Technical Feasibility of Virtual Reality-Enhanced Three-Dimensional Rotational Angiography: A Retrospective Analysis of a Novel Imaging Approach for Interventional Procedures in the Pediatric Cardiac Catheterization Laboratory.

Three-dimensional rotational angiography (3DRA) is useful in congenital interventional cardiology but remains limited by two-dimensional screen visualization, which may restrict comprehensive analysis of complex cardiovascular anatomy. Virtual reality (VR) enables immersive visualization of volumetric data. However, the technical feasibility of VR models derived from intraprocedural 3DRA remains insufficiently explored. To evaluate the technical feasibility and processing time of VR models generated from 3DRA in pediatric cardiac catheterizations, focusing on anatomical assessment, procedural simulation and fluoroscopic projection planning. This retrospective single-centre study included 62 3DRA guided procedures performed in 2024. Virtual and conventional work station based (C-3D) models were generated from anonymized 3DRA-datasets. Models were evaluated using a structured framework across four predefined categories: assessment of target-site anatomy, visualization beyond the target region, procedural simulation capability, and theoretical fluoroscopic projection planning. All assessments were performed by a multidisciplinary clinical team. VR models were successfully generated in all cases. Median VR processing times were 3.0 min for model generation, 5.0 min for refinement, 4.0 min for procedural simulation, and 7.0 min for extended anatomical analysis, defined as immersive evaluation of anatomical structures beyond the primary contrast-opacified target region. Visualization of target anatomy was feasible in 98%, beyond-target region in 84%, procedural simulation in 94%, and projection planning in all cases. Semi-quantitative comparative analysis demonstrated statistically significant deviation from the neutral reference value for target-site anatomy (p = 0.0318) and beyond-target visualization (p = 0.0495). VR-based assessment of 3DRA datasets is technically feasible and enables immersive anatomical evaluation in a heterogeneous pediatric population with congenital heart disease, providing a technical basis for future prospective studies of VR-enhanced analysis of intraprocedural 3DRA data.