Born with a rare congenital heart defect, Jazmin Estaban inspired the cardiac team at The Children’s Hospital of San Antonio to embrace three-dimensional printing technology, one of the most sophisticated solutions for surgical planning.
Before Jazmin Esteban left the womb, her health care team knew that she would be faced with unique challenges.
When she was born, doctors and nurses were ready to spring to action.
“When you are faced with a difficult situation, it’s important to have all hands on deck and to aspire to do better than your best. All of us — the health care team
and the family — had to collaborate closely to get Jazmin better.”
“We had some awareness from the prenatal ultrasound that there would be congenital anomalies,” says Jazmin’s neonatologist Cody Henderson, M.D., physician on staff with The Children’s Hospital of San Antonio. “She was not getting enough oxygen, and the respiratory distress appeared to be related to a heart abnormality.”
Specifically, Jazmin’s challenges were the result of a rare heart abnormality known as ventricular inversion with multiple complex ventricular septal defects (VSDs). As a result of the condition, blood flowed improperly from the right atrium through the left ventricle to the aorta, interfering with the delivery of oxygen-rich blood to the rest of her body.
“Jazmin has a condition in which the pumping chambers of the heart are inverted, and there are two large holes between the lower pumping chambers,” says Muhammad.
Ali Mumtaz, M.D., section chief of pediatric heart surgery with The Children’s Hospital of San Antonio. “She was diagnosed at birth because of a murmur, and she had symptoms of congestive heart failure. We knew that she would require surgery.”
Before the surgical team could operate on Jazmin, she had to first gain enough weight to be able to survive the procedure. Dr. Henderson led the effort to help her gain weight using a feeding tube. During this time, the radiology team captured computed tomography (CT) images of Jazmin’s heart to help form the best surgical plan for her.
“The holes in Jazmin’s heart were very complex,” Dr. Mumtaz says. “One hole was typical of a ventricle inversion, but the other, a sub-aortic hole, was unlike anything we had ever seen before. We sent the images to other cardiac experts from around the country, but nobody had handled a case quite like hers.”
To meet this unprecedented challenge, at the suggestion of Justin Weigand, M.D., a pediatric Cardiologist at The Children’s Hospital of San Antonio, and part of Jazmin’s care team, the team turned to an innovative tactic: using a 3-D model of Jazmin’s heart to aid in planning.
“Within the past few years, we’ve seen hospitals and health care providers partnering with software developers to combine CT and MRI images to make models of human organs,” Dr. Weigand says. “In this case, we used it to provide an exact replica of Jazmin’s heart.”
“The 3-D model helped us understand the complex hole and its relationship to the valves in the heart,” Dr. Mumtaz says. “The model enabled us to understand how to properly surgically repair the hole or possibly implement a plug device via cardiac catheterization.”
But Dr. Mumtaz and his colleagues could not have envisioned another surprise that arose when they took Jazmin to the catheterization lab.
“We thought based on the 3-D model that we could put a plug device in one of the holes, but we did not see that there was a tiny blood vessel, a coronary artery, running in front of the hole,” Dr. Mumtaz says. “The catheter pushed on the tiny coronary artery, resulting in decreased blood flow to the heart. As a result, the device had to be removed. That blood vessel is critical to heart function and supplying blood to the heart. If it was compressed or cut accidentally, that portion of the heart would not work. So we had to adjust our plan.”
To save Jazmin’s heart, Dr. Mumtaz and his colleagues performed a complex atrial switch operation called the Senning procedure, along with repair of the complex VSDs.
After an all-day surgery, the operation was a success, and today Jazmin is growing and thriving thanks to the collaborative efforts of her family and health care team.
“Everyone did a great job working together figuring out what would happen,” says Maria Martinez, Jazmin’s mother. “And they communicated with us beautifully, using the 3-D model to show us what the surgery would involve. It was wonderful to see everyone working together to keep my baby healthy.”
A Spirit of Courage
In addition to her heart condition, Jazmin also faces challenges with hearing, muscle tone and Bell’s palsy. Her family is dedicated to ensuring she gets the occupational, physical and speech therapy services she needs.
“For a baby born with so many issues, Jazmin has flourished,” Dr. Henderson says. “Her parents picked up the mantle when she was discharged and gave her the constant attention and care she needed. Their ability to augment her therapy has made this a smooth transition and maximizes her chances for getting better. She has already made great strides.”
Jazmin is now home with her mother, father, Francisco Estaban, and brother, Mario, demonstrating the inherent strength that has been critical to her survival.
“She is making little noises here and there and trying to sit on her own,” Maria says. “Her hearing is improving with her hearing aid, and she will turn to you when you talk to her. She is trying to be very independent. She doesn’t give up.”