Four-dimensional endocardial surface imaging with dynamic virtual reality rendering: a technical note.

Open heart surgery requires a proper understanding of the endocardial surface of the heart and vascular structures. While modern four-dimensional (4D) imaging enables excellent dynamic visualization of the blood pool, endocardial surface anatomy has not routinely been assessed. 4D image data were post-processed using commercially available virtual reality (VR) software. Using thresholding, the blood pool was segmented dynamically across the imaging volume. The segmented blood pool was further edited for correction of errors due to artifacts or inhomogeneous signal intensity. Then, a surface shell of an even thickness was added to the edited blood pool. When the cardiac valve leaflets and chordae were visualized, they were segmented separately using a different range of signal intensity for thresholding. Using an interactive cutting plane, the endocardial surface anatomy was reviewed from multiple perspectives by interactively applying a cutting plane, rotating and moving the model. In conclusions, dynamic three-dimensional (3D) endocardial surface imaging is feasible and provides realistic simulated views of the intraoperative scenes at open heart surgery. As VR is based on the use of all fingers of both hands, the efficiency and speed of postprocessing are markedly enhanced. Although it is limited, visualization of the cardiac valve leaflets and chordae is also possible.
Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-24-140/coif). The column “Pediatric Heart” was commissioned by the editorial office without any funding or sponsorship. J.P.F. received support from NIH for development of the 4D Cardiac MRI technique used to generate the input image data for this work (No. R01 HL127153-06). He is also a consultant for Covid Pharma from May 2023 on an ad hoc basis, for which he has not yet performed any service or received any fees. The authors have no other conflicts of interest to declare.
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