A Life-Giving
Plan
3D Printed Heart Model Helps Cardinal
Glennon Children’s Hospital Plan
Complex Surgeries
It Takes a Team of Specialists to Healan Infant’s Broken Heart

3D printing is transforming surgical planning andenabling the delivery of personalized medicine toinfants with complex congenital heart disease (CHD).
Five years ago, the cardiovascular team at SSM
Health Cardinal Glennon Children’s Hospital, apediatric medical center in St. Louis, Missouri,
embraced 3D printing as a solution for better
surgical planning for these patients.

Case Study

While congenital heart defects are the mostcommon birth defects worldwide according to theAmerican Heart Association, affecting eight outof every 1,000 babies born in the United States,
fortunately only one in four requires surgery during
the first year of life. As a pediatric referral center,
SSM Health Cardinal Glennon Children’s Hospitalsees some of the most complex patients, requiring
repair within days or weeks of birth on hearts thesize of a walnut.

The 3D model wasinstrumental in determining
the optimal surgicalapproach. It allowed us togo into the case with a solid
plan based on the best
information we could obtain.”Charles Huddleston, M.D.

Cardiothoracic Surgeon, Pediatrics
SSM Health Cardinal Glennon
Children’s Hospital

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Figure 1. MRI showing narrowed left ventricle outflow tract.

Figure 2. MRI with four chamber view showing ASD, VSD,
subaortic stenosis.

Figure 3. Echocardiogram showing subaortic narrowing.

Figure 4. Echocardiogram showing four chamber view oftransposed great vessels.

Ao – Aorta, ASD – Atrial septal defect, LA – Left atrium, LV – Left ventricle, MV – Mitral valve, RA – Right atrium, RV – Right ventricle, SubAS –Subaortic stenosis, VSD – Ventricular septal defectCase Study

One such patient was an infant diagnosed inutero via fetal ultrasound with an unusual form oftransposition of the great arteries. Deoxygenatedblue blood entered the right atrium whichconnected to the left ventricle and then the aorta,and oxygenated red blood entered the left atrium
which connected to the right ventricle and then thepulmonary artery. The patient also had a very large
ventricular septal defect (VSD) connecting bothventricles and severe narrowing between the left
ventricle and the aorta.
It was apparent early on that the patient wasbecoming fairly blue as deoxygenated blood
was being directed towards the aorta. A balloon
atrial septostomy performed in the first few daysof life resulted in some improvement. However,significant tachycardia persisted. It became clearthat the degree of subaortic narrowing was more
severe than originally anticipated, and this resulted
in significantly depressed left ventricular function.
Something needed to be done soon.

3D Printed Model Provides Clarity
The cardiothoracic surgical team led by Charles
Huddleston, M.D., and members of the cardiac
medical team including Wilson King, M.D.,
agreed that surgery was required. Due to therarity of this condition, there was controversy
over how to repair the infant’s heart. A neonatal
atrial switch seemed to be the best strategy.
This is a challenging operation that redirects theoxygenated blood to the aorta and deoxygenatedblood to the pulmonary arteries by creating intraatrial baffles.
Addressing the subaortic stenosis was extremelyproblematic, as it appeared that much of theobstruction was caused by tissue that wasextremely close to the mitral valve. Damaging themitral valve would result in significant problems forthe patient. “After reviewing the echocardiogram,many of our cardiologists as well as the referring
cardiologists were convinced it was part of the3
structural integrity of the mitral valve and resecting
it would mean replacement of that valve andsubjecting the child to lifelong disease.
Others thought it was accessory tissue not criticalto mitral valve function. From the imaging studies
alone, it was impossible to tell, limiting our ability
to confidently develop a surgical plan,” said Dr.
Huddleston (figures 1,2,3,4).
For complex cases like this, the Cardinal Glennon
surgical team relies on 3D printing. Using an
MRI dataset, the team 3D printed a model ofthe infant’s heart using a Stratasys J750™ 3Dprinter. “It’s hard to judge what to do looking
at 2D images on the screen. It is difficult tocapture all the information in one plane evenwith a 3D reconstruction on a 2D screen. Spatial
relationships are a lot easier to conceptualize witha 3D model. With the 3D model it became evident
how to redirect the blood flow to the right places
to provide oxygen to the body,” said Dr. King.

Case Study

RAASDMV

Dr. Huddleston added, “The 3D model helped
us identify the anatomy clearly and provided us
with the confidence that the accessory tissue
causing the subaortic stenosis was not an integral
part of the mitral valve. This allowed us to go into
the procedure assured that the tissue could be
removed safely without damaging the mitral valve
located near it.”Dr. Huddleston summed up his experience,“The 3D model was instrumental in determining
the optimal surgical approach. It allowed us to go
into the case with a solid plan based on the best
information we could obtain.”With the help of the 3D printed heart model, theneonatal atrial switch, VSD closure, and subaortic
stenosis resection was successfully performed
in a 20-day-old infant, and the mitral valvefunction remained intact. The cardiac function
gradually improved, and the patient’s heart
rate normalized. He is expected to have anexcellent long-term prognosis.

VSDLV

AoFigure 5. 3D model of the heart of a 5-day-old infant with congenitally corrected transposition of the great arteries with a large ventricularseptal defect and severe subaortic stenosis. (AO – aorta, ASD – atrial septal defect, RA – right atrium, LV – left ventricle, MV – mitral valve,
VSD – ventricular septal defect).

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The patient-specific heart model was printed on the Stratasys J750.

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