3-D hearts: Technology helps doctors diagnose and treat heart patients
Emmanuell Ellis has had a heart defect since he was born, undergoing surgeries as a baby and again as a teenager.
But it wasn’t until last month, when he was getting prepared for another procedure at Nationwide Children’s Hospital in Columbus, Ohio, that the 30-year-old Lima man finally understood just what was causing the problem.
The eye-opener came when Dr. Darren Berman pulled out a transparent, flexible model of Ellis’ heart, showing the two tubular grafts used to reconstruct his aorta and the calcium that had built up to cause severe narrowing in those tubes.
“That helped out a lot,” said Ellis, who was treated as part of a Nationwide Children’s program for adults born with heart disease. “For me to see it, as plain as it was, it was right there in front of me.”
The model, made on a 3-D printer and based on CT images of Ellis’ heart, is an example of the way radiologists and surgeons are teaming up to use technology to diagnose and treat heart patients at Nationwide Children’s.
Models are made in the hospital’s $350,000 3-D printing lab, which opened about a year ago. There, a team translates 2-D ultrasound, CT or MRI images into 3-D images, which are then used to create programs that tell the printer how to form replicas of patients’ hearts.
“It creates not only a pretty model to look at, but allows us to pre-procedurally plan what we think is best for that patient,” said Berman, who co-directs the cardiac catheterization and interventional therapy program at Nationwide Children’s Heart Center.
In Ellis’ case, Berman used the model to come up with a plan to use four stents to reopen the grafts. He also was able to practice the procedure, determining ahead of time how the stents would react to the calcium build-up.
“Three-D printing is not necessarily needed on every single patient,” Berman said, “but it plays an important role in the most complex hearts, where we and everybody else in the country and the world still struggle with what is the right decision-making for that patient.”
Three-D printing is the “next generation of medicine,” said Dr. Kan Hor, director of cardiac MRI at the Heart Center. It got its start in the dental industry and has become more common in other areas over the past five years, he said. Children’s hospitals tend to use it more because pediatric heart-disease cases can be unique or vary widely from one child to another.
Nationwide Children’s decision to create its own lab has helped increase accuracy and reduce the time it takes to get a model produced, said Amy Tipton, coordinator of advanced cardiac imaging and analysis. The move also cuts per-model costs, which can run as high as $2,000 for a typical outsourced heart, Hor said.
In-house models generally range in the hundreds of dollars, with the hospital funding the work, said Dr. Jayanthi Parthasarathy, who manages the 3-D printing lab.
The printer takes several hours to create the models and can use different materials and colors. Using silicon-based materials, it builds the models in layers, each thinner than a hair, said Brad Hoehne, 3-D printing and conference coordinator.
The next step is to improve on the materials, to make the models as close to human tissue as possible. In Ellis’ model, for example, two materials were used — a more flexible material for the tubing and a harder one to represent the calcium build-up.
Dealing with heart disease used to be primarily about saving lives, Berman said. But now it’s more about giving heart patients the best quality of life possible, and minimizing the potential for future operations. Models can assist surgeons in achieving those goals, by helping them do things properly the first time or giving them an opportunity to determine innovative ways to fix problems, he said.
As an example, he showed a model that came from a 4-month-old girl who had a large hole between her heart’s two lower ventricles. Doctors preparing for the girl’s surgery used a catheter to place a circular metal device to block the hole in the model.
The practice helped them determine what they needed to get to the hole, by using a different route from what was initially planned.
“We saw a much better, clearer route to get that hole closed,” Berman said. “The pre-procedural planning that comes from it was fantastic.”
Though cardiology has been the traditional focus of 3-D models, other departments are slowly getting on board.
At Nationwide Children’s, it has been used to create brain models to help neurologists pinpoint and treat lesions that cause epileptic seizures, and to create spine models to help orthopedic surgeons treat scoliosis, said Parthasarathy, who has been involved with 3-D printing for about 20 years.
Models also have been created to guide pelvic reconstruction, facial surgeries, the correction of deformities and post-trauma reconstructions. Parthasarathy even has a model that was used to help surgeons determine how best to separate conjoined twins.
“It’s been amazing really,” she said. “The last five years, I’ve seen the whole gamut of applications.”
— JoAnne Viviano writes about health and medicine for The Columbus (Ohio) Dispatch. Email her at firstname.lastname@example.org or follow her on Twitter at @JoAnneViviano.