Mia
Gonzalez spent the first 3½ years of her life missing out. She had to
skip day care and dance classes because she constantly had colds and
pneumonia. When Mia could go out and play, she was easily winded and
took multiple asthma medications to try to help her breathing.
After
about 10 hospital stays, doctors realized that Mia had a malformation
in her aorta, the vessel that pumps blood from the heart. The 4-year-old
would need an operation to close off the part of her aorta that was
putting pressure on her windpipe and making it hard to breathe, swallow
and get rid of phlegm when she got a cold.
"We
freaked out to go from thinking she had asthma to being told she needed
to have open heart surgery," said Katherine Gonzalez, Mia's mom.
But
Mia's malformation was complicated. The surgeons at Nicklaus Children's
Hospital in Miami, where Mia was treated, might have been apprehensive
about the procedure were it not for a new technology: the 3-D printer.
Earlier
this year, the hospital got a 3-D printer that makes exact replicas of
organs that doctors can use to plan surgery, and even do practice
operations. The printer uses images from patients' MRI or CT scan images
as a template and lays down layers of rubber or plastic.
Dr.
Redmond Burke, director of pediatric cardiovascular surgery at Nicklaus
Children's Hospital, meditated on the model of Mia's heart for a couple
of weeks. He showed it to colleagues for their input and even carried
it around in his gym bag for quick reference.
Burke
finally had the "Aha!" insight. Instead of making an incision on the
left side for this type of heart defect, called double aortic arch, he
should cut into Mia's chest from the right.
Doctors used a 3-D printer to make a model of Mia Gonzalez's heart.
"Without
the model, I would have been less certain about (operating on Mia) and
that would have led me naturally to make a larger incision that could
possibly cause more pain and a longer recovery time," Burke said.
Using the model, "there was no doubt, and surgeons hate doubt," he added.
He
attributes the model with saving the team and patient about two hours
in the operating room because he was able to have a clearer plan to do
the surgery.
Burke and his colleagues
have created models for about 25 young patients with congenital heart
defects. In the past, they might not even have operated on some of these
patients because the surgeries seemed too tricky, but "it's very
unlikely I will ever call someone inoperable (now) without holding a
model in my hand," Burke said.
About 75
hospitals in the United States, and around 200 worldwide, have a
printer such as the one used to make a model of Mia's heart, said Scott
Rader, general manager of Stratasys, which sells the printers.
Although
3-D printers have been used clinically for the last 20 or 25 years to
make prototypes for surgical tools and other uses, they only started
churning out simulated organs in the last few years, Rader said.
Doctors
have used the simulated organs to prepare for all kinds of tricky
operations, such as surgery to remove a brain tumor or to correct a
severe cleft palate, Rader said. Doctors can operate on them with
regular surgical tools "again and again and again until you think of the
optimal way to do surgery," Rader said.
'The biggest secret that nobody knows about'
The models can also help train medical students and explain complicated procedures to patients such as Mia and her family.
Eventually,
the printers could be used to produce actual organs that can be
transplanted into patients; just replace the rubber and plastic printer
"ink" with human cells.
"We are going to see massive advances in the next five to 10 years of how to take the technology to this point," Rader said.
Mia's surgeon carried around a model of the girl's heart for weeks.
Simulated
organs are "a disruptive technology which radically changes how we talk
to patients, how we prepare for an operation, how we do the operation
and how we teach," said Dr. Daniel B. Jones, professor of surgery at
Harvard Medical School and co-director of the Simulation and Skills
Center at Beth Israel Deaconess Medical Center in Boston.
However, the technology is not widely in use in hospitals or medical schools yet.
"This
is like the biggest secret that nobody knows about," said Jones, who
has done research on surgeons' impressions of using simulated organs.
Even those who do know about the technology might feel uncomfortable
showing patients a model of their tumor, for example, and discussing it
with them in depth.
Hospitals are starting to invest in the technology, which is more realistic now that prices have come down, Jones said.
The
printer and software usually cost in the range of $100,000, which is
less than a CT scan or MRI setup, Rader said. He predicts that interest
in the technology will continue to grow as research shows how using
simulated organs leads to better surgical outcomes and shorter operating
times.
The models have also been
invaluable in helping patients and their families feel confident that
they are doing the right thing, said Burke, who operated on Mia.
Seeing
the model "made it seem like a simple surgery, it put you at ease,"
said Gonzalez, Mia's mom. "(Mia) was used to hospitals and IVs, but to
explain that you're going to have surgery and be in pain, that is all
different," and the model helped put it in perspective, she said.
Four
months later, the surgery seems like ancient history to Mia. She has
forgotten all about her surgical scar, her mother said, and had little
pain. Although she has had some minor colds, none has landed her in the
hospital. A month later, she was even able to participate in her dance
recital.
