Anatomy Of Heart Research Articles

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review.

Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.

Kiosk 5R-FA-06 - Evaluation of Deep Learning Estimation of Whole Heart Anatomy FBom Automated Cardiovascular Magnetic Resonance Short- and Long-axis Analyses in UK Biobank

Kiosk 5R-FA-06 - Evaluation of Deep Learning Estimation of Whole Heart Anatomy FBom Automated Cardiovascular Magnetic Resonance Short- and Long-axis Analyses in UK Biobank

Fuzzy Attention U-Net Architecture Based Localization and YOLOv5 Detection for Fetal Cardiac Ultrasound Images

The importance of early identification of congenital heart disease is highlighted by the fact that it accounts for around 28% of all congenital abnormalities this is the primary reason why fetus die. The necessity of having a thorough understanding of normal cardiac architecture has been highlighted by the quick advancements in fetal heart imaging techniques that have occurred in recent years. Without this information, it is challenging, even impossible, to distinguish the many manifestations of congenital heart illness. This research suggests an immediate fetal cardiac identification technique employing US pictures with the You Only Look Once v5 (YOLOv5) framework and localization using Fuzzy Attention U-Net (FAU-Net) framework in order to enhance the interpretation of the anatomy of the fetal heart through Ultrasound (US) for precise and instantaneous diagnoses. Localization is accomplished using a FU-Net architecture, which limits the training set to image-level plane labels. This is a crucial component of the proposed study since, for big datasets, it would take too much time to produce bounding box annotations, which are not always captured. The FAU-Net design has been optimized for best performance. The YOLOv5 framework is built to function in real-time and deliver the best results for object identification. With the aid of appropriate fine-tuning, it may function effectively to automatically identify tiny fetal cardiac objects in a fast phase. Depending on how much of a detection overlapped with ground-truth bounding boxes, it was determined if it was a genuine positive or a false positive. This research primarily aids medical professionals in the diagnosis of fetal cardiac anatomy. The efficiency of the outcomes is evaluated using metrics including accuracy, memory, average precision (AP), mean average precision (mAP), and F-measure.

Hugely Dilated Atria Distorting Normal Heart Anatomy

Hugely Dilated Atria Distorting Normal Heart Anatomy

Development of a three-dimensional computer model of the equine heart using a polyurethane casting technique and in vivo contrast-enhanced computed tomography

Introduction/objectivesInsight into the three-dimensional (3D) anatomy of the equine heart is essential in veterinary education and to develop minimally invasive intracardiac procedures. The aim was to create a 3D computer model simulating the in vivo anatomy of the adult equine heart. AnimalsTen horses and five ponies. Materials and methodsTen horses, euthanized for non-cardiovascular reasons, were used for in situ cardiac casting with polyurethane foam and subsequent computed tomography (CT) of the excised heart. In five anaesthetized ponies, a contrast-enhanced electrocardiogram-gated CT protocol was optimized to image the entire heart. Dedicated image processing software was used to create 3D models of all CT scans derived from both methods. Resulting models were compared regarding relative proportions, detail and ease of segmentation. ResultsThe casting protocol produced high detail, but compliant structures such as the pulmonary trunk were disproportionally expanded by the foam. Optimization of the contrast-enhanced CT protocol, especially adding a delayed phase for visualization of the cardiac veins, resulted in sufficiently detailed CT images to create an anatomically correct 3D model of the pony heart. Rescaling was needed to obtain a horse-sized model. ConclusionsThree-dimensional computer models based on contrast-enhanced CT images appeared superior to those based on casted hearts to represent the in vivo situation and are preferred to obtain an anatomically correct heart model useful for education, client communication and research purposes. Scaling was, however, necessary to obtain an approximation of an adult horse heart as cardiac CT imaging is restricted by thoracic size.

