At birth, the doctors found Balan (name changed) to be an anatomical puzzle. All his organs, the heart, the liver, the spleen and the stomach were ‘reversed’ or seemed to be mirror images of what was normal. By itself, situs inversus, as this congenital condition is called, isn’t a problem, but in Balan’s case his displaced heart was severely compromised. Both his major arteries, for instance, arose from the right ventricle due to which his blood was impure and didn’t carry enough oxygen to the other organs. Moreover, the links that connected to the lungs were severely obstructed and there was a hole in the heart’s lower chambers.
Though Balan’s growth wasn’t affected, the condition limited his physical activities and left him fatigued at the slightest exertion.
Changing treatment
Cardiologists in Kerala found it hard to visualise the architecture of his circulatory system to begin plugging his heart’s defects. But there was a way out; 3-D printing came to their rescue.
Using imaging technology, the doctors at the Amrita Institute of Medical Sciences (AIMS) in Kerala used a cardiac magnetic resonance imaging (MRI) technique to make a virtual 3-dimensional model of Balan’s heart. This then served as a template for the cardiologists and cardiac-surgeons to perform the surgery. Balan, 8, went under the knife a week ago and is reportedly hale enough to go home soon.
Sometimes there are cardiological challenges that could be even more daunting and deemed “untreatable”. This is where 3D printing technology has been a game changer, says Dr. Mahesh Kappanayil, clinical professor, Paediatric Cardiology, AIMS, who has been responsible for putting the technology to use creatively for patient welfare.
Making heart models is particularly relevant to children as their heart is smaller than of an adult; nearly 2,00,000 children are born in India each year with congenital heart disease with a significant proportion of these children suffering from complex lesions that require surgery.
In paediatric cardiology
In the last two years the technology has been applied more frequently in paediatric cardiology to understand complicated structural disorders that present various congenital structural deformities, says Dr. Kappanayil.
Till recently, surgeons were led more by experience and guesswork and imaging technology such as cardiograms and CT scans but now being able to manufacture a tangible model of the heart that’s exactly like the patient’s is proving to be a game-changer.
The 3D image printing presents the organ in its actual size and shape, providing surgeons the complete shape of the deformity in three dimension, says Dr. Kappanayil.
The 3D prototype is formed using the same imaging technology and the same data generated by CT and MRI to create a three-dimensional model in thin slices put one on top of the other. Surgeons can encounter the complexity on the prototype by dissembling it and finding the best way to address the problem.
The 3D print machine extrudes a specialised material into the actual shape of the object screened. So far the institute had performed 10 paediatric heart surgeries. Other departments in the hospital are also realising the potential of its use in complicated surgeries especially in orthopaedics where four surgeries have been performed using 3D technology. Maxillofacial surgery, plastic surgery and transplant surgeries are among the other departments that are probing the use of the technology. The advantages of 3D printing in health care can also be realised in facial reconstruction, complicated bone fracture treatment and much more, says Dr. Krishna Kumar, Head, Paediatric Cardiology at AIMS.
Though studies on the efficacy of surgeries using the technology are not yet on since it is a relatively new area, they can certainly provide an edge in handling complicated surgeries, says S. Harikrishnan, professor of cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, in Kerala.
shyama.rajagopal@thehindu.co.in