When Harper Struntz first saw the 3D model of her original heart, it shocked her.
“I had just woken up from a nap, and I was like, ‘Oh, my god! What is that?’” says Harper, a 9-year-old from Frostburg, Md. “I was about to call my nurse in and say, ‘Someone cut themselves open!’”
Harper had a heart transplant at UPMC Children’s Hospital of Pittsburgh on March 7, 2024. After her surgery, the 3D Printing Program at UPMC printed out a life-sized physical model of her original heart.
Months earlier, the 3D printing team played a key role in Harper’s case.
Doctors had two potential options for a left ventricular assist device (LVAD) that would help keep Harper alive until she could get a transplant. So, they enlisted UPMC’s 3D Printing Program to create a virtual model of Harper’s heart to determine which LVAD to use. Her surgeons also used the model to plan the LVAD surgery.
It’s just one example of the 3D Printing Program’s impact on patient care at UPMC.
A Humble Beginning
The 3D Printing Program at UPMC began with a “bright-eyed, bushy-tailed resident” and a dream.
At least, that’s how the aforementioned resident — Anish Ghodadra, MD, interventional radiologist and founder and medical director of the 3D Printing Program — describes it.
Before coming to UPMC, Dr. Ghodadra had a background in biomedical engineering. He worked as a device engineer at a startup making devices to treat degenerative disc disease in the spine before ultimately deciding to pursue medicine.
Dr. Ghodadra was working as a resident in UPMC’s Interventional Radiology Department in 2016 when he had an idea.
“I was exposed to this new world of imaging, and at some point, it just kind of clicked,” he says. “’Maybe we can use 3D printing to try to take what we look at every day on a screen and then print a physical object out of it.’”
At the time, some hospitals were using 3D printing to create models of patient anatomy for surgical planning and practice. But the printers and raw materials were expensive, and the printers needed frequent maintenance.
“I was looking at how to make 3D printing more affordable and more practical at the point of care,” Dr. Ghodadra says.
Luckily, around that time, multiple manufacturers came out with high-quality 3D printers that were less expensive and less temperamental. Dr. Ghodadra received grants from The Beckwith Institute and the UPMC Department of Radiology to purchase a couple of 3D printers.
“They gave me a small space to work in, and I just kind of started tinkering,” Dr. Ghodadra says. “I started looking at well, first, how do I even turn a CT scan, an MRI, or an ultrasound into a visible 3D model? And what can the printer do and not do?”
A Growing Program
In the beginning, Dr. Ghodadra was the only member of the 3D printing team. And on top of that work, he was still doing his day job in interventional radiology. This meant coming in early, staying late, and working weekends to get the program off the ground.
Dr. Ghodadra’s background in engineering and medicine helped him learn the ins and outs of 3D printing technology. But he also had to get the word out to surgeons.
“I was basically talking to anybody and everybody who was listening and running out with models constantly,” he says. “I always had a model of some kind in my hand to show somebody in case I ran into a surgeon in the elevator. (I) had my elevator pitch ready to go — literally, sometimes.”
In the early days of the program, Dr. Ghodadra was creating one or two models a month. But as word of mouth grew, so did the program. The team now includes three full-time engineers alongside Dr. Ghodadra.
The program now makes around 50 models each month, and the first quarter of 2024 marked their three busiest months on record.
“We work across every subspecialty in the hospital,” says Elliott Hammersley, lead biomedical engineer of the 3D printing team. “Any surgical specialty that you can think of, we’ve probably worked with before.”
The 3D Printing Program demonstrated its capabilities during the COVID-19 pandemic in 2020. When COVID-19 testing kits were in short supply, the team designed and printed 100,000 nasopharyngeal swabs to test for COVID-19. They worked with the U.S. Food and Drug Administration (FDA) to get the swabs approved to test for COVID-19.
“That was an exciting and humbling experience,” Dr. Ghodadra says. “We were able to pivot our entire operation and meet this need in real time, take workers who were displaced by the shutdowns, and have them work the factory floor to reach so many patients so quickly.
