{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:22:20Z","timestamp":1786652540107,"version":"build-2736575974"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T00:00:00Z","timestamp":1666569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Royal Perth Hospital Imaging","award":["#SGA0010421"],"award-info":[{"award-number":["#SGA0010421"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Understanding the anatomical features and generation of realistic three-dimensional (3D) visualization of congenital heart disease (CHD) is always challenging due to the complexity and wide spectrum of CHD. Emerging technologies, including 3D printing and mixed reality (MR), have the potential to overcome these limitations based on 2D and 3D reconstructions of the standard DICOM (Digital Imaging and Communications in Medicine) images. However, very little research has been conducted with regard to the clinical value of these two novel technologies in CHD. This study aims to investigate the usefulness and clinical value of MR and 3D printing in assisting diagnosis, medical education, pre-operative planning, and intraoperative guidance of CHD surgeries through evaluations from a group of cardiac specialists and physicians. Two cardiac computed tomography angiography scans that demonstrate CHD of different complexities (atrial septal defect and double outlet right ventricle) were selected and converted into 3D-printed heart models (3DPHM) and MR models. Thirty-four cardiac specialists and physicians were recruited. The results showed that the MR models were ranked as the best modality amongst the three, and were significantly better than DICOM images in demonstrating complex CHD lesions (mean difference (MD) = 0.76, p = 0.01), in enhancing depth perception (MD = 1.09, p = 0.00), in portraying spatial relationship between cardiac structures (MD = 1.15, p = 0.00), as a learning tool of the pathology (MD = 0.91, p = 0.00), and in facilitating pre-operative planning (MD = 0.87, p = 0.02). The 3DPHM were ranked as the best modality and significantly better than DICOM images in facilitating communication with patients (MD = 0.99, p = 0.00). In conclusion, both MR models and 3DPHM have their own strengths in different aspects, and they are superior to standard DICOM images in the visualization and management of CHD.<\/jats:p>","DOI":"10.3390\/biom12111548","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T06:37:45Z","timestamp":1666593465000},"page":"1548","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Clinical Applications of Mixed Reality and 3D Printing in Congenital Heart Disease"],"prefix":"10.3390","volume":"12","author":[{"given":"Ivan","family":"Lau","sequence":"first","affiliation":[{"name":"Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashu","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Fiona Stanley Hospital, Perth, WA 6150, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Ihdayhid","sequence":"additional","affiliation":[{"name":"Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia"},{"name":"Department of Cardiology, Fiona Stanley Hospital, Perth, WA 6150, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7538-4761","authenticated-orcid":false,"given":"Zhonghua","family":"Sun","sequence":"additional","affiliation":[{"name":"Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00246-017-1586-9","article-title":"Piloting the use of patient-specific cardiac models as a novel tool to facilitate communication during clinical consultations","volume":"38","author":"Biglino","year":"2017","journal-title":"Pediatr. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1093\/ejcts\/ezx208","article-title":"Three-dimensional printed models for surgical planning of complex congenital heart defects: An international multicentre study","volume":"52","author":"Valverde","year":"2017","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"621672","DOI":"10.3389\/fped.2021.621672","article-title":"3D modeling and printing in congenital heart surgery: Entering the stage of maturation","volume":"9","author":"Yoo","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7136","DOI":"10.1038\/s41598-022-11294-6","article-title":"Comparison of blood pool and myocardial 3D printing in the diagnosis of types of congenital heart disease","volume":"12","author":"Liang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/icvts\/ivy160","article-title":"Utility of a super-flexible three-dimensional printed heart model in congenital heart surgery","volume":"27","author":"Hoashi","year":"2018","journal-title":"Interact. CardioVascular Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1177\/2150135117745005","article-title":"Novel, 3D display of heart models in the postoperative care setting improves CICU caregiver confidence","volume":"9","author":"Olivieri","year":"2018","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s11845-017-1564-5","article-title":"The role of 3D printing in preoperative planning for heart transplantation in complex congenital heart disease","volume":"186","author":"Smith","year":"2017","journal-title":"Ir. J. Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/j.jcmg.2020.06.024","article-title":"Incremental value of 3D printing in the preoperative planning of complex congenital heart disease surgery","volume":"14","author":"Yang","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Loke, Y.-H., Harahsheh, A.S., Krieger, A., and Olivieri, L.J. (2017). Usage of 3D models of tetralogy of Fallot for medical education: Impact on learning congenital heart disease. BMC Med. Educ., 17.","DOI":"10.1186\/s12909-017-0889-0"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jtcvs.2016.08.007","article-title":"Scan, plan, print, practice, perform: Development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery","volume":"153","author":"Hermsen","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sun, Z., Lau, I., Wong, Y.H., and Yeong, C.H. (2019). Personalized three-dimensional printed models in congenital heart disease. J. Clin. Med., 8.","DOI":"10.3390\/jcm8040522"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lau, I.W.W., and Sun, Z. (2019). Dimensional accuracy and clinical value of 3D printed models in congenital heart disease: A systematic review and meta-analysis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091483"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lau, I., Gupta, A., and Sun, Z. (2021). Clinical value of virtual reality versus 3D printing in congenital heart disease. Biomolecules, 11.","DOI":"10.3390\/biom11060884"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Sun, Z. (2020). Clinical applications of patient-specific 3D printed models in cardiovascular disease: Current status and clinical applications. Biomolecules, 10.","DOI":"10.3390\/biom10111577"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1002\/ccd.25810","article-title":"3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia","volume":"85","author":"Valverde","year":"2015","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/ase.2105","article-title":"Criss-cross