Visualizing Each Patient's Heart Accurately

Join us as we explore Medical Frontiers.

Even a baby, with such a tiny heart, can require surgery.

And a heart surgery is incredibly complex, and until recently, surgeons had to predict postoperative progress based on their own experience.

This heart simulator was developed to tackle the problem.

It can recreate each patient's heart in minute detail, and in a world first, it can also show the inside of a beating heart.

This creation is enabling doctors to make accurate predictions of their patients' postoperative progress.

From the moment of our hearts form in the womb, until the second we die, they beat unceasingly, keeping us alive.

It's impossible even for surgeons to see the inside of the beating heart in detail with the naked eye.

But the simulator we're looking at today can accurately show the dynamic movements of not just the heart valves, but also blood flows, blood pressure, oxygen saturation and energy consumption.

It's a world first.

It was developed by a research team at the University of Tokyo.

Dr. Washio, it's such a pleasure to meet you.

It's nice to meet you.

Takumi Washio developed software for the simulator.

He's not a medical doctor, but a mathematician.

The software can recreate each patient's heart.

It produces detailed three-dimensional images of the organ based on data from various clinical examinations, such as CT scans, ultrasounds, and electrocardiograms.

So Dr. Washio, the heart simulator, what does it specifically tell you about the heart?

It shows the movements of the heart muscles.

It also calculates the movements of the valves
and blood flow to figure out how they interact.

It indicates the movement of blood using lines and arrows.

The faster the flows, the redder the lines.

The red lines are concentrated in the aorta.

The heart pumps out blood vigorously to the rest of the body.

The simulator enables doctors to confirm the status of blood flow from any angle.

It also visualizes blood pressure inside the heart.

Blood pressure is shown in red where it's high, and blue where it's low.

It's high in the aorta, which carries blood away from the heart to the rest of the body.

Because traditionally there was no way of assessing blood pressure apart from, you know, generally at the utmost...

I mean, this is a world first.

It allows doctors to check the
blood pressure anywhere in the heart.

Usually, that's not possible
without inserting catheters.

The simulator can also show the oxygen saturation of blood inside the heart.

Red represents blood rich in oxygen.

Blue indicates low-oxygen blood that's returning from the body.

It also shows how much energy each heart muscle is consuming to move the heart.

The darker the orange, the higher the energy consumption.

The precision is incredible.

I think there were so many challenges in terms of the imaging for the heart.

I believe our software is the only one in the world
that can simulate the entire heart.

It's unique in that it can show
all of the information simultaneously.

Others focus on the relationship between
the valves and the blood flow, or the muscle movements and blood pressure.

But our simulator integrates and shows all of it.

Washio analyzed the vast number of molecules in the heart to create benchmarks for each aspect of its functions.

The heart is a fist-sized organ with a complicated structure.

The roughly 0.1-millimeter-long cardiac muscle cells give the heart its ability to move.

There are about one billion of them.

A closer look at the cardiac muscle cells reveals countless small molecules that look like matchsticks, called myosins.

They are responsible for the movements of the cardiac muscle cells.

One cardiac muscle cell contains one billion myosins.

Washio had to analyze the movements of one billion times one billion myosins to get the full picture.

In his calculations, he used 200,000 pyramids to represent the cardiac muscle cells.

He came up with an equation to gauge the heart's movements based on the motions of the myosins.

A supercomputer does the calculations.

This is amazing.

So this is where all the calculations take place!

Each unit's performance is equal to that of a PC.
The whole system has the computing power of 500 PCs.

Even in the same patient, the heart's condition
can change depending on different factors.

We have to do a lot of calculations to simulate
the patient's status under various conditions.

That's why we use this computer.

A clinical trial began in 2022 for the heart simulator, targeting young children born with heart defects.

Five medical institutions are taking part.

Pediatric cardiologist Isao Shiraishi also helped to develop the simulator.

He has spent 40 years treating children with congenital heart defects.

Congenital heart defects make life difficult
for children. They need surgery very early on.

Some receive surgery one to two months after birth
or even on the day of birth.

It's very challenging to treat babies,
because they are vulnerable.

In Japan, about one in every 100 babies is born with heart defects.

Shiraishi's hospital has been treating babies who are in critical condition.

This model mimics an infant's defective heart.