“When all was said and done, 62,000 patients were swabbed with the swabs that otherwise may not have been able to get a COVID test.”
A Valuable Tool
Dr. Ghodadra says he doesn’t sell his models — they sell themselves because of their value to surgeons and patients.
He remembers the first 3D model he ever created at UPMC. It was for a patient who had a benign bone tumor in his elbow. Nearby nerves made the tumor tricky to remove, so Dr. Ghodadra created a model to help the surgeon plan the procedure.
“Sitting down with the family, showing them the model, and showing them how we were going approach treating that tumor, you were able to see the light bulb go off in the mom’s eyes,” Dr. Ghodadra says. “They truly understood what we were going to do, the challenges around what we were going to do, and the explanation of why we were taking the approach that we were going to take.
“There’s nothing that can replace that experience for patients and families. Patients can really participate in their care.”
The process of creating a 3D model begins with a request from a surgeon. A member of the 3D printing team then asks the surgeon what they need from the model. They can adapt the model depending on the surgeon’s needs.
After that, they take all the high-quality imaging available of the patient — CT, MRI, or ultrasound — and turn it into a virtual 3D model. This requires going slice by slice through the imaging and tracing out the anatomy.
“It can take as little as five or 10 minutes for something simple like a model of bone,” Dr. Ghodadra says. “But something complicated like facial trauma, kidney tumor, or brain lesions can take hours. You need highly trained individuals who know what they’re looking at to identify that anatomy accurately and use all the engineering tools to do it quickly and efficiently.”
After the team has created the virtual 3D model, a board-certified radiologist reviews it to ensure everything is accurate. Only then does the actual printing occur. The program has 14 3D printers, and they can utilize different printers depending on the specific needs of the model.
“The difference between a successful and accurate print versus a failed print is in that planning around the physics and engineering of 3D printing and picking the right printing technology, printing parameters, the right materials, the right orientation, and supporting structures within the model,” Dr. Ghodadra says.
The time this takes can vary depending on the specific model. But it ends with a valuable tool: a 3D model that has the potential to save someone’s life.
Someone like Harper Struntz.
A Scary Sickness
Harper had just begun the third grade when she started feeling sick all the time.
“I was feeling lightheaded, always cold and hot, always dry heaving, nauseous,” she says.
Her parents made several trips to her pediatrician and to urgent care. They even took Harper to the emergency department near their home.
“Everybody told us that she was just sick, it was a really bad stomach bug that would run its course,” says Alison Drew, Harper’s mother.
Despite those assurances, Harper’s condition continued to worsen. She was hardly eating, throwing up often, and losing weight.
A few days after their trip to the emergency department, Alison says that Harper “looked like death.” Alison and her husband Chad took her back to the emergency department, where tests showed her liver enzymes were 10 times higher than normal. She was in liver failure.
They transferred Harper to the Pediatric Intensive Care Unit (PICU) at UPMC Children’s Hospital. The next day, Alison and Chad met with a hepatologist, who told them Harper might need a liver transplant.
While Harper was undergoing an abdominal ultrasound, the technician noticed that the lower chambers of Harper’s heart had become enlarged. Based on that recognition, the UPMC Children’s team ordered an echocardiogram.
Harper had dilated cardiomyopathy, a condition in which the heart’s left ventricle (the lower left chamber) becomes enlarged. Dilated cardiomyopathy can affect the heart’s ability to pump blood to the body.
“When the left ventricle is enlarged, it transitions from a cone shape to the shape of a softball,” says Matthew Zinn, DO, pediatric cardiologist, UPMC Children’s Hospital of Pittsburgh. “This change results in poor function of the heart muscle, which ultimately led to all of Harper’s presenting symptoms.
“It was fortunate that we had a very thorough abdominal exam that led to the diagnosis.”
Harper was in heart failure and would need lifesaving intervention in the form of an LVAD.
“It was terrifying because we didn’t know what was going to happen,” Alison says.
A Lifesaving Model
In heart failure, an LVAD takes over the work of pumping blood to the body, often serving as a bridge to transplant. Because of Harper’s age and size, her doctors had two LVAD options: the standard pediatric LVAD (the Berlin Heart EXCOR®) or the standard adult LVAD (the HeartMate 3).
