Volume Rendering of CT Images to Inform Closure of Complex Ventricular Septal Defects

The anatomy of structurally complex ventricular septal defects (SC-VSD) can be difficult to assess using 2-dimensional (2D) images and traditional 2D multiplanar views of 3D images. Direct identification and visualization are not always possible via the standard tricuspid approach in surgical repair. Volume rendering is a near instant method for 3D visualization of computed tomography angiography images, but application of this method to the planning of SC-VSD closure has not been described. We describe the integration of virtual patch and device placement within volume-rendered computed tomography angiography images within SlicerHeart to inform surgical and transcatheter closure of SC-VSDs in 3 patients. Virtual heart models were created and examined by a multidisciplinary team. Virtual device placement and surgical patch design was applied to better inform patient candidacy and procedural planning. Volume rendering-based visualization of SC-VSDs is feasible and may inform understanding of anatomy and conceptualization of the optimal repair. Further study is needed to demonstrate improvement in outcomes.