Right heart remodeling and outcomes of patients with tricuspid regurgitation

Abstract Background Albeit long neglected, significant (at least moderate, ≥ 2+) tricuspid regurgitation (TR) is currently known to be associated with increased mortality, and has thus become a relevant therapeutic target [1-3]. Recent and somewhat preliminary evidence has shown, however, that different subtypes of TR might respond differently to current therapeutic options [4-5]. In fact, secondary TR, rather than being a single entity, can develop because of either right ventricular (RV) remodelling (i.e functional TR) or tricuspid annulus (TA) dilation secondary to right atrial (RA) dilation (i.e isolated TR). Purpose The aim of this meta-analysis was to study the association between right heart remodeling and long-term all-cause mortality in a population of patients with significant TR, independent of the treatment option. Methods MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to July 2022. Studies reporting data on at least one echocardiographic RV anatomic and/or functional parameter and outcome in patients with significant TR were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was long-term all-cause mortality. Results Out of 3152 studies, a total of 14 were included in the final analytic synthesis, enrolling 4394 subjects. The median follow-up was 33 [24–51] months. Overall, long-term all-cause mortality was 31% (95% confidence interval [CI]: 20-41%, p = <0.001; Figure 1); however, a significant difference was noted in the medical subgroup vs. the surgery subgroup (43% [32-53%] vs 11% [20-41%]). By means of a meta-regression analysis, a significant and inverse relation was found between tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV-FAC) and mortality (11 studies enrolling 3551 subjects, coefficient -0.063 [-0.111 to -0.014], p = 0.011; 9 studies, 2975 subjects, coefficient -0.044 [-0.059 to -0.029], p < 0.001, respectively; Figure 2A and 2B), whereas a significant and concordant relation was found between TA dimension, RA area and mortality (7 studies, 2986 subjects, coefficient 0.003 [0.002 to 0.005], p < 0.001; 6 studies, 1920 subjects, coefficient -0.019 [-0.025 to -0.013], p < 0.001, respectively; Figure 2C and 2D). Conclusions The higher mortality associated with right ventricular dysfunction and reduced mortality with increasing right atrial dilatation suggest a better prognostic outcome for isolated TR than functional TR. Careful assessment of right heart anatomy and function is warranted, as it might foster the identification of different subtypes of TR with unique prognoses.Forest plot all-cause mortalityResult of the meta-regression analysis

EP24.36: Normal anatomy of the human fetal heart, its chambers and septums as a morphological basis for its ultrasound examination

EP24.36: Normal anatomy of the human fetal heart, its chambers and septums as a morphological basis for its ultrasound examination

The Right Heart in Congenital Heart Disease.

To analyze the pathophysiologic importance of the right heart in different types of congenital heart disease (CHD), summarize current diagnostic modalities, and discuss treatment options. The right ventricle (RV) plays a key role in disease progression and prognosis, either as the subpulmonary or as the systemic ventricle. Volume and/or pressure overload as well as intrinsic myocardial disease are the main factors for RV remodeling. Echocardiography and cardiac magnetic resonance imaging are important noninvasive modalities for assessing anatomy, size, and function of the right heart. Timely repair of related lesions is essential for preventing RV dysfunction. Few inconclusive data exist on conventional pharmacotherapy in CHD-related RV dysfunction. Cardiac resynchronization therapy and ventricular assist devices are an option in patients with advanced systemic RV failure. Right heart disease is highly related with adverse clinical outcomes in CHD. Research should focus on early identification of patients at risk and development of medical and interventional treatments that improve RV function.

Fetal Third-Trimester Functional Cardiovascular Abnormalities and Neonatal Elevated Bilirubin Level.

