Mixed reality holograms for heart surgery planning: first user experience in congenital heart disease

Eur Heart J Cardiovasc Imaging. 2019 Aug 1;20(8):883-888. doi: 10.1093/ehjci/jey184.


Aims: Proof of concept and feasibility study for preoperative diagnostic use of mixed reality (MR) holograms of individual 3D heart models from standard cardiac computed tomography angiograms (CTA) images. Optimal repair for complex congenital heart disease poses high demands on 3D anatomical imagination. Three-dimensional printed heart models are increasingly used for improved morphological understanding during surgical and interventional planning. Holograms are a dynamic and interactive alternative, probably with wider applications.

Methods and results: A 3D heart model was segmented from CTA images in a patient with double outlet right ventricle and transposition of the great arteries (DORV-TGA). The hologram was visualized in the wearable MR platform HoloLens® for 36 paediatric heart team members who filled out a diagnostic and quality rating questionnaire. Morphological and diagnostic output from the hologram was assessed and the 3D experience was evaluated. Locally developed app tools such as hologram rotation, scaling, and cutting were rated. Anatomy identification and diagnostic output was high as well as rating of 3D experience. Younger and female users rated the app tools higher.

Conclusion: This preliminary study demonstrates that MR holograms as surgical planning tool for congenital heart disease may have a high diagnostic value and contribute to understanding complex morphology. The first users experience of the hologram presentation was found to be very positive, with a preference among the female and the younger users. There is potential for improvement of the hologram manipulation tools.

Keywords: 3D printing; computed tomography; hologram; mixed reality; structural heart disease; three dimensional.

Publication types

  • Case Reports

MeSH terms

  • Anatomic Landmarks
  • Cardiac Surgical Procedures / methods*
  • Child
  • Computed Tomography Angiography
  • Contrast Media
  • Coronary Angiography
  • Depth Perception
  • Feasibility Studies
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / surgery*
  • Holography*
  • Humans
  • Iohexol
  • Male
  • Patient-Specific Modeling*
  • Printing, Three-Dimensional*
  • Proof of Concept Study
  • Surgery, Computer-Assisted / methods*
  • Surveys and Questionnaires


  • Contrast Media
  • Iohexol