A new technology for a novel clinical approach in a dog with a complex vascular anomaly: the "extended reality"

Abstract

Extended reality includes both virtual and augmented realities. In virtual reality objects are rendered in an artificial environment where the user can move and interact with a head mounted display. In augmented reality virtual objects are superimposed to real environment enriching it via a head mounted display. In human medicine these technologies have been already used for educational surgical purposes, but remain relatively unknown in veterinary medicine. We report a case of a 1-year-old, female, French bulldog presented for exercise intolerance and dyspnea. Echocardiography showed signs of left ventricular enlargement with reduced fractional shortening and turbulent flow distal to the pulmonary artery bifurcation. Computed tomography revealed a complex vascular network comprising the descending aorta and left pulmonary artery resembling a patent ductus arteriosus. Virtual reality was used for the surgical planning and a left thoracotomy was performed to close the abnormal vessel at the level of the entrance in the left pulmonary artery with augmented reality assistance. No complications were reported during or after the surgery and the dog completely recovered. Echocardiographic findings 3 days, 1 month and 18 months after the surgery demonstrated absence of residual flow and improving ventricular dimensions. To our knowledge this report documents the first use of extended reality for the visualization, planning and execution of the surgical correction of a complex vascular defect in veterinary medicine.

Keywords: Augmented reality; Canine; Cardiology; Vascular surgery; Virtual reality.

Fig. 1

Echocardiographic images of the shunting vessel. a Colour doppler aside B-mode image from modified left parasternal view showing an abnormal blood flow in the pulmonary artery. b Spectral Doppler through the apparent ostium revealed continuous blood flow. PA, Pulmonary Artery; Ao, Aorta

Fig. 2

Computed tomographic images contrast enhanced showing the abnormal intrathoracic vessels. a Abnormal contrast medium flowing in the left pulmonary artery (red arrow) and vascular network around the oesophagus (blue arrow) are evident. b One of three abnormal intercostal arteries arising from the descending aorta (red arrow). PA, Pulmonary Artery; Ao, Aorta; Oe, Oesophagus

Fig. 3

3D-reconstruction model of the dorsal (a) and oblique (b) aspects of the main intrathoracic vessels arising from the base of the heart. Note the complex vascular network on the right of the descending aorta (yellow arrow), three anomalous intercostal arteries (green arrows), and the abnormal vessel connected to the left pulmonary artery but not to the aorta (black arrow)

Fig. 4

The surgeon wearing the head-mounted display (Hololens) during the procedure while manipulating the augmented reality model by hand gestures

Fig. 5

Post-surgical TC scan showing the ligation point at the pulmonary bifurcation (red arrow)