The aim of the study was to analyze the neonatal outcomes of fetuses with diagnosed functional cardiovascular abnormalities, also considering the connection with neonatal hyperbilirubinemia. It was an observational study of 100 neonates who had fetal echocardiography examinations in the third trimester (mean gestational age during the last echocardiography was 34 ± 3 weeks and mean birth weight was 3550 g). There were two groups: A: normal heart anatomy + no functional anomalies; group B: normal heart anatomy + functional abnormalities. Hyperbilirubinemia was defined as a bilirubin level of >10 mg%. In group A, there were 72 cases and only 5 cases despite having normal heart anatomy and normal heart study that presented additional problems. In group B (28 cases), the prenatal functional findings included tricuspid regurgitation (TR) (15 cases, 53%), pericardial effusion (4 cases, 14%), myocardial hypertrophy (4 cases, 14%), cardiomegaly (2 cases, 7%), abnormal bidirectional blood flow across the foramen ovale (3 cases, 11%), aneurysm of atrial septum (2 case, 7%), abnormal E/A ratio for mitral and tricuspid valve (1 case, 3%), bright spot (3 case, 11%), abnormal Doppler flow in ductus arteriosus compared to aortic arch (difference >60 cm/s) (1 case, 3%), supraventricular tachycardia (SVT) (1 case), and mitral regurgitation (1 case, 3%). In group A (n = 72 cases), bilirubin levels of >10 mg/dL were observed in 8% of newborns. In group B (n = 28), bilirubin levels of > 10 m/dL were observed in 46% of cases and TR was present in group B in 53% of cases (15/28 cases). The difference between group A and B in terms of elevated bilirubin levels was statistically significant (p < 0.001). In the case of fetal normal heart anatomy and normal heart study, a good neonatal outcome may be expected. When fetal cardiovascular functional abnormalities in normal heart anatomy are detected, with special attention paid to tricuspid valve regurgitation, a neonatal elevated bilirubin level (mean 11 mg/dL, range 10-15 mg/dL) may be expected.

A Hybrid Model for Cardiac Perfusion: Coupling a Discrete Coronary Arterial Tree Model with a Continuous Porous-Media Flow Model of the Myocardium.

This paper presents a novel hybrid approach for the computational modeling of cardiac perfusion, combining a discrete model of the coronary arterial tree with a continuous porous-media flow model of the myocardium. The constructive constrained optimization (CCO) algorithm captures the detailed topology and geometry of the coronary arterial tree network, while Poiseuille's law governs blood flow within this network. Contrast agent dynamics, crucial for cardiac MRI perfusion assessment, are modeled using reaction-advection-diffusion equations within the porous-media framework. The model incorporates fibrosis-contrast agent interactions and considers contrast agent recirculation to simulate myocardial infarction and Gadolinium-based late-enhancement MRI findings. Numerical experiments simulate various scenarios, including normal perfusion, endocardial ischemia resulting from stenosis, and myocardial infarction. The results demonstrate the model's efficacy in establishing the relationship between blood flow and stenosis in the coronary arterial tree and contrast agent dynamics and perfusion in the myocardial tissue. The hybrid model enables the integration of information from two different exams: computational fractional flow reserve (cFFR) measurements of the heart coronaries obtained from CT scans and heart perfusion and anatomy derived from MRI scans. The cFFR data can be integrated with the discrete arterial tree, while cardiac perfusion MRI data can be incorporated into the continuum part of the model. This integration enhances clinical understanding and treatment strategies for managing cardiovascular disease.

Fetal Cardiac Hemodynamic and Sonographic Anomalies in Maternal COVID-19 Infection Depending on Vaccination Status-Polish Multicenter Cohort Study.

