Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair

Kuberan Pushparajah; Ka Yee Kelly Chu; Shujie Deng; Gavin Wheeler; Alberto Gomez; Saleha Kabir; Julia A Schnabel; John M Simpson

doi:10.1016/j.xjtc.2021.02.044

Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair

JTCVS Tech. 2021 Jun:7:269-277. doi: 10.1016/j.xjtc.2021.02.044.

Authors

Kuberan Pushparajah^{1

2}, Ka Yee Kelly Chu¹, Shujie Deng¹, Gavin Wheeler¹, Alberto Gomez¹, Saleha Kabir², Julia A Schnabel¹, John M Simpson^{1

2}

Affiliations

¹ School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
² Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.

Abstract

Objectives: To investigate how virtual reality (VR) imaging impacts decision-making in atrioventricular valve surgery.

Methods: This was a single-center retrospective study involving 15 children and adolescents, median age 6 years (range, 0.33-16) requiring surgical repair of the atrioventricular valves between the years 2016 and 2019. The patients' preoperative 3-dimesnional (3D) echocardiographic data were used to create 3D visualization in a VR application. Five pediatric cardiothoracic surgeons completed a questionnaire formulated to compare their surgical decisions regarding the cases after reviewing conventionally presented 2-dimesnional and 3D echocardiographic images and again after visualization of 3D echocardiograms using the VR platform. Finally, intraoperative findings were shared with surgeons to confirm assessment of the pathology.

Results: In 67% of cases presented with VR, surgeons reported having "more" or "much more" confidence in their understanding of each patient's pathology and their surgical approach. In all but one case, surgeons were at least as confident after reviewing the VR compared with standard imaging. The case where surgeons reported to be least confident on VR had the worst technical quality of data used. After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases.

Conclusions: The main impact of viewing imaging on VR is the improved clarity of the anatomical structures. Surgeons reported that this would have impacted the surgical approach in the majority of cases. Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization; thus. quality assessment of imaging is necessary before projecting in a VR format.

Keywords: 2D, 2-dimensional; 3D, 3-dimensional echocardiography; AV, atrioventricular; CT, computed tomography; TOE, transesophageal echocardiogram; TTE, transthoracic echocardiogram; VR, virtual reality; atrioventricular valves; congenital heart disease; evolving technology; surgery; virtual reality.

Abstract

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