Literature Sharing | 3D Printing and VR for Optimizing Preoperative Planning in Double-Outlet Right Ventricle (DORV) Patients
【Introduction】
Double‑Outlet Right Ventricle (DORV) is a complex congenital heart disease in which both the pulmonary artery and the aorta arise primarily from the right ventricle.The highly heterogeneous anatomy makes surgical planning a major clinical challenge.Traditional 2D echocardiography and CT imaging require physicians to mentally reconstruct 3D structures based on extensive experience, which may lead to misjudgments of spatial relationships and compromise treatment outcomes.The combined application of 3D printing and virtual reality (3D-VR) provides a breakthrough solution to this dilemma.Recent studies have confirmed that these two technologies can significantly improve anatomical visualization,raising the consistency rate between preoperative planning and actual surgery to 80%, bringing precision to the diagnosis and treatment of complex DORV.
Source:Peek JJ, Bakhuis W, Sadeghi AH, Veen KM, Roest AAW, Bruining N, van Walsum T, Hazekamp MG, Bogers AJJC. Optimized preoperative planning of double outlet right ventricle patients by 3D printing and virtual reality: a pilot study. Interdiscip Cardiovasc Thorac Surg. 2023 Aug 3;37(2):ivad072. doi: 10.1093/icvts/ivad072. PMID: 37202357; PMCID: PMC10481772.
【Materials and Methods】
Research Design and Subjects:
This was a retrospective pilot study. From 11 patients with complex DORV who had established 3D-printed models, 5 representative cases were selected — these patients covered different DORV subtypes, received different repair surgeries, and the quality of preoperative CT scans (contrast-enhanced CT, maximum slice thickness 0.6 mm) met the requirements for 3D-VR reconstruction.
3D-Printed Model Construction Workflow：
01 Image Processing : DICOM files of the patient’s CT images were collected, anonymized, and imported into professional software.
02 3D-VR Model Reconstruction :The cardiac structures were segmented semi‑automatically using 3D Slicer software, with threshold segmentation, region‑growing algorithms, and manual editing.
03 3D-Printed Model Fabrication : Following a standardized protocol, physical models with key anatomical structures were printed based on CT data, ensuring high dimensional consistency with the native heart.
04 Model Validation : Both types of 3D‑printed models clearly visualized core structures including the ventricular septal defect, great arteries, and valves, meeting the requirements for surgical evaluation.
【Results】
Significant Improvement in Anatomical Visualization
01 Feasibility of patch repair for ventricular septal defect : The 3D-VR model showed a "good" ratio of 92%, the 3D-printed model was 66%, and the 2D images only 46%.
02 Visibility of ventricular septal defect location : 3D-VR model (90%) > 3D printed model (78%) > 2D image (64%)
03 Visibility of major artery relationships : 3D printed models (96%) were slightly better than 3D-VR models (92%), both of which were significantly better than 2D images (78%).
Improved Accuracy and Efficiency in Surgical Planning
01 Increased consistency rate : The agreement rate between surgical plans based on 2D imaging and actual surgery was 66%, which rose to 78% with 3D‑printed models and 80% with 3D‑VR models.
02 Reduced planning time : The median time for planning with 2D imaging was 14 minutes, shortened to 7 minutes with 3D‑VR models, and only 4 minutes with 3D‑printed models.
【Discussion】
Core Advantages:
The greatest advantage of 3D‑printed models lies in their interactivity.Physicians can freely adjust viewing angles and create virtual cutting planes using controllers to clearly observe the spatial relationships of intracardiac structures — this is why they performed best in ventricular septal defect assessment.
Future Perspectives:
With technological advancements, the application of 3D printing in congenital heart disease will be further expanded.In addition to DORV, other complex congenital heart diseases such as pulmonary stenosis and transposition of the great arteries can also benefit from 3D-printed models for optimized treatment.The integration of augmented reality (AR) and mixed reality (MR) is expected to overlay virtual models onto the intraoperative view, enabling real-time navigation.Meanwhile, the incorporation of artificial intelligence may automate image segmentation and reduce model construction time, promoting the widespread adoption of these technologies in routine clinical practice.
【Conclusions】
3D printing and 3D‑VR technologies provide significant added value for preoperative planning in patients with double‑outlet right ventricle (DORV) by improving the visualization of complex anatomical structures.Compared with conventional 2D imaging, both techniques clarify spatial relationships more effectively, increasing the consistency rate between surgical plans and actual operations to 80%, while enhancing planning confidence and reducing planning time.