Most obstetrical studies have focused on maternal response to the SARS-CoV-2 virus but much less is known about the effect of COVID-19 on fetal physiology. We aimed to evaluate the effect of the maternal SARS-CoV-2 infection on the fetal homeostasis with the use of detailed ultrasonography and echocardiography and consideration of the effect of vaccination. This was a multi-center study of fetuses who had prenatal detailed ultrasound and echocardiographic examinations performed by fetal cardiology specialists. The subjects were divided based on the COVID vaccination status (vaccinated women who did not have COVID-group V, unvaccinated women who had COVID-group UV, and unvaccinated women who did not have COVID-control group). We evaluated the ultrasound and echocardiography results obtained. The study group included 237 gravidas from four prenatal cardiology centers. In the group of fetuses with normal heart anatomy, normal cardiovascular function had 147 (81%) fetuses and functional cardiovascular anomalies were present in 35 (19%) cases. Functional cardiovascular anomalies were present in 11 (16%) fetuses in the V group, 19 (47%) fetuses in the UV group and 5 (8%) fetuses in the control group (p < 0.01). There were 56 (24%) fetuses with extracardiac anomalies. Extracardiac anomalies were present in 20 (22%) fetuses in the V group, 22 (45%) fetuses of the UV group and in 14 (14%) fetuses in the control group (p < 0.01). Our study has proved that maternal COVID-19 infection can affect the fetal physiology and mild cardiac and extracardiac markers detected by fetal ultrasonography and echocardiography. Moreover, maternal vaccination results in lower occurrence of these findings in fetuses.

Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns.

Peripheral perfusion index has been proposed as a possible method for detecting circulatory impairment. We aimed to determine the normal range of peripheral perfusion index in healthy newborns and compare it with that of newborns with CHD. Right-hand saturation and right-hand peripheral perfusion index levels were recorded, and physical examination and echocardiography were performed in newborns who were 0-28 days old and whom were evaluated in our paediatric cardiology outpatient clinic. The saturation and peripheral perfusion index levels of newborns with normal heart anatomy and function were compared with those of newborns with CHD. Out of 358 newborns (238 mature and 75 premature) enrolled in the study, 39 had CHD (20 mild CHD, 13 moderate CHD, and 6 severe CHD), of which 29 had CHD with left-to-right shunting, 5 had obstructive CHD, and 5 had cyanotic CHD. No newborn had clinical signs of hypoperfusion or heart failure, such as prolonged capillary refill, weakened pulses, or coldness of extremities. Peripheral perfusion index level was median (interquartile range) 1.7 (0.6) in healthy newborns, 1.8 (0.7) in newborns with mild CHD, and 1.8 (0.4) in newborns with moderate and severe CHD, and there was no significant difference between the groups regarding peripheral perfusion index level. Peripheral perfusion index remains unchanged in newborns with CHD without the clinical signs of hypoperfusion or heart failure. Larger studies with repeated peripheral perfusion index measurements can determine how valuable this method will be in the follow-up of newborns with CHD.

Cell to whole organ global sensitivity analysis on a four-chamber heart electromechanics model using Gaussian processes emulators.

Cardiac pump function arises from a series of highly orchestrated events across multiple scales. Computational electromechanics can encode these events in physics-constrained models. However, the large number of parameters in these models has made the systematic study of the link between cellular, tissue, and organ scale parameters to whole heart physiology challenging. A patient-specific anatomical heart model, or digital twin, was created. Cellular ionic dynamics and contraction were simulated with the Courtemanche-Land and the ToR-ORd-Land models for the atria and the ventricles, respectively. Whole heart contraction was coupled with the circulatory system, simulated with CircAdapt, while accounting for the effect of the pericardium on cardiac motion. The four-chamber electromechanics framework resulted in 117 parameters of interest. The model was broken into five hierarchical sub-models: tissue electrophysiology, ToR-ORd-Land model, Courtemanche-Land model, passive mechanics and CircAdapt. For each sub-model, we trained Gaussian processes emulators (GPEs) that were then used to perform a global sensitivity analysis (GSA) to retain parameters explaining 90% of the total sensitivity for subsequent analysis. We identified 45 out of 117 parameters that were important for whole heart function. We performed a GSA over these 45 parameters and identified the systemic and pulmonary peripheral resistance as being critical parameters for a wide range of volumetric and hemodynamic cardiac indexes across all four chambers. We have shown that GPEs provide a robust method for mapping between cellular properties and clinical measurements. This could be applied to identify parameters that can be calibrated in patient-specific models or digital twins, and to link cellular function to clinical indexes.

