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4D Cardiac CT-derived Anatomic Digital Twins Influence Surgical Planning In Complex Congenital Heart Disease
Matthew Bramlet, MD1, Mark Plunkett, MD2, Reid Jockisch, MS2, Connor Davey, BA2, Bradley P. Sutton, PhD3.
1University of Illinois, Peoria, IL, USA, 2OSF HealthCare, Peoria, IL, USA, 3University of Illinois, Champaign-Urbana, IL, USA.
Objective(s):This study evaluated whether dynamic patient-specific 4-dimensional cardiac computed tomography-derived anatomic digital twins improve surgeon understanding and influence operative planning in complex congenital heart disease.
Methods:A retrospectively gated cardiac computed tomography dataset from a complex congenital heart disease case was reconstructed across 19 phases of the cardiac cycle to generate a patient-specific 4-dimensional heart model. Automated myocardial segmentation was performed using a deep learning workflow and converted into sequential 3-dimensional models for immersive virtual reality review. Four congenital cardiac surgeons independently completed standard preoperative planning using conventional imaging before separate reevaluation with the dynamic model. Changes in operative reasoning and confidence were assessed.
Results:All participating surgeons demonstrated changes in operative reasoning, confidence, or both after interaction with the dynamic model. Temporal reconstruction of sequential cardiac phases improved surgeon mental representation of the relationship between the ventricular septal defect, tricuspid valve tissue, and potential baffle pathway. Following 4-dimensional review, 3 of 4 surgeons independently changed their preferred operative strategy from 2-ventricle repair toward bidirectional Glenn palliation based on concerns regarding baffle feasibility and atrioventricular valve interference. The remaining surgeon incorporated an alternative operative contingency into family counseling. Subsequent operative findings confirmed these concerns, and bidirectional Glenn palliation was ultimately performed.
Conclusions:
Dynamic patient-specific 4-dimensional cardiac computed tomography anatomic digital twins improved surgeon understanding of complex congenital heart anatomy and influenced operative planning. Continued institutional investment in scalable 3-dimensional and 4-dimensional modeling workflows may support broader clinical adoption of patient-specific digital planning tools in congenital heart disease.
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