Table 1.

Surgical comments on visualization using virtual reality compared with standard 2D and 3D echocardiography

Visualization of the lesion much clearer.

Probably with more complex lesions that are harder to evaluate from 2D and 3D, VR might offer some more understanding; however, with the given case, I thought I've had good understanding from the beginning, so I feel VR only offered more amusement to my experience.

How little the posterior leaflet moves.

Everything just looks clearer and I can manipulate the orientation to my surgical perspective in all directions.

The leaflets looked worse on the VR simulation than what I could understand from the echo. Chord lengthening wouldn't be helpful in this scenario and posterior leaflet patch wouldn't make such a difference. The valve looked maybe too dysplastic for repair, but I'd give a try.

Able to visualize the precise leaflet component that is prolapsing but not able to see the reason, ie, is it chordal rupture?

There is a bigger area of noncoaptation in A1, which I had felt was A2.

I could understand better the leaflet disposition with the VR rather than the echo.

Better visualization of the precise location of the defect.

VR gave me a clearer image and understanding of the LAVV in this particular patient.

Yes. How the different scallops of the MV leaflet move in relation to the cardiac cycle. A2 and P2 close (and open) later.

I could see better the absence of coaptation of both leaflets and the annular dilatation. Prolapse in A1-P1 seemed to me more prominent in VR. Posterior leaflet looked tethered in VR.

2D, 2-Dimensional; 3D, 3-dimensional; VR, virtual reality; LAVV, left atrioventricular valve; MV, mitral valve.