Not all children are the same: how the Aesculapius project uses imaging to bridge the gap in Congenital Heart Diseases

Background Congenital heart disease (CHD) is the most common congenital malformation worldwide, with an estimated incidence of 8–10 per 1,000 live births. Despite advances in diagnosis and treatment, profound disparities persist between high- and low-resource settings, significantly impacting survival and long-term outcomes. Objective To describe the rationale, methodology, and outcomes of the Aesculapius Project, which employs advanced imaging and three-dimensional (3D) printing as educational tools to reduce inequalities in pediatric cardiac surgery training. Methods/Program Design The programme, initiated by two humanitarian foundations, that are Bambini Cardiopatici nel Mondo and European Heart for Children, provides, free of charge, training for early-career surgeons from resource-limited countries. Imaging modalities, including computed tomography (CT) and magnetic resonance imaging (MRI), are used to generate patient-specific 3D cardiac models. These models are employed in structured courses comprising lectures, supervised hands-on surgical simulations, and remote follow-up. Results/Evidence To date, 81 physicians from 16 countries have been trained. Participants performed, under expert surgeons’ supervision, 10–20 simulated procedures using 3D models of complex CHD, with technical performance scores improving by an average of 30%. Feedback highlighted the educational value of repeated supervised practice and video-assisted review. Conclusions/Implications The Aesculapius Project demonstrates that 3D anatomical models can provide an ethical and useful teaching framework in pediatric cardiac surgery. This initiative represents a step toward expanding access to advanced surgical training in resource-limited settings.