3-year-old Ivy was born with a complex congenital heart disease (CHD), and diagnosed with absent pulmonary valve syndrome and Tetralogy of Fallot. When she was 6 months old, the girl underwent an operation to repair these conditions, which were causing her pulmonary arteries to dilate out of proportion and compressing her airways. The surgeon at the time carried out the LeCompte Maneuver during the repair, which involves the re-plumbing of the pulmonary arteries anterior to the aorta to relieve pressure on the patient’s lungs. A conduit was positioned between the right ventricle and the pulmonary arteries.
During the postoperative period Ivy’s airways were still very flaccid because of the long-standing vascular compression and made it difficult for the patient to be weaned from the ventilator. She eventually received a tracheostomy to allow long-term ventilation. Because of the vascular compression, the tracheostomy tube worked as a stent to prevent the collapse of the lower part of her airways.
Three years later the right ventricle to pulmonary artery (RV-PA) conduit was in need of an upgrade. Ivy’s case was brought forward to the joint multidisciplinary meeting between Dr. Simone Speggiorin and his colleagues at the East Midlands Congenital Heart Centre in Leicester, UK. The team discussed the possibility of relieving the vascular compression of the airways as well as replacing the RV-PA conduit.
Using Materialise Mimics to reconstruct the patient’s airways, aorta and pulmonary arteries in 3D, it became quite easy to see what the problem was. The surgeons were able to undo the structures one by one until they could inspect the deeper, underlying organs of the patient and pinpoint the exact problem.
Although the initial diagnosis had been that the airways were getting compressed by the pulmonary arteries, the evidence on the screen showed that the pulmonary arteries were forcing the aorta towards the spine. Consequently, it was the aorta that was compressing the airways between the ascending aorta and descending aorta. By relying on Materialise Mimics, Dr. Speggiorin and his team were able to play around with various solutions, before finally deciding they should reposition the aorta in front of the pulmonary arteries. The software also allowed them to clearly explain to the parents of the girl what would happen during the operation.
The team completely planned the congenital heart surgery based on the 3D reconstruction. In Dr. Speggiorin’s words, “in the theatre everything went as planned, which was probably the most surprising thing because in surgery, things never tend to go as planned.”
The charity Keep the Beat supports the 3D modeling program of the cardiac department. Founder Adam Tansey and Dr. Speggiorin saw great potential in 3D visualization to help future cases, and Dr. Speggiorin’s dream would be to have a team working on 3D reconstructions full time. He feels that it is especially valuable for young surgeons in particular, who haven’t had many chances to explore the human anatomy during surgery. As a result, it is harder for them to precisely visualize an anatomy on the basis of a CT or MRI scan, in particular when the case is rare and they haven’t yet encountered it. 3D modeling and visualization is an extremely useful tool for the team to ensure the surgery is planned as well as possible, which could have a positive impact on the outcome of the surgery. And as Dr. Speggiorin notes, this technology could also help to alleviate the gap between inexperienced and experienced surgeons, enabling hospitals to maintain the same level of safety for the patients.