Models such as these have been used in surgical training.

There's a hole in the wall between
the right and left ventricles.

It's not supposed to be here.
We'll practice patching it up.

Conventional 3D models show only the shape of the defective heart.

Although they can help train the surgeon how to operate, they cannot predict the heart's condition after surgery.

But the heart simulator can.

These models mimic changes in the heart's shape.

But it has been difficult to predict
three-dimensional changes to the heart's blood flow.

To do that, we need to accurately reproduce
the heart's pre-surgery condition with a computer.

There are several surgical options for each patient.

The simulator enables us to choose the best one
based on various clinical data.

The accuracy of the simulator's predictions was verified in a baby's heart surgery.

The verification was carried out by world-renowned cardiac surgeon Shunji Sano.

He has performed heart surgery on over 9,000 children.

As for complex heart diseases, no two hearts are identical,
even if the patients' diagnoses are the same.

We must make comprehensive judgments based on
our own experience and knowledge.

It's as if surgeons are being tested every day.

He attempted to verify the accuracy of the simulator's predictions on a baby with a rare heart defect that's said to affect one in every 100,000 people.

Why did you choose this case for simulation?

This case was so difficult that I wondered
which surgery would be the best.

I was curious whether
the simulator could handle it.

Many surgeons would get cold feet after
seeing the baby's malformation and give up.

Normally, clean blood is pumped out from the heart via the aorta to the rest of the body.

However, this baby's aorta was connected to the right ventricle, where dirty blood returns from the body.

There was also a large hole in the wall between the baby's left and right ventricles.

An image created by the simulator shows the baby's heart before surgery.

The dirty blood, shown in blue, and the clean blood, in red, are mixed, making the heart unable to deliver enough oxygen to the body.

Sano had two surgical options in mind.

But his team was divided over them.

The decision was left to Sano.

Most experienced doctors would find it
hard to decide between the two.

His team had the simulator predict and reproduce the baby's heart condition after surgery in each option.

The two have a big difference in blood flow dynamics in the aorta, which sends clean blood from the heart to the rest of the body.

One of the options would result in higher blood pressure in the area being operated on, because the patched vessel is slightly bent.

This would cause stress and energy loss in the baby's heart.

Even if the energy loss in each heartbeat
is small, the total burden will be large because the heart is moving unceasingly.
This could eventually lead to heart failure.

Blood flows just like water.
It's best if it can go around curves smoothly.

How does the simulator help you?

The computer picked the one that I chose
based on my intuition and expertise.

It was a relief.

My mood is not always the same,
and it can affect my judgment.

If the simulator gave me a prediction,
I would choose it without hesitation.

Babies born with serious heart defects need extremely difficult surgery.

An organization is available for patients and their parents to help them cope with the tough situation.

Nakamura Noriko is the group's vice chairperson.

She explains the simulator's benefits from the perspective of patients and their families.

When I saw the heart simulator for the first time, I was amazed at its ability to
visualize the heart accurately.

It is not easy for new parents to accept that their baby cannot survive without surgery.

Nakamura says that's where the heart simulator comes in.

When parents are told about their baby's disease,
they usually search the internet to learn about it.

But the information they find often
confuses and worries them even more.

It would be a great help if they could see how
the child's heart moves and functions in a way that can easily be understood by anyone.

I hope the simulator will help surgeons provide
surgeries of equal quality across the country.

That would ensure patients
and their families happy lives.

As a member of the development team, the veteran pediatric cardiologist Shiraishi, works with Nakamura's group.

He is using the heart simulator to train doctors.

About 80 percent of the work involves recreating
pre-surgery heart movements on the computer.

Japan faces a shortage of pediatric cardiac surgeons.

It takes time for doctors to acquire the advanced skills required for heart surgery on children.

Training novice doctors is an urgent issue.

Pediatric surgery department director Hajime Ichikawa has high hopes for the heart simulator's use as an educational tool.

It's extremely beneficial for training.

It enables doctors to proceed with surgery,
confident that they're making the right decisions.

Until now, they would be nervous because
they only had 2D data before surgery.

They had to picture it in 3D in their minds.

But the simulator makes 3D data available.
That's the biggest advantage.

It's like a car with an advanced navigation system
or an automatic brake, made available only recently.

