Oct 21, 2015 | Tarek Alsaied, MD
Education

Recently, one of my patients received his fourth surgery for congenital heart disease (CHD). He was born with tricuspid atresia, was treated through the single ventricle repair pathway and underwent an atrio-pulmonary Fontan procedure in the 1980s. He had a very large atrium with refractory intra-atrial re-entry tachycardia and an intracardiac thrombus that was growing in size. This put him at a high risk for stroke and pulmonary edema given his single ventricle physiology.

The decision was made to do a Fontan conversion and maze procedure at that same time. Given his complex anatomy, the surgeons and the electrophysiologists utilized a 3-D printed model for his heart that allowed for a virtual surgery before his actual surgical day. We are pleased that he did very well postoperatively, with a smooth course so far.

Over the last few years, 3-D printing technology has become routine in industry with increased application in the medical field. In pediatric cardiology, the use of 3-D printing has increased significantly, and almost every regional or national meeting last year included a presentation or two that discussed the use of this novel technology.

The process of 3-D printing includes specialized software that converts the data from digital images (mostly computerized tomography [CT] and magnetic resonance images [MRI]) into a 3-D digital model. A segmentation process separates the heart from the surrounding tissues. When the digital 3-D model is ready, it is sent to the 3-D printer. The 3-D printer creates the model by laying down successive layers of material until a model of the entire heart is created. Each of these layers can be seen as a thinly sliced cross-section of the eventual object.

Potential useful applications for 3-D printing include cases of aortic arch obstruction to clarify the arch anatomy, and double outlet right ventricle to clarify the location of the ventricular septal defect and the relationship of the great arteries. 3-D printing has a potential role in the management of any complex CHD, including procedures like the maze procedure for cases of atrial fibrillation with CHD.

3-D printing in CHD has also been used for medical education to teach medical students, pediatric residents, and cardiology and intensive care fellows about different types of CHDs. Learners have reported great improvement in their understanding after the use of 3-D models.

A major part of our current knowledge in congenital heart disease is taken from native pathologic samples. As the samples are getting older and as we repair most children with complex congenital heart disease in the current era, 3-D printing will be a great tool to archive and reproduce many of these samples.

3-D printing may also provide a very valuable educational tool for families of children with CHD to achieve a better understanding of their child's condition. This may improve their participation in their child's care and improve the outcomes.

The availability of the 3-D printing technologies has increased over the last few years with collaboration among universities, industry and children's hospitals. Furthermore studies have shown the potential for 3-D printing from echocardiographic images in the future which will make this technology more accessible for patients without a cardiac MRI or CT scan. () 3-D printing is a relatively affordable and feasible technique. Fellows in training and early career cardiologists have a critical role in taking this technology to the next level as they have always participated in innovations in the field of pediatric cardiology.

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This article was authored by Tarek Alsaied, MD, a pediatric cardiology fellow in the Heart Institute at the Cincinnati Children's Hospital Medical Center.