| Objective: To explore the application method and value of 3D printing and virtual reality(VR)and mixed reality(MR)technology in the surgical diagnosis and treatment of complex congenital heart disease(CHD),so as to lay a theoretical and practical foundation for the popularization and standardization of clinical application.Methods: 3D printing was applied to the surgical diagnosis and treatment of multiple complicated congenital heart diseases.The consistency between the 3D printing model and computed tomography(CT)images was compared and analyzed through the measurement of 150 corresponding sites.VR and MR technology were respectively applied to surgical diagnosis and treatment of coronary artery fistula(CAF)/ abnormal origin of coronary arteries(AOOCA)and pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries(PA/VSD/MAPCAs).Through the score(0~10)and evaluation of the surgeons,their application value was analyzed and their application methods,characteristics and limitations were discussedResults: The measurement error of CT image and 3D printed heart model printed by domestic 3D printer was-0.07±0.67 mm,P>0.05,and Pearson correlation coefficient was 0.997,which proved that the error was small and had good consistency.Bland-altman analysis showed that 143/150(95.33%)points were within the consistency threshold and were considered acceptable in clinical practice.The average score of the surgeon for the consistency of the real heart and the 3D printed heart model was 8.83±0.43,indicating a good consistency between them.The average score of the auxiliary diagnosis and treatment for the 3D printed heart model was 8.72±0.67,indicating its high application value.The surgeons agreed that the VR virtual heart model with 4 cases of CAF and 4 cases of AOOCA had a good matching degree with the real heart.The cardiovascular structure shown by VR technology was clear and intuitive,which could assist in accurate preoperative diagnosis and surgical planning.All the 8 cases were successfully operated and discharged from the hospital in good condition.The surgeons also agreed that the MR virtual heart model of 7 cases of PA/VSD/MAPCAs had a good matching degree with real heart.The cardiovascular structure showed by MR technology were clear and straightforward,including MAPCAs,which will help the accurate preoperative diagnosis,surgery planning and intraoperative navigation.In intraoperative navigation,MR technology won 3 cases of 7 and 4 cases of 8 of evaluation,indicating it’s obviously functional.But it also meant that it has room for improvement.All 7 cases underwent unifocalization surgery.Among them,6 cases successfully discharged from the hospital and 1 case died of low cardiac output syndrome,independent of surgical procedures and navigation.Conclusion: 3D printing,VR and MR technologies can accurately,intuitively and clearly reproduce the anatomical structure of complex congenital heart disease in vitro,which can play a positive role in preoperative diagnosis,surgical planning,intraoperative navigation and other aspects of surgical diagnosis and treatment.Each of the three technologies has its own characteristics and needs to be improved.3D printing technology can simulate the actual operation,but both of the printing materials and technology need to be improved.VR technology is characterized by its "endoscopic" perspective to explore the intracardial and intravascular structures,as well as marking the operative points,but the operating tools need to be enriched.The feature of MR technology is that it can superposition the virtual cardiovascular model with the real cardiovascular structure,which plays a unique role in intraoperative navigation.However,the superposition method and effect need to be improved,the operating tools need to be improved,and the display equipment needs to be upgraded. |
PDF Full Text Request