centers, Israel, between January 2018 and September 2022. For 19 eligible patients, cardiac CT datasets were processed to generate high-fidelity 3D VR models. Two independent cardiologists assessed the models, quantified the distances between the conduit and the major coronary arteries before and after simulated balloon expansion, and provided structured qualitative feedback on VR usability.

RESULTS

VR-based anatomical measurements demonstrated strong inter-operator agreement (intraclass correlation coefficient >0.7 across most parameters). Both cardiologists rated VR significantly superior to CT alone for delineating coronary trajectories and assessing compression risk (mean score 4.58 vs. 3.78, p < 0.0001). VR model generation was technically successful in all cases, with intuitive user interface performance and rapid rendering times.

CONCLUSIONS

Patient-specific 3D VR modeling is technically feasible and provides clinically meaningful advantages for planning RV-PA conduit interventions. VR enhances visualization of complex coronary anatomy beyond what is achievable with standard CT imaging and may support more accurate risk stratification, improved procedural planning, and potentially reduce catheterization-associated complications. These preliminary findings support further prospective evaluation for the integration of VR tools into routine congenital cardiac practice.