The role of virtual reality in management of complex congenital heart diseases in comparison to conventional cardiac computed tomography scan.

BACKGROUND

Virtual reality (VR) image reconstruction enables the computer-assisted conversion of two-dimensional imaging data into virtual "models" or replicas. This helps reconstruct patient-specific virtual three-dimensional (3D) cardiac models in complex congenital heart diseases (CHD) to better understand the anomaly and surgical decision-making. The study aimed to evaluate the role of VR by creating patient-specific cardiac VR images from high-resolution imaging data of computed tomography (CT) angiography in such patients.

METHODS

Patients with complex CHD with a dilemma in surgical management plan after initial evaluation with echocardiography and conventional cardiac CT scans were included for VR cardiac structural reconstruction. All cases were reviewed by the same team, and decisions before VR and after VR were grouped as either "corrective surgery" or "no surgery or medical management". Agreement in terms of therapeutic decision between the pre-VR and post-VR was analyzed using Cohen's kappa test.

RESULTS

Out of 754 patients diagnosed to have CHD, 413 (54.7%) patients had a clear surgical plan. 146 (19.3%) underwent cardiac catheterization-based intervention procedures while 185 (24.5%) required only medical follow-up. Ten patients (1.3%) had a management dilemma and were included in the study. The commonest indication was to assess the routability of the aorta to the left ventricle. There was an agreement between the pre-VR and post-VR management decisions for three patients (k = -0.21, 95% CI = -0.60, 0.18).

CONCLUSIONS

VR reconstruction in CHD is useful in a selected group of patients to improve surgical planning and outcomes in pediatric cardiac surgery.