Quantitative membranous septum area assessment with advanced three-dimensional CT visualization with a mixed reality-capable device

Introduction Permanent pacemaker implantation rates remained elevated for patients receiving transcatheter aortic valve implantation for aortic stenosis and aortic regurgitation. Therefore, detailed assessment of the membranous septum anatomy is essential to understand mechanism and mitigate risk. This study aims to examine the accuracy and reproducibility of a novel 3D hologram system to measure transcatheter aortic valve implantation related aortic valvar complex anatomy and present a novel methodology to measure membranous septum area with it. Methods Cardiac computer tomography series of aortic stenosis, aortic regurgitation and coronary artery disease patient cohorts were analysed using CarnaLife Holo (MedApp SA, Kraków, Poland) so as to quantify and compare their membranous septum areas. 3mensio Structural Heart was used as a benchmark comparator, with annulus area selected as the quantitative parameter. Results Intraclass correlation coefficient values between the software all exceeded 0.99, with no statistically significant difference noted between annulus area measurements. Bland-Altman plotting illustrated narrow boundaries of agreement, with no significant outliers. In interobserver agreement analysis for 3D hologram, annulus area measurements were not significantly different between two investigators (p=0.906). No significant difference was found between the membranous septum areas between the three cohorts after ANOVA testing (p=0.1640). Conclusion 3D holographic software provides feasible and reproducible tool for visualising and measuring the aortic valvar complex anatomy. In addition, its ability to assess the shape, pattern and area of the membranous septum offers anatomic insights not readily available with other software.