“She was right on the borderline,” Dr. Zinn says.
If she received the Berlin Heart EXCOR®, Harper would have to stay in the hospital until she received a transplant. The HeartMate 3 would allow her to wait for the transplant out of the hospital.
Dr. Zinn decided to do a fit test to see if the HeartMate 3 would fit in Harper’s chest. So, the UPMC Children’s team enlisted the 3D Printing Program to create a digital 3D model of Harper’s heart. They then took a digital file of the HeartMate 3 and overlaid it on her heart and chest scans to see if it would fit.
“That was an intense morning,” Elliott says. “Because she needs a heart transplant. She needs an LVAD. Can we fit it? Yes or no?”
Ultimately, the fit test showed that Harper could receive the HeartMate 3.
“That allowed us to move forward with the LVAD that would potentially provide her greater ability to rehab physically, nutritionally, and mentally,” Dr. Zinn says.
Harper’s surgical team also used the data from the fit test to plan the procedure. Harper became the youngest patient ever at UPMC Children’s to receive the HeartMate 3.
A New Heart
Harper went on the heart transplant waiting list in December 2023. In March 2024, she received a successful heart transplant at UPMC Children’s.
After Harper’s transplant, Maureen Heneghan, MS, CCLS, a child life specialist working with Harper and her family, mentioned the 3D printing team. The possibility occurred to her that they could create a physical model of Harper’s old heart.
“Once we heard about the 3D print, we thought that was awesome,” Alison says.
Maureen enlisted the 3D Printing Program to produce a 3D model of Harper’s heart from her pre-LVAD images.
“I think it is an awesome connection to allow kids to see what their heart looked like, why it required treatment, and then be able to keep a piece of their old heart with them forever,” Maureen says.
“This was a great full-circle moment,” Elliott says.
“It’s rewarding. I got to be part of the team that helped put the bridge to transplant in. And then after the transplant, I got to give her the heart that she lost.”
The model is a one-to-one recreation of Harper’s old heart, which was almost double the size it should have been.
“It creeps me out, that it was this big inside of me,” Harper says. “But knowing it’s not that big anymore is helpful.”
A Bright Future
After her transplant, Harper is healthy again. She returned home in April but came back to western Pennsylvania in June for the Dr. Bill Neches Heart Camp for Kids. UPMC Children’s hosts the camp each year at YMCA Camp Kon-O-Kwee Spencer in Fombell, Pa.
“Harper has an amazing personality,” Dr. Zinn says. “She wants to do everything and doesn’t want you to hold her back. She’s ready to go. Her personality is what pushes her forward.”
Harper has a bright future, and so does the 3D Printing Program at UPMC.
The program recently moved into a new, updated, centralized location at UPMC Presbyterian, which will allow the program to continue to expand. Within the new space, there are three “clean rooms” that will allow the team to create sterile, patient-specific surgical tools.
“These can actually help the surgeons do the surgery,” Dr. Ghodadra says. “So, we can sit down with the surgeon, virtually perform a surgery, plan different aspects of where we’re going to cut bone, for example, and then design the guides that help them then execute the plan that we created virtually.
“No more guessing. No more eyeballing it. It’s precision surgery.”
As technology continues to advance, so will the program’s capabilities. Dr. Ghodadra says the team will soon create patient-specific implants. For example, they can create a 3D plate to contour to the skull of a patient undergoing a cranioplasty.
“Looking back, never in my wildest dreams did I think we would be where we are today,” Dr. Ghodadra says. “I’d always hoped we would get here. But to truly be at the spot where you’ve got this wonderful team that I work with, this beautiful new space, and it’s no longer this tool searching for an application, a hammer looking for a nail. It has become the hammer for a lot of procedures.
“It’s been a very humbling journey to see us grow from that one little printer in a closet to this fleet we have now. And every day, there’s new applications. It never gets old; it keeps me getting out of bed and coming into work every day.”
Learn more about the 3D Printing Program at UPMC.