Feb 10, 2017 | By Julia

A savvy cardiologist at Children’s Hospital Los Angeles has successfully used a 3D printed model heart to help save an infant’s life.

When 18-month-old Nate Yamane’s pulmonary artery began narrowing due to a life-threatening heart condition, Pediatric Interventional Cardiologist Frank Ing realized he would require a stent, a small mesh tube that’s used to treat narrow or weak arteries.

Though stents are relatively common nowadays, Nate’s case presented a unique challenge: the infant’s tiny pulmonary artery had narrowed to just nine millimetres, requiring a customized device specially outfitted to the small space. Perfect measurements were crucial.

Using CT scans of Nate’s heart, the Hospital team was able to create a 3D printed model of the obstructed area. Dr. Ing could then fashion a special, tiny stent to fit exactly into the narrowed artery from the 3D model. The results were successful: Nate’s oxygen level improved overnight.

Pediatric Interventional Cardiologist Frank Ing​

“The 3D model was very helpful because it gave me confidence that [the size of the stent] was going to work," says Dr. Ing.

Considering Nate’s rocky young life, confidence had already proved hard to come by. Born in June 2015 with the rare condition Tetralogy of Fallot (TOF) with pulmonary atresia, the infant had difficulty breathing almost immediately after birth. His pulmonary artery was obstructed, preventing blood flow from the heart to the lungs.

Crisis was averted after Nate was rushed to the Children’s Hospital Los Angeles from a South Bay hospital, but complications persisted.

Doctors say Nate’s particularly severe case of TOF arose due to his pulmonary artery not forming properly while in utero. Generally the human body responds to this type of obstruction by growing collateral arteries that redirect blood around the problem area and to the lungs.

3D printed model of Nate's heart

“Imagine blood flowing in the artery like cars on the freeway, and it’s blocked. Cars exit and find an alternate route to its destination; blood does the same, and in this case finds its way through collateral vessels to the lungs,” explains Dr. Ing, Chief of the Division of Cardiology and Co-director of the Heart Institute at Children’s Hospital Los Angeles.

Although a typical development with these types of blockages, these vessels need to be quickly rebuilt after birth to prevent heart failure. “We use whatever the body gives us,” Dr. Ing explains. The standard surgical procedure here is known as unifocalization, in which surgeons repair the vessels by sewing them together.

Only a month into his young life, Nate had already undergone two of these open heart surgeries as well as a catheterization procedure. Still, in December 2015, it was discovered that Nate’s pulmonary arteries were narrowed in both the right and left branch.

Beginning with the right side, Ing’s team was able to open the blockage using a balloon. For the left side, however, they required a stent. Since Nate’s left pulmonary artery had narrowed to just 15 mm, special measures were taken: Dr. Ing carefully cut the Hospital’s smallest existing stent and folded it back on itself, using a special technique developed by his team, and effectively tailoring a functional custom stent.

Although Nate’s blood flow improved almost immediately, and his blood pressure dropped to healthier levels, he still wasn’t recovering as well as hoped. Over the next several months, Nate continued to barely gain weight—an urgent issue, since he would need sufficient strength and weight before doctors could even consider performing another procedure. Nate underwent physical therapy, and his family did everything possible to assist in his weight gain.

By January of 2017, Nate was finally ready for his next heart procedure. On January 19, Dr. Ing inserted the second, even smaller stent he had fashioned from the 3D printed model into Nate’s right pulmonary artery. The open-heart surgery was performed in the Children’s Hospital Los Angeles catheterization lab in front of a large audience of international cardiologists watching via live video feed. Dr. Ing and his team were able to successfully open up Nate’s right pulmonary artery. The infant’s oxygen levels improved almost immediately, giving hope where before there had been almost none.

Cardiologists around the world watched Nate's procedure via live video feed

So far, Nate’s condition has remained stable. Doctors say he will still require additional surgeries in the months and years ahead, but he’s already getting bigger and stronger. His weight is currently up to 21.5 lbs, and he’s eating much better, according to his mother. “He’s rolling around with energy and even took his first baby steps,” she says. “There’s a big difference and a lot of improvement. We’re going in the right direction.”

 

 

Posted in 3D Printing Application

 

 

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