Ejection Fraction Estimation from Echocardiograms Using Optimal Left Ventricle Feature Extraction Based on Clinical Methods.

Echocardiography is one of the imaging systems most often utilized for assessing heart anatomy and function. Left ventricle ejection fraction (LVEF) is an important clinical variable assessed from echocardiography via the measurement of left ventricle (LV) parameters. Significant inter-observer and intra-observer variability is seen when LVEF is quantified by cardiologists using huge echocardiography data. Machine learning algorithms have the capability to analyze such extensive datasets and identify intricate patterns of structure and function of the heart that highly skilled observers might overlook, hence paving the way for computer-assisted diagnostics in this field. In this study, LV segmentation is performed on echocardiogram data followed by feature extraction from the left ventricle based on clinical methods. The extracted features are then subjected to analysis using both neural networks and traditional machine learning algorithms to estimate the LVEF. The results indicate that employing machine learning techniques on the extracted features from the left ventricle leads to higher accuracy than the utilization of Simpson's method for estimating the LVEF. The evaluations are performed on a publicly available echocardiogram dataset, EchoNet-Dynamic. The best results are obtained when DeepLab, a convolutional neural network architecture, is used for LV segmentation along with Long Short-Term Memory Networks (LSTM) for the regression of LVEF, obtaining a dice similarity coefficient of 0.92 and a mean absolute error of 5.736%.

P12: Mechanical Characterization of Synthetic Tissues for Cardiac Surgical Training

Background: Synthetic heart models are commonly used for surgical training, especially for complex procedures. However, current models are expensive and poorly mimic heart tissue mechanics and anatomy. 3D printing unconventional materials can produce more realistic models at a more affordable price; therefore, this study investigates the potential of several 3D printed materials as a synthetic tissue for surgical heart models. Methods: Three synthetic cardiac tissues were fabricated: hydrogel samples (3Dresyn SAE1) on a Form2 laser printer, soft polymer samples (3Dresyn SEA10) on a Form2 laser printer, and silicone samples (Dragon Skin Fast 10A) on an Eazao Zero liquid deposition printer. Synthetic tissues were compared to fresh bovine cardiac tissues in terms of puncture resistance, suture retention, and tensile strength using an AEL universal testing machine and 20N PCE Instruments force gauge. Results: There are no significant differences between the mechanical properties of cardiac tissue and the hydrogel-printed SAE1 samples according to ANOVA with a Tukey’s HSD test (Fig1A). There are significant differences between the SEA10 soft polymer sample and cardiac tissue for the puncture and tension tests, but not for the suture retention test (Fig1A). All mechanical test results are significantly different between the 10A silicone and cardiac samples (Fig1A). An example heart is printed with the hydrogel material to demonstrate usability (Fig1B). Conclusion: The 3D printed hydrogel samples better matched the mechanical properties of cardiac tissue than the other printed samples. Although the hydrogel material proved adequate for surgical simulation, other synthetic tissues should be explored to reduce the cost and time of printing, and to better mimic cardiac tissue.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

Cardiac digital twins of the adult population: linking electrophysiological functions to anatomy

