The Value of Three-dimensional Echocardiographic Virtual Endoscopy for the Diagnosis of Congenital Heart Disease in Children: A Novel Visualization Technique Using Virtual Reality

  • Hai-Hong Xue, Shanghai Children’s Medical Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, China
  • Kun Sun, Shanghai Children’s Medical Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, China
  • Jian-Guo Yu, Department of Electronic Engineering, Fudan University, Shanghai, China, China
  • Bin-Jin Chen, Department of Electronic Engineering, Fudan University, Shanghai, China, China
  • Guo-Zhen Chen, Department of Pediatric Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, China
  • Wen-Jing Hong, Department of Pediatric Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, China
  • Li-Ping Yao, Department of Pediatric Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, China
  • Lan-Ping Wu, Department of Pediatric Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, China

    • Objective The purpose of this study was to evaluate the feasibility and value of our newly developed three-dimensional echocardiographic intracardiac endoscopic simulation system (3DE IESS) in the diagnosis of congenital heart disease in children. Methods Three experienced pediatric cardiologists blinded to the patients’ diagnoses separately reviewed 40 two-dimensional echocardiographic (2DE) data-sets and 40 corresponding VE datasets, judging whether abnormal intracardiac anatomy was present on a 5-point scale (1=definitely absent; 2=probably absent; 3=cannot determine; 4=probably present; and 5=definitely present). Results Three-dimensional echocardiographic intracardiac endoscopic imaging could be reconstructed successfully by 3DE IESS in all 40 patients. The three observers’ independent examination of 2D and VE datasets provided 162 diagnostic evaluations of each method. The receiver operating characteristic (ROC) curve for VE was closer to the optimal performance point than that for 2DE. The area under the ROC curve was 0.96 for VE and 0.93 for 2DE, respectively. Kappa values (range, 0.73-0.79) for VE and 2DE indicated substantial agreement. Conclusion 3D echocardiographic VE can enhance our understanding of intracardiac structures and provide intuitional, reproducible and clinically useful visualizations. This may open a new door for the diagnosis of congenital heart diseases.
    Keywords: three-dimensional echocardiography, virtual endoscopy, virtual reality, congenital heart disease