Bringing paediatric coronary artery abnormalities into view: the role of virtual reality

Virtual reality (VR) is increasingly being used to present imaging data of congenital cardiac cases for surgical and interventional planning, as well as for education. This study aims to explore the use of VR in illustrating coronary artery anomalies, leveraging its capability for interactive three-dimensional visualization and manipulation.

Seven paediatric cases with coronary artery pathologies were selected, representing both congenital and acquired anomalies. CT coronary angiography datasets were processed using the commercially available VR software Elucis for segmentation and visualization of coronary anatomy.

The study cohort comprised of seven paediatric patients, four infants (aged 2 days-11 months) with cardiac diagnoses of TGA with single coronary origin, ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery), Kawasaki disease with right coronary artery aneurysm, Sinus of Valsalva aneurysm; and three teenagers (aged 13-16 years) with ALCAPA, Kawasaki disease with left anterior descending(LAD) artery aneurysm and Kawasaki disease with obstructed LAD and a LIMA(left internal mammary artery) graft. We were able to depict the coronary artery origins in all 7 cases with VR. Coronary artery aneurysms were well demonstrated in all the Kawasaki cases. Large collaterals in the ALCAPA were well shown by VR. The spatial relationship between the Sinus of Valsalva aneurysm and the coronary arteries were well demonstrated. Teenagers had larger coronaries and segmentation time used was less than that of infants (2 h vs. 1 h).

VR of paediatric coronary anomalies is feasible and provides a practical tool for pre-surgical planning, interventional strategy development, and medical education.