The 3D fine print

In February 2015, Dr Swati Garekar, a paediatric cardiologist at Fortis Hospital in Mumbai's Mulund, was tied in knots over a 9-month-old with an abnormal hole in the heart. The child, the son of a policeman from Nagpur, had DORV (double outlet right ventricle), a congenital heart condition in which two big arteries emerged out of the right ventricle of the heart, instead of one each from the right and the left. It led to pure and impure blood getting mixed and required a complex surgical fix. But neither an echocardiogram nor a CT scan could give Garekar a detailed picture of the mess inside the heart that would barely be bigger than the baby's fist. "Which way would the surgeon go in? What should be the best procedure? Say, we open up the patient, put him on bypass, reach his heart and see that the insides are not what we thought?" asks Garekar. 

The team, including paediatric cardiac and transplant surgeon Dr Vijay Agarwal and cardiac imaging consultant Dr Alpa Bharati, grappled with uncertainty over whether to hit the operation theatre blind. Garekar says she was reminded of some cases in European hospitals where the doctors took CT/MRI scans and printed them out in 3D. Imagine holding a replica of the heart, prising open its chambers, feeling its arteries and anomalies and charting out the path of blood flow, without having to cut open the patient. "I started flipping the Yellow Pages and found a company that can print a 3D model," says Garekar. In June, the baby was successfully operated upon, like Agarwal, confident of the anatomy after studying a 3D model in sandstone, channelled the artery from the right ventricle to the left through the hole in the heart. 

While this infant's case is reported as a first for cardiac India 3D Printer Market, in the three years since, a lot more is being heard about how the medical fraternity is notching up milestones. Ever since his first surgery with a 3D print in 2015, Agarwal, now with Fortis Gurugram, has studied at least 50 such models before making that nick on the chest. In February 2017, surgeons at Medanta-The Medicity in Gurugram replaced the second and the third vertebrae of a 32-year-old woman, damaged by tuberculosis of the spine, with a titanium 3D printed one. The surgery was the first of its kind in India and among the earliest in the world, with only China and Australia reporting a case each before. According to reports in the media, this April, doctors at AIIMS, Delhi, conducted an eight-hour surgery on a 40-year-old patient, to perform a complex hip replacement with a 3D printed implant. Says Firoza Kothari, the co-founder and CTO of Anatomiz3D, which 3D printed the heart model at Fortis, "In 2015 when we started, we would get about one print order a month. Now, it goes up to 40."

Health care apart, the country too can be seen warming up to 3D printing in general. According to a 2015 report by 6Wresearch, global market research and consulting firm, India's 3D printing market is projected to be worth $79 million by 2021, with low cost of manufacturing, increasing penetration across various applications, and its Make in India initiative spurring the rise. While the automotive sector accounts for the largest revenue and volume share, medical is seen as an area exhibiting "promising growth". "In 2016, when we started our medical division, we got three to four cases a year. We had to run after doctors trying to understand the need and convince them about 3D printing. But since then, we've worked with over 50 doctors covering 100 specialisations," says Atit Kothari, part of the leadership team at Imaginarium, a 3D printing company based in Mumbai.

Media Courtesy: Forbes India

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