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Lippert M, Dumont KA, Birkeland S, Nainamalai V, Solvin H, Suther KR, Bendz B, Elle OJ, Brun H. Cardiac anatomic digital twins: findings from a single national centre. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:725-734. [PMID: 39563912 PMCID: PMC11570384 DOI: 10.1093/ehjdh/ztae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/11/2024] [Accepted: 07/30/2024] [Indexed: 11/21/2024]
Abstract
Aims New three-dimensional cardiac visualization technologies are increasingly employed for anatomic digital twins in pre-operative planning. However, the role and influence of extended reality (virtual, augmented, or mixed) within heart team settings remain unclear. We aimed to assess the impact of mixed reality visualization of the intracardiac anatomy on surgical decision-making in patients with complex heart defects. Methods and results Between September 2020 and December 2022, we recruited 50 patients and generated anatomic digital twins and visualized them in mixed reality. These anatomic digital twins were presented to the heart team after initial decisions were made using standard visualization methods. Changes in the surgical strategy were recorded. Additionally, heart team members rated their mixed reality experience through a questionnaire, and post-operative outcomes were registered. Anatomic digital twins changed the initially decided upon surgical strategies for 68% of cases. While artificial intelligence facilitated the rapid creation of digital anatomic twins, manual corrections were always necessary. Conclusion In conclusion, mixed reality anatomic digital twins added information to standard visualization methods and significantly influenced surgical planning, with evidence that these strategies can be implemented safely without additional risk.
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Affiliation(s)
- Matthias Lippert
- The Intervention Centre, Division for Technology and Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo 0424, Norway
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Oslo 0450, Norway
| | - Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Varatharajan Nainamalai
- The Intervention Centre, Division for Technology and Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo 0424, Norway
| | - Håvard Solvin
- The Intervention Centre, Division for Technology and Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo 0424, Norway
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Oslo 0450, Norway
| | - Kathrine Rydén Suther
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bjørn Bendz
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Oslo 0450, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Division for Technology and Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo 0424, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Henrik Brun
- The Intervention Centre, Division for Technology and Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo 0424, Norway
- Department for Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
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Peek JJ, Bakhuis W, Sadeghi AH, Veen KM, Roest AAW, Bruining N, van Walsum T, Hazekamp MG, Bogers AJJC. Optimized preoperative planning of double outlet right ventricle patients by 3D printing and virtual reality: a pilot study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad072. [PMID: 37202357 PMCID: PMC10481772 DOI: 10.1093/icvts/ivad072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES In complex double outlet right ventricle (DORV) patients, the optimal surgical approach may be difficult to assess based on conventional 2-dimensional (2D) ultrasound (US) and computed tomography (CT) imaging. The aim of this study is to assess the added value of 3-dimensional (3D) printed and 3D virtual reality (3D-VR) models of the heart used for surgical planning in DORV patients, supplementary to the gold standard 2D imaging modalities. METHODS Five patients with different DORV subtypes and high-quality CT scans were selected retrospectively. 3D prints and 3D-VR models were created. Twelve congenital cardiac surgeons and paediatric cardiologists, from 3 different hospitals, were shown 2D-CT first, after which they assessed the 3D print and 3D-VR models in random order. After each imaging method, a questionnaire was filled in on the visibility of essential structures and the surgical plan. RESULTS Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D. The feasibility of ventricular septum defect patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01). The percentage of proposed surgical plans corresponding to the performed surgical approach was 66% for plans based on US/CT, 78% for plans based on 3D printing and 80% for plans based on 3D-VR visualization. CONCLUSIONS This study shows that both 3D printing and 3D-VR have additional value for cardiac surgeons and cardiologists over 2D imaging, because of better visualization of spatial relationships. As a result, the proposed surgical plans based on the 3D visualizations matched the actual performed surgery to a greater extent.
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Affiliation(s)
- Jette J Peek
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Wouter Bakhuis
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nico Bruining
- Department of Clinical Epidemiology and Innovation (KEI), Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Theo van Walsum
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
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Computed tomography in tetralogy of Fallot: pre- and postoperative imaging evaluation. Pediatr Radiol 2022; 52:2485-2497. [PMID: 34427695 DOI: 10.1007/s00247-021-05179-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Tetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart disease (CHD) and the most frequent complex CHD encountered in adulthood. Although children with TOF share four characteristic features (subaortic ventricular septal defect, overriding aorta, right ventricular hypertrophy, pulmonary stenosis), the clinical spectrum and course are in fact greatly heterogeneous. Echocardiography remains the mainstay for diagnosis, presurgical planning and postoperative follow-up. However, with continued technological advances, CT now plays an increasing role in TOF evaluation and management, helping to minimize routine invasive catheter angiography. Preoperatively, CT is uniquely suited to assess associated pulmonary arterial, aortic and coronary anomalies as well as extra-cardiovascular structures and is particularly helpful for delineating complex anatomy in the TOF subtypes of absent pulmonary valve and pulmonary atresia with major aortopulmonary collaterals. Postoperatively, CT is useful for identifying surgical complications and for long-term monitoring including volumetry quantification, especially in children for whom MRI is contraindicated or limited by implanted devices such as pacemakers and stents. In this article, we review key clinical features and considerations in the pre- and postoperative TOF patient and the burgeoning role of CT for facilitating accurate diagnosis and personalized intervention.
