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Mixed Reality For Preoperative Planning And Intraoperative Assistance Of Surgical Correction Of Complex Congenital Heart Defects
Matteo Ponzoni, MD, Israel Valverde, MD, Christoph Haller, MD, Brandon Peel, BEng, Shi-Joon Yoo, MD, David Barron, MD, Osami Honjo, MD, PhD.
The Hospital for Sick Children, Toronto, ON, Canada.
Objective(s): Mixed reality (MR) is an innovative visualization tool that presents virtual elements in a real-world environment, enabling real-time interaction between the user and the combined digital/physical reality. We herein present two cases demonstrating the potential of MR to enhance preoperative planning and intraoperative assistance for the surgical correction of complex congenital heart defects (CHD).
Methods: The patients underwent ECG-gated computed tomography and segmentation of DICOM images was performed. Tridimensional models were then uploaded into a MR headset (Microsoft HoloLens2) and used for preoperative navigation of cardiac anatomy and intraoperative assistance of surgical steps.
Results: The first patient was a 5-year-old boy with sinus venosus defect (SVD) and partial anomalous pulmonary venous drainage (PAPVD) of five right pulmonary veins into the superior vena cava and right atrium. MR was used preoperatively to identify the five anomalous vein orifices and, intraoperatively, guide their rerouting across the SVD into the left atrium (using a patch) via a right mini-thoracotomy. The second case featured a 3-year-old boy with right atrial isomerism, dextrocardia, double outlet right ventricle palliated with bilateral bidirectional cavopulmonary shunt undergoing Fontan completion. MR allowed the identification of separate orifices for the inferior vena cava and suprahepatic veins into the common atrium, helping design an intra-extracardiac Fontan pathway. Intraoperatively, MR was used to optimize the conduit position to prevent compression of the pulmonary veins.
Conclusions: MR represents a promising tool for preoperative planning in complex CHDs, however, its systematic adoption in the intraoperative setting requires further implementation of current hardware technology.
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