Augmented Reality Application in a Complex Case of Self-Expanding Transcatheter Pulmonary Valve Implantation.

The use of augmented reality (AR) for pre-procedural planning has increased over the past decade, yet its real-time application during complex cardiac interventions remains novel. This case highlights the integration of AR technology during a challenging transcatheter pulmonary valve replacement (TPVR) using a self-expanding system in a pediatric patient. A 12-year-old male with a history of congenital pulmonary valve stenosis presented with progressive right ventricular dilation and exercise intolerance. Dynamic CTA was processed via ARTICOR® software (Artiness, Milano, Italy) and visualized through the Microsoft HoloLens for intraprocedural support. During initial balloon sizing, unexpected waist formation raised concern for wire malposition. AR visualization enabled identification of native leaflet avulsions/perforations previously unrecognized on conventional imaging. With this insight, successful wire repositioning and repeat balloon sizing were achieved, allowing for the accurate valve deployment. This case demonstrates the feasibility and clinical utility of AR-guided procedural support in complex TPVR. Real-time 3D visualization holds significant promise for improving safety and precision in congenital heart interventions.