Saving lives: Can a computer fix your heart?

Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} The United Kingdom continues to be a top draw for health tourism from the Middle East, with cardiothoracic procedures for children being drawing in vast numbers annually. As a tertiary referral hospital, complexes such as the Great Ormond Street Hospital are renowned for treating complex cases of congenital heart defects – problems with the heart’s pumping that are present at birth, with this institution treating over 1,400 inpatients and over 9,000 outpatients from the Middle East in 2012-13. GOS is now utilising new experimental devices and other treatments in the relative safety of a computer programme to save innocent lives. In the past few years, patients with the most complex heart defects, such as transposition of the great arteries, where the principal blood vessels of the heart are attached back to front, and tetralogy of Fallot, the most common cardiac cause of blue babies, are likely to require open-heart surgery at one or more points in their early lives. However, a series of landmark trials of a new form of therapy in the past decade have given these patients continued treatment without the repeated trauma of highly invasive surgery. Professor Taylor, an expert in cardiovascular imaging, at GOS, said: “When I started here, we’d just begun to offer a new form of therapy to children with leaky pulmonary valves, which can arise in a number of different conditions. “Rather than fix this by implanting a replacement valve into the heart via surgery on the chest, we’d begun to trial a technique that involved passing a fine catheter tube up through an vein in the leg, and implanting the valve into the heart by expanding a balloon inside a metal ‘stent’, which then fixes the valve in place. “By 2007, we’d carried out the first ever couple of hundred cases of this kind of ‘non-surgical’ valve replacement. “Today, thousands of the valves are being implanted in children worldwide. The difference it makes to children’s treatments could not be more pronounced.” Miracle cure of the future For the 15 per cent of patients needing pulmonary valve replacement who are eligible for this treatment, it means a huge reduction in days spent in hospital – in particular in the Cardiac Intensive Care Unit, where bed space is always in critically short supply. More importantly, compared with open-heart surgery, where recovery can take up to six weeks, these children are back on their feet within a matter of days. “I think people get very used to their symptoms,” reflects Professor Taylor. “So often you would see a patient not complaining of any symptoms, have the treatment, and two days later they say: ‘I didn’t realise I couldn’t walk up three flights of stairs, but I can now!’ It’s that sort of change that you really notice.” Over the 10 years this programme has been running, not a single patient has died from the procedure, with, Professor Taylor determined to deliver similar benefits to the 85 per cent of patients currently ineligible for this non-surgical form of valve replacement therapy. “Using MRI and CT images, we have now started to take the next big step to design devices that fit patients’ needs, and ensure that when these devices are implanted this is done safely and securely, a process that is becoming known as personalised medicine.” Professor Taylor’s research means that his team can test what might be best for the patient well in advance of surgery, by trialling new experimental devices and other treatments in the relative safety of a computer programme. Added to this is the technological bonus of 3D printing – a special form of rapid prototype modelling that will literally ‘print’ a physical shape from a computer model. This allows surgeons to hold a resin copy of their patient’s heart and physically plan their surgery to accommodate its unique shape. Capturing cardiac imaging data as part of a global collaboration with four leading centres in the United States, as well as research institutes in Milan and Paris, institutes now store this vital information alongside clinical data on a patient’s condition. These methods allow the team to treat patients virtually – within the safety of a computer simulation – and run advanced software programmes that test how treatments (drugs, non-surgical devices and surgery) will perform under the unique conditions of that individual’s own heart. This allows the doctors to decide which treatment is best for each individual patient. F