STATE OF THE ART ARTICLE
Role of virtual reality in congenital heart disease
Chin Siang Ong MBBS
Aravind Krishnan BA
Chen Yu Huang PhD
Philip Spevak MD
Luca Vricella MD
Narutoshi Hibino MD PhD
Juan R. Garcia MA, CCA
Lasya Gaur MD
Division of Cardiac Surgery, Johns Hopkins
Hospital, Baltimore, MD, USA
Department of Art as Applied to Medicine,
Johns Hopkins School of Medicine,
Baltimore, MD, USA
Division of Pediatric Cardiology, Johns
Hopkins Hospital, Baltimore, MD, USA
Lasya Gaur, MD, Pediatric Cardiology, 1800
Orleans Street M2321, Johns Hopkins
Children’s Center, Baltimore MD 21230.
Ministry of Science and Technology
(Taiwan) Postdoctoral Research Abroad
Program, Grant/award Number: 105-2917-
I-564-003-A1 (CYH); American Heart
Association Predoctoral Fellowship, Grant/
award Number: 17PRE33670481 (CSO);
Tan Kah Kee Foundation Postgraduate
Scholarship, 2017 (CSO)
Objective: New platforms for patient imaging present opportunities for improved surgical planning
in complex congenital heart disease (CHD). Virtual reality (VR) allows for interactive manipulation
of high-resolution representations of patient-specific imaging data, as a supplement to traditional
2D visualizations and 3D printed heart models.
Design: We present the novel use of VR for the presurgical planning of cardiac surgery in two
infants with complex CHD to demonstrate interactive real-time views of complex intra and extra-
Results: The use of VR for cardiac presurgical planning is feasible using existing imaging data. The
software was evaluated by both pediatric cardiac surgeons and pediatric cardiologists, and felt to
be reliable and operated with a very short learning curve.
Conclusions: VR with controller-based interactive capability allows for interactive viewing of 3D
models with complex intra and extracardiac anatomy. This serves as a useful complement to
traditional preoperative planning methods in terms of its potential for group based collaborative
discussion, user defined illustrative views, cost-effectiveness, and facility of use.
cardiac surgery, congenital diaphragmatic hernia, congenital heart disease, truncus arteriosus,
ventricular septal defect, virtual reality
Virtual reality (VR) is broadly defined as a three-dimensional (3D) simu-
lation of the real-world, with the ability for a user to interact directly
with the simulation.
VR integrates imaging data and user input into a
unified graphical output, often onto a wearable technology like a
Originally, VR flourished in the gaming community, though
its use in medicine dates back to the early 1990s.
In its earliest
applications to biomedicine, VR was largely applied to the behavioral
though the advent of “controllers,” or sensors that track hand
position and movements in real time have vastly expanded the ability to
interact with the virtual space and thus its applications to surgery.
Presently, VR is widely used in medicine, from stroke rehabilitation,
tools for trainees to learn how to perform laparoscopic surgery.
This interactive rendered 3D environment of VR lends itself well
to congenital heart disease (CHD), as surgical planning involves careful
presurgical discussion of often widely varying and nuanced structural
heart disease. Planning of surgical patch or baffle placement, conduit
sizing, placement of surgical cannulae, or approach (in cases of cardiac
malposition) can vary by patient. Utility of a 3D modality beyond tradi-
tional echocardiographic and cross-sectional imaging is currently under-
scored by the rise in 3D printing.
In pediatric cardiology and cardiac
surgery, the use of VR is emerging. In published literature, VR was used
to construct a training tool for minimally invasive surgery.
this method lacked the ability to interact with the heart nor could it
provide interactive sectioning or 4-chamber views.
Juan R. Garcia and Lasya Gaur contributed equally to this study.
Congenital Heart Disease. 2018;13:357–361. wileyonlinelibrary.com/journal/chd
2018 Wiley Periodicals, Inc.
Received: 21 December 2017
Revised: 24 December 2017
Accepted: 29 December 2017