Peoria Public Radio’s Denise Molina reports the doctor is also asking other cardiologists to send him their best congenital heart disease images, with the hope of building a library of hearts.
It’s an unassuming scene in an office at the Jump Trading Simulation Center. Bioengineer Subeen Admani is overseeing an image working its way through a 3D printer.
"...So the hearts, the small ones, take like 45 minutes to an hour...hour and a half..."
“My job is to provide surgeons with the most accurate information going to surgery on a child with congenital heart disease,” says Bramlet.
And that’s exactly what he’s aiming to expand upon in a cost effective way that uses today’s technological connectivity.
Pediatric cardiologists currently use imaging techniques like MRI’s, CT-scans, and echocardiograms to get the best pictures of someone’s heart before they go into surgery. Doctors may also opt for a 3D reproduction, a see-through acrylic replica that can cost upwards of $6000.
But about four years ago, Dr. Bramlet saw a medical institution in Toronto using MRI images to print hearts on a 3D printer. He was able to test out the technology at the Jump Trading Simulation and Education Center early last year, printing many hearts from MRI images that cost as little as $20 each.
But it was unclear whether doctors and surgeons could gain any additional knowledge from 3D models. So, Dr. Bramlet decided to print the heart of a patient going into surgery whose diagnosis was clear. He says the model showed the same anatomy, and some new information.
“We saw an additional defect, an additional hole in the heart that’s notorious for going unnoticed, and it changed the surgery. So, just the trial run made a tremendous impact that day and Dr. Fortuna, the cardiothoracic surgeon, that was operating on the patient called me from the O.R. saying, ‘Matt, your heart tells the truth,’ and it was that moment where he said, ‘This is bigger than what we ever anticipated,’” says Bramlet.
Dr. Karl Welke is a congenital heart surgeon at the Children’s Hospital of Illinois at OSF Saint Francis Medical Center.
“We try to get the best idea that we can going into the operating room of what we’re going to have to deal with, and we’re looking at images that are 2D on a screen. We’re looking at echocardiograms which are essentially shadows of the heart, things like that and trying to approximate what we’re going to see in the operating room and base our operations on that. The 3D model takes us one step closer to seeing what we see in the operating room,” says Welke.
Doctors Bramlet and Welke say the 3D heart models are not only allowing medical professionals to get a better look at the anatomy, they are also changing the course of some surgeries. Dr. Bramlet has printed three hearts over the last year that have played a key role in determining how a surgery proceeds.
Luke’s dad, Justin says his son had already been through heart surgery at six months-old. Doctors in Iowa City told the family they would need to re-construct Luke’s heart, leaving the then 3-year old with one instead of two ventricles pumping blood to his body and lungs. Snodgrass says that meant his son would need a heart transplant later in life.
“To my wife and I, we just felt that they keep telling us he’s got all of these great working parts. They just need to get them connected, but they did not feel that they were able to do that. We just had a lot of concern about what his future life would be” says Snodgrass.
Initially, Peoria Doctors Bramlet and Welke say they agreed with the surgical plan of Luke’s doctors in Iowa. But then Dr. Welke says they printed the heart:
“We would’ve proceeded that way had we not known anything different. So it was the knowledge gained from the 3D model that allowed us to change the course and leave him with two ventricles instead of one. In our world, that is a major difference,” says Welke.
“He runs everywhere. You know, he’s like any other normal four year old, just full of energy, he doesn’t get winded, he eats good. Before the surgery, he would come in the house from the yard and we’d have to carry him halfway and when he got in he would go lay down on the couch for a little bit and be real relaxed…basically just trying to get his energy back. Now he runs in the house, throws his shoes off and runs downstairs, is playing and you know, you just can’t stop him anymore,” says Snodgrass.
Snodgrass says Luke was left with a pacemaker in his diaphragm that will eventually need to be moved to his shoulder area when he’s older. But other than that, there are no major surgeries scheduled for Luke. Snodgrass says the 3D printing technology not only changed his son’s life, it was also informative when talking about medical options with doctors.
“By being able to have that 3D image, the doctors can kind of take away some of that questioning and some of that risk, and are able to provide more answers and more certainty as to yes, we can go in there and make some fixes or no, it’s just not going to be possible. I think that takes a lot of the stress out of some of the decision-making from a parent’s standpoint” says Snodgrass.
And that’s a benefit Dr. Bramlet hopes to extend and share with other doctors and medical institutions. He’s working to build a so-called Library of Hearts. But not a large room filled with 3D heart models. Rather, the pediatric cardiologist is hoping to build an online database of the best images of heart defects. Dr. Bramlet says there’s not a widely accessible library.
“Right now in the nation, there are a handful of pathologic libraries. These libraries have developed over the years, but the majority of these hearts were from autopsies back 50 years ago and they’ve been handled and used over the years and they’re starting to fall apart. But they’re not being replenished because of surgical advances and differences in how they’re able to acquire these hearts and costs. And so, these libraries are disappearing,” says Bramlet.
Dr. Bramlet is asking other doctors and institutions to send him pre and post op MRI and CT scans of congenital heart disease at all ages. He says the idea is for the images to be downloadable, so anyone with access to any type of 3D printer can reproduce them.
“If you have a med student who’s got a friend with a 3D printer, he can say, ‘Hey can you print this file for me? I’m really struggling with this,’ or a family that says, you know, ‘Our nephew has this; let’s see if we can find this online and print it out.’ And so the availability of that is like…it’s almost a national archive and it’s something that you don’t have to be a part of some large institution to have access to it. And that’s what we’re aiming for,” says Bramlet.
Dr. Bramlet says the heart library will be based out of the Jump Trading Simulation and Education Center. Physicians and medical institutions interested in donating images can contact the center at firstname.lastname@example.org.