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3D Virtual reality assessment of right ventricle-pulmonary artery conduit dilation and coronary compression risk: a
David Hochstein1,2,3, Yona Rothé2,3,4, Avshalom Shaffer2,3
1Internal Medicine Department C, Sheba Medical Center, Ramat Gan, Israel.
Insights
Patient-specific 3D virtual reality models enhance planning for right ventricle-to-pulmonary artery conduit interventions in children. This technology improves visualization of coronary arteries, aiding risk assessment and potentially reducing complications during stenting.
Area of Science:
- Congenital Heart Surgery
- Medical Imaging
- Virtual Reality in Medicine
Background:
- Right ventricle-to-pulmonary artery (RV-PA) conduits are vital for pediatric congenital heart disease patients.
- Conduit obstruction is a common complication, often requiring transcatheter intervention.
- Coronary artery compression is a significant risk during RV-PA conduit stenting.
Purpose of the Study:
- To evaluate the feasibility and clinical utility of 3D reconstruction and virtual reality (VR) modeling for pre-procedural planning.
- To assess the ability of VR to enhance coronary risk assessment during RV-PA conduit interventions.
- To determine if VR improves visualization beyond standard CT imaging.
Main Methods:
- Retrospective analysis of 19 pediatric patients undergoing RV-PA conduit dilation and stenting.
- Generation of high-fidelity 3D VR models from cardiac CT datasets.
- Independent assessment of VR models by two cardiologists to quantify coronary artery compression risk.
Main Results:
- VR-based measurements showed strong inter-operator agreement.
- Cardiologists rated VR superior to CT alone for coronary anatomy visualization and compression risk assessment (p < 0.0001).
- VR model generation was technically successful with intuitive performance and rapid rendering.
Conclusions:
- Patient-specific 3D VR modeling is feasible for planning RV-PA conduit interventions.
- VR offers significant advantages in visualizing complex coronary anatomy and assessing risks.
- VR may improve procedural planning and reduce complications in pediatric cardiac interventions.
Background:
Right ventricle-to-pulmonary artery (RV-PA) conduits are crucial to establishing or restoring RV-PA continuity in children with complex congenital heart disease. Progressive conduit obstruction is common, particularly in growing patients, and may necessitate transcatheter dilation and stenting. One of the major procedural concerns in these cases is the risk of coronary artery compression during stent implantation. This study evaluated the technical feasibility and clinical utility of patient-specific three-dimensional (3D) reconstruction and virtual reality (VR) modeling to enhance pre-procedural planning and coronary risk assessment.
Methods:
This retrospective bi-center feasibility analysis of pediatric patients who underwent evaluation for RV-PA conduit dilation and stenting was conducted at the Sheba and Wolfson Medical Centers, Israel, between January 2018 and September 2022. For 19 eligible patients, cardiac CT datasets were processed to generate high-fidelity 3D VR models. Two independent cardiologists assessed the models, quantified the distances between the conduit and the major coronary arteries before and after simulated balloon expansion, and provided structured qualitative feedback on VR usability.
Results:
VR-based anatomical measurements demonstrated strong inter-operator agreement (intraclass correlation coefficient >0.7 across most parameters). Both cardiologists rated VR significantly superior to CT alone for delineating coronary trajectories and assessing compression risk (mean score 4.58 vs. 3.78, p < 0.0001). VR model generation was technically successful in all cases, with intuitive user interface performance and rapid rendering times.
Conclusions:
Patient-specific 3D VR modeling is technically feasible and provides clinically meaningful advantages for planning RV-PA conduit interventions. VR enhances visualization of complex coronary anatomy beyond what is achievable with standard CT imaging and may support more accurate risk stratification, improved procedural planning, and potentially reduce catheterization-associated complications. These preliminary findings support further prospective evaluation for the integration of VR tools into routine congenital cardiac practice.
