Immersive Three-Dimensional Visualization as a Routine Tool for Complex Congenital Cardiac Surgical Planning: A Perspective

Complex congenital cardiac surgery demands precise three-dimensional (3D) spatial understanding, yet preoperative planning continues to rely predominantly on two-dimensional (2D) image interpretation. Contemporary cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are volumetric by design, but their value is constrained by how data are ultimately converted into shared spatial understanding. The growing availability of CT-based segmentation, virtual reality (VR) visualization, and three-dimensional printing offers a practical means to externalize patient-specific anatomy into manipulable, immersive representations. Current evidence, though modest and largely single-centre, consistently shows that 3D models can faithfully represent complex anatomy and that clinicians repeatedly report improved comprehension of spatial relationships through their use. In this perspective, we argue for a deliberate, case-selected approach to 3D image visualization in complex congenital cardiac surgery, identify the human and institutional factors that determine real-world utility beyond hardware and software alone, and propose criteria for systematic adoption. Prospective outcome data are needed; in their absence, thoughtful incorporation of these tools into surgical planning workflows represents a clinically rational approach.