title: Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect.
abstract: BACKGROUND
  This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD).
  
  
  METHODS
  12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg) after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D) images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR) system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility.
  
  
  RESULTS
  All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included.
  
  
  CONCLUSIONS
  This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I-Space VR system limits the applicability in virtual reality 3D echocardiography in clinical practice.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus MC University Hospital, Rotterdam, The Netherlands. g.bolraap@erasmusmc.nl
authors.forename: Goris
authors.initials: G
authors.lastname: Bol Raap
authors.forename: Anton H J
authors.initials: AH
authors.lastname: Koning
authors.forename: Thierry V
authors.initials: TV
authors.lastname: Scohy
authors.forename: A Derk-Jan
authors.initials: AD
authors.lastname: ten Harkel
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: Meijboom
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Peter J
authors.initials: PJ
authors.lastname: van der Spek
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D002675:Child, Preschool; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006696:Holography / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014584:User-Computer Interface