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This project is supported by the Wellcome Trust and EPSRC Centre for Medical Engineering. Background QRS duration derived from 12-lead ECGs provides an estimate of the ventricular depolarization time and is an important metric to assess cardiac function. The QRS duration is determined in part by the combination of heart size and conduction velocity (CV). Differences in QRS duration in terms of gender, body mass index (BMI) and age have been well-documented, however, the relative impact of concurrent changes in heart size and CV on QRS duration is poorly understood. Cardiac digital twins, as in-silico replicas, provide a non-invasive physics and physiology-constrained framework to separate the impact of CV and heart anatomy on the QRS duration across populations. Purpose This study aims to identify the impact of CV and heart size on differences in QRS duration and quantify their difference in the general population in different groups of gender, BMI and age. Methods Patient-specific biventricular models (n=400) were constructed using long- and short-axis cardiac magnetic resonance (CMR) images from patients without self-reported cardiovascular diseases in the UK Biobank. Cardiac electrophysiology was simulated using a physiological-detailed model that includes fiber orientation, anisotropic conductivity, the His-Purkinje system activation, and fast endocardial conductivity[1]. 12-lead ECGs were reconstructed from the simulations and the QRS duration was computed based on corresponding vectorcardiogram (VCG) reconstructed from ECG data [2]. We calibrated patient-specific CVs to match the clinically measured QRS duration in ECGs at rest and then compare the heart size, QRS duration and estimated CVs for different patient groups. Results QRS duration was approx. 7% longer in males than females (median: 90ms vs 84ms, P&amp;lt;0.001). Consistent with a longer QRS duration in males had larger hearts (male: 165.5 mL vs 123 mL, P&amp;lt;0.001), while the median CVs were the same between genders (both: 0.594 m/s). QRS duration was longer for obese (BMI≥30) and overweight group compared to healthy (BMI&amp;lt;25) groups (88ms and 86 ms vs 84 ms, P=0.05 and 0.3). Again, the change in QRS duration with BMI was reflected with a corresponding increase in heart size (healthy: 127 mL, overweight: 147.6 mL, obese:160 mL), while CV remained unchanged (healthy: 0.58 m/s vs overweight and obese: 0.594 m/s, P=0.051 and 0.32). There was no significant difference in QRS duration, CV or myocardial volume for different age groups (medians: 86-88 ms and 0.573-0.594 m/s and 138.7-143 mL). Conclusions QRS duration is shorter in females and individuals with healthy weights. Most of the change in QRS duration can be explained by heart size, with the estimated CV remaining consistent across groups.

Zero or near-zero x-ray pacemaker implantation in paediatric patients. dream or reality?

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Transvenous implantation of pacemaker is performed with fluoroscopy for leads’ insertion and implantation in the heart. This implies radiation exposure for patients and operators. Fluoroscopy allows a two-dimensional view of lead movements, and sometimes it is difficult to implant lead in the complex heart anatomy, or in alternative right ventricular (RV) pacing sites, that often requires higher radiation doses. These alternative pacing sites may prevent pacing-induced ventricular dysfunction. They are his bundle pacing area (HBP), ventricular septum close to the conduction system area (VS), RV outflow tract (RVOT). The use of three-dimensional-electroanatomic mapping system (3D-EAM) may reduce fluoroscopy and guide lead implantation. Published median fluoroscopy data for similar procedure are: 6 mGy (1), 13 mGy and 231 microGy/m2 (2). Purpose of this study is to seek out if a 3D-EAM-guided transvenous implantation into RV alternative sites pacing in paediatric patients can be accomplished with zero or near-zero X-rays. Methods Retrospective analysis of children and adolescents with congenital or acquired (idiopathic) complete atrioventricular block (CAVB) without other congenital heart defects who underwent 3D-EAM-guided pacing in alternative RV sites. The implant procedure was divided in 4 steps: 1-contrast venography; 2- 3D mapping: with a steerable catheter (femoral vein), the 3D-EAM acquired geometric reconstruction of the right heart and a pacing map identified RV sites with narrower paced QRS; 3-axillary vein puncture; 4-lead and pacemaker implantation: 3D-EAM guided stylet-directed screw-in lead implantation toward desired RV sites. Data are reported as median (25th-75th centiles). Results 54 CAVB patients (42 females), underwent 3D EAM-guided pacing (27 VVIR, 27 DDD) at age 11.5 (7.7-14) years, weight 42 (26-54) kg. Pacing sites were: 10 HBP, 4 RVOT, 40 VS (Figure 1). Procedure time was 170 (143-193) min, total fluoroscopy exposure and that of the 4 steps are reported in Table 1. The lowest exposures were: 0.2 mGy, 8 microGy/m2 (VVIR) and 0.6 mGy, 15 microGy/m2 (DDD). Paced QRS was 115 (100-120) ms. Conclusions 3D-EAM-guided alternative RV pacing sites was accomplished with very low fluoroscopic exposure, close to zero in some cases. Therefore, with 3D-EAM we can significantly reduce radiological doses also in difficult pacing procedures in paediatric patients, thus reducing radiological risks and preserving ventricular function. The dream is becoming reality.