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Diagnostic Value of Abdominal B-Ultrasound for Congenital Heart Disease Complicated with Extracardiac Malformation in the Second Trimester of Pregnancy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6967655. [PMID: 35845573 PMCID: PMC9283033 DOI: 10.1155/2022/6967655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022]
Abstract
Objective To explore the diagnostic value of abdominal B-ultrasound in the diagnosis of congenital heart disease complicated with extracardiac malformations in the second trimester of pregnancy. Methods 50 pregnant women with congenital cardiac malformations and extracardiac malformations diagnosed in our hospital from 2015 to 2019 were retrospectively analyzed. The diagnostic results and the types of congenital heart disease complicated with extracardiac malformations were compared to analyze the diagnostic value of abdominal B-ultrasound. Results In the diagnosis of 50 fetuses with congenital heart disease and extracardiac malformation, the tetralogy of Fallot syndrome accounts for the largest proportion. Abdominal B-ultrasound in the second trimester was associated with a higher detection rate of fetal heart malformation (72%) versus in the third trimester (40%) (P < 0.05). The single atrium and single ventricle had the highest diagnostic accuracy of fetal congenital heart malformation in the second trimester. The highest success rate of detection at different gestational weeks was observed at the 14th gestational week (P < 0.05). Four-chamber cardiac section (4CV) had the lowest diagnostic accuracy (62%) for cardiac malformations, and the 4CV + three-vessel-trachea plane (3VVT) had the highest diagnostic accuracy (90%) for cardiac malformations. Conclusion Abdominal B-ultrasound features a high diagnostic value for congenital heart disease complicated with extracardiac malformations in the second trimester of pregnancy, and the second trimester is the optimal detection timing with the highest detection accuracy.
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Watanabe F, Kojima T. A novel, inexpensive three-dimensional computer graphics teaching tool to provide ultrasound technique education to anesthesia trainees. J Clin Anesth 2022; 78:110677. [DOI: 10.1016/j.jclinane.2022.110677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
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Lindquist EM, Gosnell JM, Khan SK, Byl JL, Zhou W, Jiang J, Vettukattil JJ. 3D printing in cardiology: A review of applications and roles for advanced cardiac imaging. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Lau I, Gupta A, Sun Z. Clinical Value of Virtual Reality versus 3D Printing in Congenital Heart Disease. Biomolecules 2021; 11:884. [PMID: 34198642 PMCID: PMC8232263 DOI: 10.3390/biom11060884] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/22/2022] Open
Abstract
Both three-dimensional (3D) printing and virtual reality (VR) are reported as being superior to the current visualization techniques in conveying more comprehensive visualization of congenital heart disease (CHD). However, little is known in terms of their clinical value in diagnostic assessment, medical education, and preoperative planning of CHD. This cross-sectional study aims to address these by involving 35 medical practitioners to subjectively evaluate VR visualization of four selected CHD cases in comparison with the corresponding 3D printed heart models (3DPHM). Six questionnaires were excluded due to incomplete sections, hence a total of 29 records were included for the analysis. The results showed both VR and 3D printed heart models were comparable in terms of the degree of realism. VR was perceived as more useful in medical education and preoperative planning compared to 3D printed heart models, although there was no significant difference in the ratings (p = 0.54 and 0.35, respectively). Twenty-one participants (72%) indicated both the VR and 3DPHM provided additional benefits compared to the conventional medical imaging visualizations. This study concludes the similar clinical value of both VR and 3DPHM in CHD, although further research is needed to involve more cardiac specialists for their views on the usefulness of these tools.
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Affiliation(s)
- Ivan Lau
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6102, Australia;
| | - Ashu Gupta
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, WA 6150, Australia;
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6102, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
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Bruckheimer E, Goreczny S. Advanced imaging techniques to assist transcatheter congenital heart defects therapies. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aregullin EO, Mohammad Nijres B, Al-Khatib Y, Vettukattil J. Transcatheter Fontan completion using novel balloon and stent system. Catheter Cardiovasc Interv 2021; 97:679-684. [PMID: 33444467 DOI: 10.1002/ccd.29463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 11/10/2022]
Abstract
Despite advances in percutaneous interventions, transcatheter Fontan completion remains experimental and performed only in select cases. Non-surgical Fontan completion requires surgical preconditioning at an earlier stage of palliation. We describe transcatheter Fontan completion in a 15-year-old male with previously failed surgical Fontan palliation without surgical preconditioning.
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Affiliation(s)
- E Oliver Aregullin
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Bassel Mohammad Nijres
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Yasser Al-Khatib
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Joseph Vettukattil
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
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