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Kowalik GT, Kerfoot E, Kunze K, Neji R, Moon T, Mellor N, Razavi R, Pushparajah K, Roujol S. Fast, automated, real-time 3D passive balloon catheter tracking during MRI-guided cardiac catheterization using orthogonal projection imaging and real-time image-based catheter detection. Magn Reson Med 2025; 93:311-320. [PMID: 39219165 DOI: 10.1002/mrm.30265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/02/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE MRI-guidance of cardiac catheterization is currently performed using one or multiple 2D imaging planes, which may be suboptimal for catheter navigation, especially in patients with complex anatomies. The purpose of the work was to develop a robust real-time 3D catheter tracking method and 3D visualization strategy for improved MRI-guidance of cardiac catheterization procedures. METHODS A fast 3D tracking technique was developed using continuous acquisition of two orthogonal 2D-projection images. Each projection corresponds to a gradient echo stack of slices with only the central k-space lines being collected for each slice. To enhance catheter contrast, a saturation pulse is added ahead of the projection pair. An offline image processing algorithm was developed to identify the 2D coordinates of the balloon in each projection image and to estimate its corresponding 3D coordinates. Post-processing includes background signal suppression using an atlas of background 2D-projection images. 3D visualization of the catheter and anatomy is proposed using three live sagittal, coronal, and axial (MPR) views and 3D rendering. The technique was tested in a subset of a catheterization step in three patients undergoing MRI-guided cardiac catheterization using a passive balloon catheter. RESULTS The extraction of the catheter balloon 3D coordinates was successful in all patients and for the majority of time-points (accuracy >96%). This tracking method enabled a novel 3D visualization strategy for passive balloon catheter, providing enhanced anatomical context during catheter navigation. CONCLUSION The proposed tracking strategy shows promise for robust tracking of passive balloon catheter and may enable enhanced visualization during MRI-guided cardiac catheterization.
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Affiliation(s)
- Grzegorz T Kowalik
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Karl Kunze
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Tracy Moon
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nina Mellor
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Abdelaziz MEMK, Tian L, Lottner T, Reiss S, Heidt T, Maier A, Düring K, von zur Mühlen C, Bock M, Yeatman E, Yang G, Temelkuran B. Thermally Drawn Polymeric Catheters for MR-Guided Cardiovascular Intervention. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2407704. [PMID: 39403885 PMCID: PMC11615795 DOI: 10.1002/advs.202407704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/31/2024] [Indexed: 12/06/2024]
Abstract
Cardiovascular diseases (CVDs), including congenital heart diseases (CHD), present significant global health challenges, emphasizing the need for safe and effective treatment modalities. Fluoroscopy-guided endovascular interventions are widely utilized but raise concerns about ionizing radiation, especially in pediatric cases. Magnetic resonance imaging (MRI) offers a radiation-free alternative with superior soft tissue visualization and functional insights. However, the lack of compatible instruments remains a major obstacle. An adapted thermal drawing platform that enables low-cost and rapid prototyping of instruments for MR-guided endovascular interventions is introduced. This platform is demonstrated through the development of two exemplary catheter systems: a tendon-driven steerable catheter with helical lumina and an active tracking Tiger-shaped catheter with an embedded coaxial wire. These catheters exhibit mechanical properties comparable to commercial counterparts and show promising outcomes in both in vitro and in vivo feasibility testing. This scalable thermal drawing platform addresses the limitations of existing manufacturing approaches and facilitates the exploration of diverse designs, potentially accelerating advancements in catheter technologies for MR-guided cardiovascular interventions.
