Young patients with congenital heart disease are living longer as a result of breakthroughs in treatment, but many still face a multitude of physically traumatic open-heart surgeries as they grow into adulthood. The Smidt Heart Institute's congenital heart team is pioneering ways to ease the burden of such procedures by combining hybrid approaches to care with 3-D technology.
A key challenge facing physicians is the limited number of treatment options available to young congenital heart patients suffering from pulmonary dysfunction after open-heart surgery. Just 15 percent of cases can use the only available pulmonary valve repair procedure, the Melody Transcatheter Pulmonary Valve. For everyone else, open-heart surgery typically has been the only choice.
Doctors in the Guerin Family Congenital Heart Program are harnessing 3-D imaging and printing technology to make the less-invasive transcatheter valve technology available for more patients.
The 3-D printer emits layer upon layer of a thin, clear plastic material. Using precise specifications, it yields a perfectly reconstructed model of a patient's heart or valve.
"We can take any imaging modality, such as CT scans or MRIs, and from that data create 3-D images that are remarkably accurate in terms of dimension, geometry and size," said Evan Zahn, who directs Pediatric Cardiology. "With these models, we can literally work out where gaps need to be filled and where we might need to use stents and other devices to create an ideal 'landing zone' for the valve in complex patients."
The congenital heart surgical and interventional teams are using the 3-D imaging in combination with a hybrid approach that uses techniques from interventional cardiology combined with a less-invasive surgical approach.
Successes resulting from the hybrid approach include using a catheter to place a valve in the right ventricle of a patient with tetralogy of Fallot — a condition caused by a combination of four heart defects present at birth. The teams used the patient's MRI scan to create a 3-D reconstruction of his right ventricle and outflow tract. The model allowed the team to simulate the hybrid approach and avoid the need for open-heart surgery and a cardiopulmonary bypass.
"We hope to make these less-invasive techniques more accessible as our patients live longer," Zahn said.