Emerging 3D technologies and applications within congenital heart disease: teach, predict, plan and guide

Case Report: 3D imaging-assisted minimally-invasive hybrid closure surgery of a complex coronary artery fistulas

Coronary artery fistulas (CAFs) are rare congenital heart defects that are typically managed through interventional closure, traditional surgery, or minimally invasive hybrid closure surgery. However, treating CAFs with complex anatomy, such as tortuous vessels, presents a significant challenge, particularly in young children. We report the case of a 3.8-year-old child (15 kg/100 cm) with a complex CAF, treated using a minimally invasive hybrid closure surgery approach with a 4  ×   4 mm Amplatzer Duct Occluder II (ADO II) (Abbott, USA). Three-dimensional (3D) imaging was utilized to visualize the CAF's anatomy, guide the surgical planning, and accurately determine the puncture site on the right ventricular free wall, as well as the optimal sheath direction and insertion depth. The procedure was carried out efficiently and safely, guided by preoperative 3D imaging and intraoperative transesophageal echocardiography. Follow-up at one year demonstrated excellent outcomes with no complications.

Editorial: Celebrating Diversity and Advancements in Pediatric Cardiology-A Journey through Specialized Research

The field of pediatric cardiology is as vast and diverse as the young patients it serves (Figure 1) [...].

Extended Reality International Grand Rounds: An Innovative Approach to Medical Education in the Pandemic Era

PROBLEM

While bedside training has always presented its own unique challenges, the COVID-19 pandemic era has intensified barriers to suitable provider and trainee experiences for both patient care and medical education.

APPROACH

This project introduced an innovative solution with the Extended Reality International Grand Rounds, a collaboration between the University of Michigan Center for Medical and Surgical Extended Reality and Imperial College London. Three complex cases were presented to trainees through a wireless, extended reality (XR) headset and augmented by holographic visual aids and expert commentary. This pilot rounding experience was performed through the first-person view of one clinician at the bedside.

OUTCOMES

In 2020, 140 attendees participated in XR International Grand Rounds, and 82 (59%) and 61 (44%) completed pre- and postsurveys, respectively. Survey analysis showed that the majority of respondents (65, 79.3%) had very little to no baseline experience with XR technologies and nearly all (75, 91.5%) agreed that the development and implementation of XR curricula are important in medical training, indicating an unmet need. Nearly all respondents (59, 96.7%) found value in the ability to visualize patients' clinical findings in the XR rounding experience and 60 (98.4%) found value in the ability to visualize patient-specific imaging and test findings in an XR format. Limiting exposure to high-risk patients and care team members with this innovative format was believed to be important to 79 (96.3%) respondents at baseline and that perception was unchanged following the event.

NEXT STEPS

This solution to a long-standing dilemma, newly stressed by a unique era in medicine, was a successful collaboration using state-of-the-art XR technology. Next steps will include introducing more advanced physical exam visualization and detection and comprehensive evaluation of the patient experience, as well as expanding the international experience in a format that is scalable to other interested institutions.

Simulation of Cardiac Flow under the Septal Defect Based on Lattice Boltzmann Method

In this paper, the lattice Boltzmann method was used to simulate the cardiac flow in children with aseptal defect. The inner wall model of the heart was reconstructed from 210 computed tomography scans. By simulating and comparing the cardiac flow field, the pressure field, the blood oxygen content, and the distribution of entropy generation before and after an operation, the effects of septal defect on pulmonary hypertension(PH), cyanosis, and heart load were analyzed in detail. It is found that the atrial septal defect(ASD) of the child we analyzed had a great influence on the blood oxygen content in the pulmonary artery, which leads to lower efficiency of oxygen binding in the lungs and increases the burden on the heart. At the same time, it also significantly enhanced the entropy generation rate of the cardiac flow, which also leads to a higher heart load. However, the main cause of PH is not ASD, but ventricular septal defect (VSD). Meanwhile, it significantly reduced the blood oxygen content in the brachiocephalic trunk, but rarely affects the blood oxygen contents in the downstream left common carotid artery, left subclavian artery, and descending aorta are not significantly affected by VSD. It causes severe cyanosis on the face and lips.