When Caitlin Veitz was 20 weeks pregnant, the happy expectation surrounding her first ultrasound quickly turned into fear and anguish: her baby daughter’s heart was growing outside of the chest wall. Doctors weren’t able to reassure Caitlin, because the condition is so rare that there was very little data to rely on. Although congenital heart problems affect around 1 in 100 children, a relatively high incidence, baby Kieran’s condition is “one of the, if not the, most rare congenital heart defects,” says Dr. Joseph Dearani, pediatric cardiac surgeon at Mayo Clinic. Kieran’s survival would depend on a very complex surgery involving highly specialized experts—armed with 3D technology.
That’s exactly what Kieran received at Mayo Clinic, and even before she was born. Dr. Jane Matsumoto, radiologist and co-director of the 3D anatomic modeling lab at Mayo Clinic, began by converting Caitlin’s ultrasound into a 3D virtual model, using the Materialise Mimics® Innovation Suite. Dr. Matsumoto segmented and color-coded the major organs, and worked with Caitlin’s obstetrician to see where the defect was located in relation to Caitlin’s uterus, placenta, the heart and liver. Dr. Matsumoto also prepared a 3D-printed model of Kieran’s anatomy, while the baby was still in the womb. This helped doctors see from the outset exactly what they would be dealing with.
The 3D-printed replica of Kieran proved to be a game-changer for the surgeons. With this life-size model, the doctors could see that the baby’s liver, intestines and heart were all developing outside her body. “From the model, we realized that trying to fix both [defects] at once would put too much stress on the baby,” recalls Dr. Christopher Moir, pediatric surgeon. The surgeons had to first prioritize moving the heart back into the chest. The planning was all in place, to conduct a C-section in the 37th week of pregnancy and operate thereafter.
However, it didn’t go as planned. A sudden rise in Caitlin’s blood pressure accompanied by an alarming weakening in the baby’s vital signs meant that the doctors had to conduct an emergency delivery several days ahead of schedule. Facing a serious emergency, the hospital pulled together about 60 doctors and nurses from 12 different teams within 90 minutes.
“The delivery was done in the cardiac surgery operating room,” says Dr. Dearani, hinting at how little time the surgical team could afford to take between the two events. It took multiple teams five hours in all to shift Kieran’s heart back within her chest. What could have been an emergency verging on tragedy was handled spectacularly well, thanks to weeks of advanced planning, supported by 3D virtual planning and 3D Printing. The meticulous pre-operative planning had left minimal chance for surprises in the operating room, even when the surgery had to take place days before intended—and the planning was rewarded with success. After four and a half months of observation in a pediatric intensive care unit, Kieran was ready to go home. Six months later, the little braveheart is well on track for growth, on par with other babies her age.
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All images courtesy of Mayo Clinic
Materialise is unfamiliar with the 3D-printed model used in this case. When evaluating a 3D printed device which is intended for the use in the diagnosis, or in the cure, mitigation, treatment or prevention of disease, where applicable, ensure that the manufacturer is registered or cleared with the country of distribution.