A Model Case

Expanding use of 3-D printing technology helps doctors treat teen鈥檚 heart condition
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Dr. Daisuke Kobayashi had been treating children鈥檚 sick hearts for years, and had all of the Detroit Medical Center鈥檚 sophisticated imaging technology at his disposal. But he still couldn鈥檛 get a clear enough picture of teenager Ariana Smith鈥檚 aorta to figure out the best way to treat her.

A walnut-sized aneurysm blocked his view of what he suspected was a congenital narrowing of Smith鈥檚 aorta, the body鈥檚 biggest vessel. Both the aneurysm and the aorta needed treatment to prevent chronic or catastrophic consequences.

Kobayashi wasn鈥檛 sure if he should treat Smith 鈥 who turns 18 in October 鈥 with a minimally invasive repair, or prescribe traditional open-heart surgery by another doctor. Taking safety, effectiveness, and invasiveness into account, he recalled a lecture given by Materialise, a global company with North American headquarters in Plymouth. Todd Pietila, the company鈥檚 business development manager,听had shown Children鈥檚 Hospital doctors how 3-D printed models could help them.

Kobayashi and Pietila鈥檚 discussion eventually led to the firm printing a 3-D model of part of Smith鈥檚 heart and aorta. The model gave Kobayashi and his team the tool they needed to help the Taylor teen. They even used the model to test run a procedure they planned to use.

Their strategy required careful pre-procedure conversations.

鈥淚n these complex cases, we discuss a lot,鈥 Kobayashi says. 鈥淲e were not completely sure that the stent would align, and if it doesn鈥檛 align and fit well, she needs surgery. And if we didn鈥檛 plan well, there could be complications.鈥

Their planning paid off. During three hours in the catheterization lab in March, doctors used a balloon catheter to stretch the narrowing. They also inserted two stents in Smith鈥檚 aorta that block blood flow to the aneurysm, making it harmless.

The procedure went smoothly.

Smith is among a growing number of people to benefit directly from 3-D printing. Doctors are increasingly using imaging scans of a patient鈥檚 body, along with software that translates that data, to construct, layer by layer, replicas such as the teen鈥檚 heart model.

鈥淲e鈥檙e always met with some level of skepticism,鈥 says Pietila, who鈥檚 talked to doctors in every major hospital in southeast Michigan about 3-D printing. 鈥淧eople look at it and say, 鈥楻ight, but I鈥檓 not sure how I can use it.鈥 When they saw Ariana鈥檚 case, it became clear.鈥

He adds that the patient-specific models his company makes also give patients a peek inside their body in a way that鈥檚 easy for them to grasp.

鈥淚 think it gives them a sense of involvement in their care,鈥 he says.

Jacqueline Foster, Smith鈥檚 mother, says she looked at the heart model the day after the catheterization. 鈥淚 thought it was really cool that I was holding it and could see the actual size of the aneurysm,鈥 Foster says, adding that her daughter is doing 鈥済reat.鈥

Smith graduated from high school in May, and she is looking for a job and at colleges for a possible nursing degree. She returns for a repeat heart catheterization in September, in part to check on her aneurysm.

The technique of 3-D printing has many uses in health care. Some, including invisible braces, in-ear hearing aids, and custom foot orthotics, are already widespread.

Less commonly, doctors at the University of Michigan use 3-D-print splints for babies with underdeveloped tracheas, giving their bodies time to develop a functioning airway as the splint slowly dissolves.

Today about 15 percent of people who have a knee replacement benefit from a 3-D printed surgical guide, helping their surgeon determine where best to cut bone and drill holes. It鈥檚 a big step up from the traditional approach: using a ruler and the patient鈥檚 X-ray to plan surgery.

The technology is also helping the medical devices industry. Manufacturers can use 3-D printing to generate prototypes of their design that allow much speedier testing and refinements.

The brave-new-world technology is even being used with stem cells and growth factors to bio-print human tissue for drug testing and other uses, with the eventual goal of printing replacement organs or body parts.

Its use in surgical and treatment planning may become more widespread when 3-D printing gets the insurance code that doctors need for billing. For now, physicians pay for models out of their fee or with some other strategy, which may include a discount from Materialise, says Managing Director Bryan Crutchfield.

鈥淚t鈥檚 allowing doctors to really visualize what the problem is and what is the best way to solve it,鈥 because now they know what they are getting into, he says.