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3D Tech Tools Make Complex Heart Surgeries Safer

February is American Heart Month, a time when all people can focus on their cardiovascular health.

By Ashley Antle

The newest generation of imaging tools and technology at Cook Children’s Medical Center’s three-dimensional lab for the planning and printing of congenital heart disease (3D aPPROaCH Lab) makes it possible for cardiac surgeons to see, study, feel and manipulate congenital heart defects and complex heart conditions prior to stepping into the operating room to surgically repair them.3D Approach Lab (3)

In the 3D aPPROaCH Lab, physicians use two-dimensional (2D) imaging data to create 3D pictures. Those 3D images are then used to create virtual reality simulations of a patient’s specific anatomy. This allows a surgeon to practice a procedure virtually beforehand so that there are few, if any, surprises during an operation. For an even more hands-on assessment, the lab’s 3D printer can print a life-size model of the heart, allowing physicians to gain a better understanding of the anatomy and needed interventions.

To understand the difference the 3D aPPROaCH Lab makes in the repair of congenital heart defects, imagine being in a vacation rental home. You’ve spent a little time there and are somewhat familiar with the space, but not so much that you can navigate the house in the dark without running into an unexpected piece of furniture that your mind’s eye failed to capture or recall. Back in your own home, however, you easily navigate your living room in the dark without breaking a toe or bruising a shin. Having walked through the space over and over, your mind’s eye is stamped with a detailed map, giving you the spatial awareness you need to navigate the space even with the lights off.Ivy Chacon 3

Similarly, with 2D scans, surgeons have a general idea of what to expect during surgery having seen some portion of the anatomy. But they know a 2D view doesn’t always tell the whole story. Surgeons often have to take a “wait-and-see” approach to complex operations knowing they may encounter things that were not visible via 2D scans. While surgeons are trained to think fast and provide a fix on the fly, those unexpected encounters increase the risk of complications and the potential for additional surgeries.

With 3D virtual reality tools and printed models, surgeons are able to visualize all parts of the anatomy, inside and out, plan a more comprehensive repair and practice their surgical approach prior to an operation. These tools reduce the surprise factor and increase the ability of the surgeon to perform a safe, more complex and long-term surgical repair.

“Three-dimensional printing moves us in medicine from a place where we're just having a conceptual understanding of complex hearts to a place where we are out there practicing an intervention, much like a pilot in a flight simulator,” said Steve Muyskens, M.D., cardiologist and medical director of cardiac MRI and the 3D aPPROaCH Lab at Cook Children’s. “We can take things that you can't get to because they're inside of a person and maybe are out of the ordinary or unique approaches due to their anatomy or their specific problem and actually practice the approach and fix. So when you get into that unique situation, you have better bearings, and you have a better chance of having a successful outcome.” Ivy Chacon 4

Vincent Tam, M.D. cardiothoracic surgeon and medical director of cardiothoracic surgery at Cook Children’s, uses the 3D aPPROaCH Lab to prepare for his complex heart surgeries.

“There is no question that having an accurate three-dimensional model in your hands is obviously much easier and much better in terms of planning and thinking ahead of what you may encounter in terms of what the inside of the heart looks like and what you may have to do to correct the defect,” Dr. Tam said. Ivy Chacon 2

For patients, these tools can mean the difference between surviving versus thriving.

“This moves us beyond just a simple understanding and gives us the ability to offer more complex and long-term surgical solutions,” Dr. Muyskens said. “We're not just trying to get patients to survive like we were 30 or 40 years ago. We want to be able to do complex repairs early on to reduce complications so that children thrive into adulthood and need fewer interventions down the road.”

That was the case for Ivy Chacon. She was the first patient to benefit from the full technology of the 3D aPPROaCH Lab in 2017 when she had heart surgery at 19 months old. Chacon was born with an extremely rare heart defect called congenitally corrected transposition of the great arteries and dextrocardia. Dr. Tam, along with Hisashi Nikaidoh, M.D., retired Cook Children’s cardiothoracic surgeon, performed a complex atrial switch operation, along with an aortic translocation. Now 7, Chacon runs, jumps and keeps up with her classmates on the school playground. According to her mother, Elizabeth Franco, no one would ever know she was born with a complicated and critical heart defect.

Dr. Tam used a printed 3D model of Ivy’s heart to explain his surgical plan to Franco. She said the ability to see and touch an exact model of Ivy’s heart made all the difference in understanding her daughter’s condition and operation. 

“Being able to have this detailed information and provide families with a much better understanding is definitely a game changer,” Dr. Muyskens said.

Since its opening in 2017, the 3D aPPROaCH Lab has been used to prepare for approximately 40 highly complex pediatric cardiothoracic surgeries. It’s also used by other specialties for their complicated cases, including plastic surgery, orthopedics, the emergency department, urology and general surgery.

The future of the lab and its abilities are limited only by the ideas and imaginations of the physicians that use it.

“The sky is really the limit,” Dr. Muyskens said. “It's not so much where I want to go with the lab, but really more about where the surgeons and people who utilize the lab want to go. It’s a very unique opportunity for the way we've structured it here at Cook Children’s in that anybody right now can call us up and say, ‘Hey, I want a model of this, or I want to create something like a drill guide to assist in surgery. Can I do that?’ We're here to help them achieve whatever goal they want.”