heart three-dimensional printed models in medical education: A multicentre study on their value as a supporting tool to conventional imaging","volume":"15","author":"Valverde","year":"2022","journal-title":"Anat. Sci. Educ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"022","DOI":"10.31083\/j.rcm2301022","article-title":"The role of 3D printed heart models in immediate and long-term knowledge retention in medical education","volume":"23","author":"Lau","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1007\/s00270-019-02257-y","article-title":"Simulation of endovascular aortic repair using 3D printed abdominal aortic aneurysm model and fluid pump","volume":"42","author":"Karkkainen","year":"2019","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/PRS.0000000000005215","article-title":"Effective application of mixed reality device holoLens: Simple manual alignment of surgical field and holograms","volume":"143","author":"Mitsuno","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1111\/bjet.13049","article-title":"HoloLens and mobile augmented reality in medical and health science education: A randomised controlled trial","volume":"52","author":"Moro","year":"2021","journal-title":"Br. J. Educ. Technol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"633611","DOI":"10.3389\/fcvm.2021.633611","article-title":"Cinematic rendering in mixed reality holograms: A new 3D preoperative planning tool in pediatric heart surgery","volume":"8","author":"Gehrsitz","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_22","first-page":"193","article-title":"Computer-assisted transcatheter heart valve implantation in valve-in-valve procedures","volume":"11","author":"Soulami","year":"2016","journal-title":"Innovations"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jcct.2017.09.013","article-title":"Feasibility and safety of augmented-reality glass for computed tomography-assisted percutaneous revascularization of coronary chronic total occlusion: A single center prospective pilot study","volume":"11","author":"Opolski","year":"2017","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_24","unstructured":"Microsoft (2021, October 03). HoloLens 2 Fundamentals: Develop Mixed Reality Applications. Available online: https:\/\/docs.microsoft.com\/en-us\/learn\/paths\/beginner-hololens-2-tutorials\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.crad.2020.10.017","article-title":"Mixed-reality hologram for diagnosis and surgical planning of double outlet of the right ventricle: A pilot study","volume":"76","author":"Ye","year":"2021","journal-title":"Clin. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100077","DOI":"10.1016\/j.yjbinx.2020.100077","article-title":"Use of mixed reality for surgery planning: Assessment and development workflow","volume":"112","author":"Kumar","year":"2020","journal-title":"J. Biomed. Inform."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1093\/ehjci\/jey184","article-title":"Mixed reality holograms for heart surgery planning: First user experience in congenital heart disease","volume":"20","author":"Brun","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_28","unstructured":"Microsoft (2022, August 19). Spatial awareness getting started\u2014MRTK2. 8 March 2022. Available online: https:\/\/docs.microsoft.com\/en-us\/windows\/mixed-reality\/mrtk-unity\/mrtk2\/features\/spatial-awareness\/spatial-awareness-getting-started?view=mrtkunity-2022-05."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"843","DOI":"10.2174\/1573405617666210218102046","article-title":"Investigation of three-dimensional printing materials for printing aorta model replicating type B aortic dissection","volume":"17","author":"Wu","year":"2021","journal-title":"Curr. Med. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Wu, C.A., Squelch, A., Jansen, S., and Sun, Z. (2021). Optimization of computed tomography angiography protocols for follow-up type B aortic dissection patients by using 3D printed model. Appl. Sci., 11.","DOI":"10.3390\/app11156844"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sun, Z., and Wee, C. (2022). 3D printed models in cardiovascular disease: An exciting future to deliver personalized medicine. Micromachines, 13.","DOI":"10.3390\/mi13101575"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10278-021-00553-z","article-title":"Vascular 3D printing with a novel biological tissue mimicking resin for patient-specific procedure simulations in interventional radiology: A feasibility study","volume":"35","author":"Kaufmann","year":"2022","journal-title":"J. Digit. Imaging"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lee, S., Squelch, A., and Sun, Z. (2021). Quantitative assessment of 3D printed model accuracy in delineating congenital heart disease. Biomolecules, 11.","DOI":"10.3390\/biom11020270"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e0194333","DOI":"10.1371\/journal.pone.0194333","article-title":"Clinical value of patient-specific three-dimensional printing of congenital heart disease: Quantitative and qualitative assessments","volume":"13","author":"Lau","year":"2018","journal-title":"PLoS ONE"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"15301","DOI":"10.1016\/j.jtcvs.2016.12.054","article-title":"Hands-on surgical training of congenital heart surgery suing 3-dimensional print models","volume":"153","author":"Yoo","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_36","first-page":"Doc23","article-title":"3D-printed heart models for hands-on training in pediatric cardiology-the future of modern learning and teaching?","volume":"39","author":"Brunner","year":"2022","journal-title":"GMS J. Med. Educ."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e10295","DOI":"10.2196\/10295","article-title":"Three-dimensional portable document format (3D PDF) in clinical communication and biomedical sciences: Systematic review of applications, tools and protocols","volume":"6","author":"Newe","year":"2018","journal-title":"JMIR Med. Inform."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Newe, A., Becker, L., and Schenk, A. (2014). Application and evaluation of interactive 3D PDF for presenting and sharing planning results for liver surgery in clinical routine. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0115697"}],"container-title":["Biomolecules"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-273X\/12\/11\/1548\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:01:31Z","timestamp":1760144491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-273X\/12\/11\/1548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,24]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["biom12111548"],"URL":"https:\/\/doi.org\/10.3390\/biom12111548","relation":{},"ISSN":["2218-273X"],"issn-type":[{"value":"2218-273X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,24]]}}}