CONGRESS ABSTRACT

Objective: Virtual reality (VR) is becoming widely available in the medical field. Its application in surgery is not always clear and straightforward. However, in complex anatomical and uncommon situations, it may be decisive in visualizing preoperatively the surgical scenario, analyse and move through different anatomical planes and ultimately plan the most secure surgical technique.     Methods: We took advantage of a VR platform for the preoperative assessment of a complex third redo surgery with the diagnosis of a massive chronic pseudoaneurysm of the left ventricle. Due to the complex anatomy of the lesion and unclear point of origin on simple 2D CT scan, we employed an advanced 3D reconstruction software to plan surgical exclusion.    Results: The 47-year-old patient, who had previously undergone two mitral valve replacement surgeries for rheumatic valve disease, was referred to our institution for a massive pseudoaneurysm of the LV, arising from the mitral valve annulus. Upon routine preoperative workup imaging, the clear point f origin of the pseudoaneurysm could not be identified with certainty, therefore virtual reality was employed. The patient underwent reintervention, through median sternotomy. The previously implanted mechanical ball-in-cage prosthesis was removed, and without excessive time loss, the hole on the ventricular side of the annulus, at the level of the anterolateral commissure, was clearly visible and perfectly reflected the preoperative reconstructions. The entry-point was completely excluded with a heterologous pericardial patch and a new 27mm mechanical prosthesis was implanted. Pre-discharge CT scan showed complete exclusion of the pseudoaneurysm, with effective and direct closure of the only orifice, identified with the help of 3D VR reconstruction.    Conclusions: VR in cardiac surgery becomes of incredible importance in preoperative planning of complex cases, as it allows visualization of cardiac anatomy and permits sectioning/cutting through different volume reconstructions to identify the best surgical option, without damaging otherwise healthy and vital structures.