Abstract
Mixed reality (MixR) 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 aimed to explore the feasibility of MixR in enhancing preoperative planning and intraoperative guidance for the correction of various complex congenital heart defects (CHDs). Patients underwent cardiac computed tomography or cardiac magnetic resonance and segmentation of digital imaging and communications in medicine (DICOM) images was performed. Three-dimensional models were then uploaded into a MixR headset (Microsoft HoloLens 2), displayed as holograms, and used for preoperative navigation of cardiac anatomy and intraoperative assistance of surgical steps. We adopted MixR in 5 different clinical scenarios: minimally-invasive partial anomalous pulmonary venous connection repair of 5 anomalous veins; intra-extracardiac Fontan completion in right atrial isomerism and dextrocardia; arterial switch operation for transposition of the great arteries with abnormal coronary pattern in situs inversus; complete unifocalization of major aortopulmonary collateral arteries; total artificial heart implantation for failing Fontan. Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3D navigation. As a result, the surgeon was able to simulate the surgical approach and plan the best surgical strategy. Intraoperatively, MixR provided a real-time virtual map by overlaying holograms onto the patient's anatomy. MixR represents a promising tool for preoperative planning and 3D visualization in complex CHDs, however, its systematic adoption in the intraoperative setting requires further implementation of current hardware technology and software versatility.
Published Version
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