The simulator will make it possible for
complicated heart surgeries to be done by any doctor in the country,
not just highly skilled surgeons.

Researchers from medicine, engineering, and mathematics worked together for 20 years to develop the simulator.

Now, it's finally at the stage to start helping to save young lives.

So, Doctor, I imagine this research must have been incredibly difficult, really demanding.

I mean, you mentioned it was over 20 years - what motivated you to get through it?

I studied mathematics and aspired to
become a mathematician at first.

But at a certain point, I realized that what I was
studying was far removed from the real world.

I've wanted to use mathematics to help people.

I have worked with not just mathematicians,
but also molecular biophysicists and doctors.

I believe that by creating the heart simulator,
we are doing something beneficial for the world.

So, Doctor, what are some of the issues of the heart simulator that need to be addressed?

We have to shorten the
time required for calculations.

They're now done on patients who have one month
until surgery, and take about two weeks to finish.

But sometimes, surgery is required
within a few days.

It's not possible yet to
do the simulations so quickly.

Various problems occur during calculations.
Its performance is not yet stable.

We need to make improvements to the simulator so that doctors, hospital technicians
and programmers can use it.

Thank you for having me.

For today's Tips for Healthy Living, we are joined by personal trainer Hanazawa Kiyotaka.

Hanazawa practiced kendo, a traditional Japanese martial art.

He used his experiences to develop a new type of exercise called "shindo."

Nice to meet you.

So what actually is shindo?

It's a fitness program performed with
a wooden sword called a "bokuto."

It combines the swinging of the sword,
a basic movement in "kendo," with footwork.

First, we sit in the formal "seiza" position.

A shindo session starts with meditation, just like in kendo.

This helps to improve concentration.

Sit up straight.

Meditate.

Breathe in and out slowly through your nose for one minute.

Stop.

Bow.

Next is the proper way to hold the "bokuto."

Hold the bottom of the bokuto with your left hand.
Place it a fist's length away from your belly button.

Wrap your right hand around it gently.

You can use other items with a similar shape, such as the cardboard tube.

It doesn't have to be heavy - anything that you can swing will do.

Today, Erica will try muscle training based on the most dynamic kendo technique called "men."

Stand with your feet wide apart.

Swing the bokuto down from the basic posture
as you exhale.

After lowering it, tighten your arms
as if to wring the bokuto.

That helps to tone your upper arms.

As you lower the bokuto, squat to strengthen the muscles in your thighs.

Exhale while swinging the bokuto down.
Inhale, exhale, inhale, exhale...

Make sure not to lower the bokuto too much.
Return to the original position and squat slightly.

It's quite a really powerful exercise.

Next is a move to strengthen the muscles in your buttocks.

Hold the bokuto above your head and lower it as
you take a big step forward with your right foot.

Repeat, but step forward with your left foot.
Continue alternating between left and right.

Make sure you lower your buttocks when you step forward.

Swing the bokuto down quickly if you want to increase the load achieved.

Repeat this eight times on each side.

I think particularly for people who are working at their computers the whole day, everyone's very, very tight between the shoulder blades.

Your shoulder blades move when you swing the bokuto.
This helps to improve your posture.

Next, swing the sword down diagonally like a samurai while moving one foot out to the side.

Keep your body upright when moving your foot to the side.
This way, you're using muscles in the inner thigh.

Actually, quite complex.

You're doing great.

Next is a difficult move similar to those in kendo training.

Swing the sword down diagonally as you sweep one of your feet behind the other.

Lower your torso as much as you can.

This helps to tone your hip muscles.

Lower.

Repeat this 16 times on each side.

This is a really... it's a tough workout.

Stand with your feet wide apart. Lower your torso
and draw a big "8" with the tip of the bokuto.

Keep the axis of your body still while twisting.

This will tighten your abdominal muscles.

Let's go faster.

Good.

Wow. That's incredible workout because it feels like a functional movement exercise.

But doing it with a wooden "katana" and doing it in the style of kendo is in your "shindo."

I think it's so beautiful to watch.

It's so much fun to do with the music together.

This exercise involves movement in both your upper
and lower body, so you can burn more energy.

I recommend it also as a way to familiarize
yourself with Japanese culture.

Let's wrap up our session with a bow.

Attention! Bow!