Clinical Application of Three-dimensional Printing and Extended Reality in Congenital Heart Disease

This PhD study investigates the clinical role of the two emerging techniques, which are 3D printing and virtual reality, to improve the visualisation and surgical planning of congenital heart disease. This research findings show that both of these technologies can enhance the users’ perception on the spatial relationship of the heart structures and defects, and therefore improving the management of congenital heart disease

Use of extended realities in cardiology

Recent miniaturization of electronic components and advances in image processing software have facilitated the entry of extended reality technology into clinical practice. In the last several years, the number of applications in cardiology has multiplied, with many promising to become standard of care. We review many of these applications in the areas of patient and physician education, cardiac rehabilitation, pre-procedural planning and intraprocedural use. The rapid integration of these approaches into the many facets of cardiology suggests that they will one day become an every-day part of physician practice

Preparing for the future of cardiothoracic surgery with virtual reality simulation and surgical planning:a narrative review

Background and Objective: Virtual reality (VR) technology in cardiothoracic surgery has been an area of interest for almost three decades, but computational limitations had restricted its implementation. Recent advances in computing power have facilitated the creation of high-fidelity VR simulations and anatomy visualisation tools. We undertook a non-systematic narrative review of literature on VR simulations and preoperative planning tools in cardiothoracic surgery and present the state-of-the-art, and a future outlook. Methods: A comprehensive search through MEDLINE database was performed in November 2022 for all publications that describe the use of VR in cardiothoracic surgery regarding training purposes, education, simulation, and procedural planning. We excluded papers that were not in English or Dutch, and that used two-dimensional (2D) screens, augmented, and simulated reality. Key Content and Findings: Results were categorised as simulators and preoperative planning tools. Current surgical simulators include the lobectomy module in the LapSim for video assisted thorascopic surgery which has been extensively validated, and the more recent robotic assisted lobectomy simulators from Robotix Mentor and Da Vinci SimNow, which are increasingly becoming integrated into the robotic surgery curriculum. Other perioperative simulators include the CardioPulmonary VR Resuscitation simulator for advanced life support after cardiac surgery, and the VR Extracorporeal Circulation (ECC) simulator for perfusionists to simulate the use of a heart-lung machine (HLM). For surgical planning, there are many small-scale tools available, and many case/pilot studies have been published utilising the visualisation possibilities provided by VR, including congenital cardiac, congenital thoracic, adult cardiac, and adult thoracic diseases. Conclusions: There are many promising tools becoming available to leverage the immersive power of VR in cardiothoracic surgery. The path to validate these simulators is well described, but large-scale trials producing high-level evidence for their efficacy are absent as of yet. Our view is that these tools will become increasingly integral parts of daily practice in this field in the coming decade.</p

Translating computational modelling tools for clinical practice in congenital heart disease

Increasingly large numbers of medical centres worldwide are equipped with the means to acquire 3D images of patients by utilising magnetic resonance (MR) or computed tomography (CT) scanners. The interpretation of patient 3D image data has significant implications on clinical decision-making and treatment planning. In their raw form, MR and CT images have become critical in routine practice. However, in congenital heart disease (CHD), lesions are often anatomically and physiologically complex. In many cases, 3D imaging alone can fail to provide conclusive information for the clinical team. In the past 20-30 years, several image-derived modelling applications have shown major advancements. Tools such as computational fluid dynamics (CFD) and virtual reality (VR) have successfully demonstrated valuable uses in the management of CHD. However, due to current software limitations, these applications have remained largely isolated to research settings, and have yet to become part of clinical practice. The overall aim of this project was to explore new routes for making conventional computational modelling software more accessible for CHD clinics. The first objective was to create an automatic and fast pipeline for performing vascular CFD simulations. By leveraging machine learning, a solution was built using synthetically generated aortic anatomies, and was seen to be able to predict 3D aortic pressure and velocity flow fields with comparable accuracy to conventional CFD. The second objective was to design a virtual reality (VR) application tailored for supporting the surgical planning and teaching of CHD. The solution was a Unity-based application which included numerous specialised tools, such as mesh-editing features and online networking for group learning. Overall, the outcomes of this ongoing project showed strong indications that the integration of VR and CFD into clinical settings is possible, and has potential for extending 3D imaging and supporting the diagnosis, management and teaching of CHD

Perceived impact on siblings of having a brother or sister with congenital heart disease

Background: Survival rates for children with congenital heart disease have increased. However, many of these children are now living with increased co-morbidities. Contemporary healthcare promotes home care, and this is being provided by children’s families. Siblings of children with congenital heart disease are often unintentionally overlooked in research and family centred care strategies. Having a sibling with congenital heart disease affects siblings too, the extent and perceived impact remain unknown. Aim: To explore perceived impact on children and young people of having a sibling with congenital heart disease. Methods: Guided by a family advisory group and Bronfenbrenner’s bio-ecological systems theory, a mixed methods sequential exploratory study design was used for this exploratory research and integrated findings are reported. The population was children and young people who had a brother/sister with congenital heart disease, aged 8-17 years old, living in the UK. Phase one involved virtual semi-structured interviews (n=17) exploring experiences. The Pictorial Representation of Self and Illness tool was used to allow visual demonstration of perceived impact. Phase one data were analysed using reflexive thematic analysis. Phase two involved questionnaires (n=52) in which Resilience, Interpersonal perceptions, Intrapersonal relationships, Fear and Communication were measured using two validated scales, the Sibling Perception Questionnaire and Child and Youth Resilience Measure. Results: Five themes were identified from phase one: My life looks different, Always you before me, My role in our family, Effects on me and moving forward and How COVID-19 changed things for me. In phase two high levels of resilience were demonstrated but communication, intrapersonal perception and intrapersonal relationships could be strengthened and level of fear about the illness could be reduced to improve outcomes. Integrated findings suggest relationships, peer support, communication, information, and inclusion of siblings at home and in hospital were vital recommendations for practice. Contribution to knowledge: This is the first study to utilise a mixed methods design and Bronfenbrenner’s bio-ecological systems theory to gain a holistic view of the perceived impact on siblings of having a brother or sister with congenital heart disease, from a sibling’s perspective. Virtual interviews and online questionnaires helped to gain a broad understanding of the ever-evolving landscape of perceived impact. Whilst findings suggest this population group are generally resilient, interventions focusing on maintaining resilience and supporting positive relationships, communication and inclusion should be developed to support siblings throughout their life course