Virtual reality for preoperative planning in large ventricular septal defects

We present the case of an 18 month-old-boy and 7 kg with diagnosis of a large inlet-type ventricular septal defect (VSD) with anterior extension to the perimembranous septum palliated with a pulmonary artery band at the age of 4 months. The large size of the VSD created doubts concerning the uni- or biventricular approach. Current-traditional imaging was not conclusive. A 3D virtual reality model (VR-model) of the cardiovascular anatomy based on magnetic resonance imaging (MRI) images was created. Virtual reality model provided unique views for comprehensive and full perception of the relative size of the VSD compared to the entire ventricular mass septum and its relationships with the other cardiac structures which are not achievable by current imaging technique. It allowed movement, magnification, and 360° rotation of the VR-model to improve the analysis of all the structures (Supplementary material online, Videos S1 and S2). The 3D surgical simulation concluded that VSD closure may be possible. There was a precise correlation between the VR-model (Panels A–C) and the intraoperative surgeon’s view (Panels D and E). A Dacron patch was successfully placed with no residual defects on follow-up imaging (* in Panel F). We present the first case to demonstrate the advantages of VR in a case of large VSD. It is a new tool that can be invaluable for the surgeon as a complement to conventional imaging in cases of complex CHD. Comparison showing the precise correlation between VR (Panels A–C) and reality (Panels D–F) ATL, anterior tricuspid leaflet; LH, left hand; PTL, posterior tricuspid leaflet; RH, right hand; RVOT, right ventricular outflow tract; STL, septal tricuspid leaflet.