Virtual Reality for surgical and interventional planning for sinus venosus atrial septal defect repair

Background

Surgical correction is the standard of care for sinus venosus atrial septal defects (SVASD). Transcatheter closure has been recently achieved through placement of a coated stent in the SVC in selected patients with favorable anatomy. However, patient's selection stays challenging.

Objectives

We aimed to assess the utility of the Virtual reality (VR) in patient selection for surgical or transcatheter closure.

Methods

7 patients were included with a median age of 50 years (5 adults et 2 infants). Patient-specific cardiac scanner data were obtained to create accurate 3D models of the heart using DICOM to PRINT software (v1.0.3.3038, 3D Systems Inc, USA). Cardiac models were then imported into a VR environment (HTC Vive Pro 2 and SteamVR 2.2.3), allowing exploration of the anatomy in immersive details.

Results

In all patients, VR provided a comprehensive understanding of SVASD anatomy, including its relationship with adjacent structures. In 3 of 5 adult cases, VR allowed for confirmation of the possibility of percutaneous correction without pulmonary vein obstruction by placing the OPTIMUS XXL® stent in the SVC. For the last 2 adults, VR confirmed that the intra-cardiac anatomy was unfavorable for the percutaneous treatment with a risk of pulmonary vein obstruction. These findings were consistent with the multidisciplinary reports for all five patients, which was not known before the simulation (Figure 1, Figure 2, Figure 3).

In the two pediatric cases, it facilitated the choice of surgical technic (tunnelization patch or Warden procedure). Surgeons and cardiologists reported enhanced spatial awareness and improved insight into potential surgical approaches.

Conclusion

VR facilitated interdisciplinary collaboration and seems to be a valuable tool for interventional and surgical planning in SVASD repair due to its ability to provide immersive, patient-specific visualization. Further research is warranted to validate its efficacy in larger cohorts and assess its impact on surgical and interventional outcomes.