Development of 3D Visualization Technologies such as Virtual Reality

We have developed a novel mobile cardiac display software, Cardiac Review 3D, to visualize and interactively explore 3D models on a tablet device. We have also adapted this software for use in a shared virtual reality environment. Providers/patients can intuitively manipulate and explore a detailed digital representation of the heart, as well as mark key points on any external or internal surface. This allows realistic clinical decision-making and surgical planning.

  • Olivieri LJ, Zurakowski D, Ramakrishnan K, Su L, Alfares FA, Irwin MR, Heichel J, Krieger A, Nath DS. Novel, 3D Display of Heart Models in the Postoperative Care Setting Improves CICU Caregiver Confidence. World J Pediatr Congenit Heart Surg. 2018 Mar;9(2):206-213

Use of 3D Models for Medical Education and Training

Our lab has been a strong advocate for using 3D models in medical education of congenital heart disease. At Children’s National Hospital, 3D models have been used to teach medical residents and healthcare providers in the inpatient services, in lecture or "just-in-time" training formats. Our research shows that when taught with 3D models, healthcare providers have increased learner satisfaction, which is correlated with longer memory retention.

  • Costello JP, Olivieri LJ, Krieger A, Thabit O, Marshall MB, Yoo SJ, Kim PC, Jonas RA, Nath DS. Utilizing Three-Dimensional Printing Technology to Assess the Feasibility of High-Fidelity Synthetic Ventricular Septal Defect Models for Simulation in Medical Education. World J Pediatr Congenit Heart Surg. 2014 Jun 23;5(3):421-426.
  • Costello JP, Olivieri LJ, Krieger A, Thabit O, Marshall MB, Yoo SJ, Kim PC, Jonas RA, Nath DS. Incorporating Three-Dimensional Printing Into A Simulation-Based Congenital Heart Disease and Critical Care Training Curriculum for Resident Physicians. Congenit Heart Dis. 2014 Nov 11.
  • Olivieri LJ, Su L, Hynes CF, Krieger A, Alfares FA, Ramakrishnan K, Zurakowski D, Marshall MB, Kim PCW, Jonas RA, Nath DS. Just-in-time training using 3D printed cardiac models after congenital cardiac surgery. World Journal for Pediatric and Congenital Heart Surgery. 2016 Mar;7(2):164-8
  • Loke YH, Harahsheh AS, Krieger A, Olivieri LJ. “Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease”. BMC Medical Education. 2017 Mar 11;17(1)54.

Use of 3D Models for Patient Education

We currently have a pilot 3D education program for adolescents with congenital heart disease. In this program, we schedule individual online conference sessions and use adolescents’ specific digital heart model to teach them about their hearts. We have received significant positive feedback and are planning on expanding this program to include adults with congenital heart disease.

Computational Simulation of Heart Disease

3D modeling can also be used to create computational models of blood flow inside the heart. We collaborate with engineers to incorporate computational fluid dynamics in understanding congenital heart disease. This includes studying changes to the heart vessels after congenital heart surgery.

  • Capuano F, Loke YH, Cronin I, Olivieri L, Balaras E. Computational Study of Pulmonary Flow Patterns after Repair of Transposition of Great Arteries. J Biomech Eng. 2019 Mar 5. doi: 10.1115/1.4043034.
  • Loke YH, Capuano F, Mandell J, Cross RR, Cronin I, Mass P, Balaras E, Olivieri LJ. Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation. World J Pediatr Congenit Heart Surg. 2019 Sep;10(5):572-581. doi: 10.1177/2150135119861358.

Computation Simulation to Guide Surgery (Virtual Surgery)

We can use 3D modeling and computer simulation to virtually plan cardiac procedures and cardiac surgery, forming a strong collaboration between cardiologists, engineers and surgeons to create patient-specific grafts that can be implanted. We have published research related to vascular graft implantation in complex heart operations, such as the right ventricle to pulmonary artery conduit placement, Fontan operation or coarctation repair. We have developed a workflow process that allows for virtual planning, simulation and 3D printing of patient-specific grafts that could be implanted into patients.

  • Olivieri L, Krieger K, Chen M, Kim P, Kanter P. 3D Heart Model Guides Complex Stent Angioplasty of Pulmonary Venous Baffle Obstruction in a Mustard Repair of D-TGA. Int J Card. 2014 January. Int J Cardiol. 2014 Mar 15;172(2):e297-8
  • Ong CS, Loke YH, Opfermann J, Olivieri L, Vricella L, Krieger A, Hibino N. “Virtual Surgery for Conduit Reconstruction of the Right Ventricular Outflow Tract.” World J Pediatr Congenit Heart Surg. 2017 May;8(3):391-393.
  • Grant EK, Olivieri LJ. “The Role of 3-D Heart Models in Planning and Executing Interventional Procedures” Can J Cardiol. 2017 Feb 24
  • Siallagan D, Loke YH, Olivieri L, Opfermann J, Ong CS, de Zélicourt D, Petrou A, Daners MS, Kurtcuoglu V, Meboldt M, Nelson K, Vricella L, Johnson J, Hibino N, Krieger A. Virtual surgical planning, flow simulation, and 3-dimensional electrospinning of patient-specific grafts to optimize Fontan hemodynamics. J Thorac Cardiovasc Surg. 2017 Dec 5.
  • Aslan S, Loke Y, Mass P, Nelson K, Yeung E, Johnson J, Opfermann J, Matsushita, Inoue T, Halperin H, Olivieri L, Hibino N, Krieger A. “Design and Simulation of Patient-Specific Tissue-Engineered Bifurcated Right Ventricle-Pulmonary Artery Grafts using Computational Fluid Dynamics”. IEEE, November 12, 2019.
  • Kim B, Loke, Y, Stevenson, F, Siallagan D, Mass, P, Opfermann J, Hibino N, Olivieri L, Krieger A. “Virtual Cardiac Surgical Planning Through Hemodynamics Simulation and Design Optimization of Fontan Grafts” MICCAI, October 2019
  • Yeung E, Inoue T, Matsushita H, Opfermann J, Mass P, Aslan S, Johnson J, Nelson K, Kim B, Olivieri L, Krieger A, Hibino N. “In vivo implantation of 3-dimensional printed customized branched tissue engineered vascular graft in a porcine model.” J Thorac Cardiovasc Surg. 2019 Oct 9.

Flow Loop Experimentation in the MRI

Simulation results from computational fluid dynamics should be validated with benchtop testing. For pediatric cardiology, this can be done by setting up “flow loops,” a series of tubes connected to a pump that can recreate realistic pressure and flow conditions of blood through large vessels. We have leveraged our experience in 3D printing to develop a flow loop that can generate realistic flow rates over 3D-printed heart vessels. Additionally, the flow loop can be scanned in the cardiac MRI suite such that we can investigate complex flow patterns in large blood vessels of the heart.

3D Cardiac Review: A Medical Modeling App