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t m c » p u l s e | d e c e m b e r 2 0 1 5 7 "As good as our imaging is, whether it's MRI or CT or even echo, they tend to present complicated data with a 2-D slice," said Little, who has been working with 3-D printing at Houston Methodist for several years now. He added that their surgical procedures are becoming increasingly complex and the technology they use needs to be just as advanced. "I really see this as on the crest of the wave, where the new stuff is hitting the ground and it's brand new. We're using imaging techniques to see images we've never really seen before. We're planning a surgery we've never done before. That's where this stuff is really valuable in terms of the frontiers in medicine." Little's colleague, C. Huie Lin, M.D., Ph.D., an adult congenital and interventional cardiologist at Houston Methodist, recently had a case in which a young Jehovah's Witness patient was born with a heart defect. After her first successful surgery, she was left with a wide open, leaking pulmonary valve and needed another operation, but two centers had already turned her down because she could not take blood transfu- sions and they were concerned she would not make it through the surgery. When Lin was presented with her case, he had her undergo a CT scan in her home- town of South Carolina and then created a 3-D printed model based off the data. "I didn't want her to drive all the way out here and not be able to do anything for her," said Lin, who used the model to more accurately study her condition, experiment with different approaches and devise a plan that was minimally invasive and required very little blood loss—all before she even stepped foot in the hospital. "Without the 3-D printed models, we wouldn't have been able to figure this out. We wouldn't have been able to come up with a way to actually do the procedure in advance," Lin said, echoing the same sentiments as Krishnamurthy and Little. Another benefit of 3-D printed models is for the people sitting on the other side of the doctor's desk. "It's great for teaching the [patient's] parents. It's probably the biggest value," Krishnamurthy said. "A surgeon can basically hold the heart in their hands and tell them, 'This is exactly what I'm going to do and these are the risks of the procedure.'" "Before [3-D printed models], we would just use our hands like puppet motions to explain what's happening," Little said. Krishnamurthy added that the parents' under- standing of their child's case and surgical operation is dramatically altered when they see the model. If we really take the phrases 'informed consent' and 'informed decision-making' seriously, and if we have this useful tool that can sig- nificantly enhance that, then why are we not doing it for every case? — RAJESH KRISHNAMURTHY, M.D. Section Chief of Radiology Research at Texas Children's Hospital "We've had parents come in and say, 'This is the first time I've really understood what they're planning to do to my child,'" he said. "We should be doing this on every single case, just for one reason: parental comprehension. If we really take the phrases 'informed consent' and 'informed decision-making' seriously, and if we have this useful tool that can significantly enhance that, then why are we not doing it for every case?" The reason this is not happening? Cost. Little, Krishnamurthy and other doctors agree that printing out 3-D models is simply too expensive, ranging any- where from $400 to $3,000 per print, based on com- plexity, and is not covered by insurance. Both Texas Children's and Houston Methodist are selective with which cases are approved to spend the time, effort and financial resources on 3-D printing, but it's not difficult to see that the benefits will eventually eclipse the cost, especially as models become more inexpen- sive to produce. "[Providing 3-D printing] is an important thing that's going to reduce complications of the surgery, lower your length of hospital stay and improve your outcome," Little said. "In the long run, it's much better to pay $1,500 for a model and be in the hospital for four days less." Stephen Little, M.D., director of the Valve Clinic at Houston Methodist DeBakey Heart and Vascular Center. Rajesh Krishnamurthy, M.D., right, examines a 3-D printed model from a pair of conjoined twins. His team studied the model during surgical planning to get a more accurate understanding of the physiological structures and relationship of the organs. Credit: Allen Kramer/ Texas Children's Hospital

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