Does Immersive Virtual Reality with the Use of 3D Holography Improve Learning the Anatomy of the Heart?: Results of a Preliminary Study

Immersive virtual reality with the use of 3D holography is a new method that is being currently introduced for teaching anatomy, yet the actual educational benefits associated with its use remain unclear. Here, we present our preliminary observations and conclusions after the pilot phase of the study on a 3D holographic human heart. The study was conducted on a group of 96 students of medical faculty. Students were randomly divided into two groups: 57 students who were taught anatomy using traditional methods (plastinated human hearts, anatomical models, and atlases) and 39 students who were taught using 3D holographic hearts. Assessment of knowledge retention of the heart anatomy comprised 3 tests, which were performed 1 week and 3 and 6 months after the classes on heart anatomy. We have found that although anatomical classes with the use of immersive virtual reality were attractive for students; still, unsupervised teaching with the use of 3D holograms was not superior to traditional medical education. Differences between the groups in terms of anatomical knowledge retention were not statistically significant. Results of this pilot study suggest that in order to achieve better knowledge retention and understanding of the anatomy of the heart, classes should be precisely planned and strictly supervised by academic teachers. Moreover, students should get familiar with the use of virtual reality goggles before the classes.

The Efficacy of Sildenafil in Children with Uni-Ventricle Congenital Heart Disease Post Bidirectional Cavopulmonary Shunt: An Evidence-Based Case Report

BACKGROUND: Univentricular congenital heart disease (CHD) is an anatomical heart defect where one of the ventricles does not develop. Management of univentricular defects is performed gradually; bidirectional cavopulmonary shunt (BCPS) is one of the surgical approaches conducted before the definite treatment in the Fontan procedure. Therefore, the average rate of pulmonary artery pressure and vasculature resistance is critical factors in determining good post-surgical outcomes. However, studies exploring the evidence that sildenafil administration can reduce pulmonary pressure in patients with univentricular defects are currently limited. AIM: This evidence-based case report aims to investigate whether sildenafil administration toward post-BCPS patients reduces mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) before undergoing the Fontan procedure. METHODS: Available evidence was screened through four databases in PubMed, Cochrane, Embase, and ProQuest on October 9, 2022. The keywords used were (((((single Ventricle) OR univentricular heart) AND BCPS) OR Glenn) AND sildenafil) AND hemodynamic. A result of three cohorts and one clinical trial was identified and critically appraised. RESULTS: Analytical testing of the two studies by Park I and Jeremiasen et al. shows that sildenafil significantly reduces mPAP from 19.5 ± 5.5 mmHg to 14.3 ± 3.0 mmHg (p = 0.023) and from 19 mmHg (SD = 3) to 14 mmHg (SD = 2) (p &lt; 0.01). The studies from Hill KD and Mori et al. illustrate that sildenafil significantly reduces the PVR index by as much as 24% (p &lt; 0.01) and from 3.2 ± 0.5 wood unit to 1.6 ± 0.6 wood unit (p &lt; 0.0001). CONCLUSION: The administration of sildenafil decreases pulmonary artery pressure and vasculature resistance in post-BCPS pediatric patients, allowing patients to undergo the Fontan procedure.