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Affiliation(s)
- Mohamed E. M. K. Abdelaziz
- The Hamlyn Centre for Robotic SurgeryImperial College LondonLondonSW7 2AZUK
- Department of Electrical and Electronic EngineeringFaculty of EngineeringImperial College LondonLondonSW7 2AZUK
| | - Libaihe Tian
- The Hamlyn Centre for Robotic SurgeryImperial College LondonLondonSW7 2AZUK
- Department of MetabolismDigestion, and ReproductionFaculty of MedicineImperial College LondonLondonSW7 2AZUK
| | - Thomas Lottner
- Department of Diagnostic and Interventional RadiologyMedical PhysicsFaculty of Medicine, University of Freiburg79106FreiburgGermany
| | - Simon Reiss
- Department of Diagnostic and Interventional RadiologyMedical PhysicsFaculty of Medicine, University of Freiburg79106FreiburgGermany
| | - Timo Heidt
- Department of Cardiology and AngiologyUniversity Heart Center Freiburg – Bad KrozingenFaculty of MedicineUniversity of Freiburg79106FreiburgGermany
| | - Alexander Maier
- Department of Cardiology and AngiologyUniversity Heart Center Freiburg – Bad KrozingenFaculty of MedicineUniversity of Freiburg79106FreiburgGermany
| | - Klaus Düring
- MaRVis Interventional GmbH82467Garmisch‐PartenkirchenGermany
| | - Constantin von zur Mühlen
- Department of Cardiology and AngiologyUniversity Heart Center Freiburg – Bad KrozingenFaculty of MedicineUniversity of Freiburg79106FreiburgGermany
| | - Michael Bock
- Department of Diagnostic and Interventional RadiologyMedical PhysicsFaculty of Medicine, University of Freiburg79106FreiburgGermany
| | - Eric Yeatman
- Department of Electrical and Electronic EngineeringFaculty of EngineeringImperial College LondonLondonSW7 2AZUK
| | - Guang‐Zhong Yang
- Institute of Medical RobotsShanghai Jiao Tong UniversityShanghai200240China
| | - Burak Temelkuran
- The Hamlyn Centre for Robotic SurgeryImperial College LondonLondonSW7 2AZUK
- Department of MetabolismDigestion, and ReproductionFaculty of MedicineImperial College LondonLondonSW7 2AZUK
- The Rosalind Franklin InstituteDidcotOX11 0QSUK
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Voges I, Raimondi F, McMahon CJ, Ait-Ali L, Babu-Narayan SV, Botnar RM, Burkhardt B, Gabbert DD, Grosse-Wortmann L, Hasan H, Hansmann G, Helbing WA, Krupickova S, Latus H, Martini N, Martins D, Muthurangu V, Ojala T, van Ooij P, Pushparajah K, Rodriguez-Palomares J, Sarikouch S, Grotenhuis HB, Greil FG, Bohbot Y, Cikes M, Dweck M, Donal E, Grapsa J, Keenan N, Petrescu AM, Szabo L, Ricci F, Uusitalo V. Clinical impact of novel cardiovascular magnetic resonance technology on patients with congenital heart disease: a scientific statement of the Association for European Pediatric and Congenital Cardiology and the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:e274-e294. [PMID: 38985851 DOI: 10.1093/ehjci/jeae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is recommended in patients with congenital heart disease (CHD) in clinical practice guidelines as the imaging standard for a large variety of diseases. As CMR is evolving, novel techniques are becoming available. Some of them are already used clinically, whereas others still need further evaluation. In this statement, the authors give an overview of relevant new CMR techniques for the assessment of CHD. Studies with reference values for these new techniques are listed in the Supplementary data online, supplement.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Kiel, Germany
| | | | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Lamia Ait-Ali
- Institute of Clinical Physiology CNR, Massa, Italy
- Heart Hospital, G. Monastery foundation, Massa, Italy
| | - Sonya V Babu-Narayan
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
- Institute for Biological and Medical Engineering and School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Barbara Burkhardt
- Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Dominik D Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Kiel, Germany
| | - Lars Grosse-Wortmann
- Division of Cardiology, Oregon Health and Science University Hospital, Portland, OR, USA
| | - Hosan Hasan
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, and Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sylvia Krupickova
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Heiner Latus
- Clinic for Pediatric Cardiology and Congenital Heart Disease Klinikum, Stuttgart Germany
| | - Nicola Martini
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Duarte Martins
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Tiina Ojala
- New Children's Hospital Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Jose Rodriguez-Palomares
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, The Netherlands
- Servicio de Cardiología, Hospital Universitario Vall Hebrón, Institut de Recerca Vall Hebrón (VHIR), Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Gerald Greil
- Department of Pediatrics, UT Southwestern/Children's Health, Dallas, TX, USA
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Sanguineti F, Garot P, Toupin S, Pezel T, Bohbot Y, Tawa C, Poupineau M, Boileve V, Landon V, Duhamel S, Garot J. Feasibility, safety and diagnostic yield of interventional cardiac magnetic resonance for routine right heart catheterization in adults. Arch Cardiovasc Dis 2024; 117:275-282. [PMID: 38472043 DOI: 10.1016/j.acvd.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Real-time cardiac magnetic resonance generates spatially and temporally resolved images of cardiac anatomy and function, without the need for contrast agent or X-ray exposure. Cardiac magnetic resonance-guided right heart catheterization (CMR-RHC) combines the benefits of cardiac magnetic resonance and invasive cardiac catheterization. The clinical adoption of CMR-RHC represents the first step towards the development of cardiac magnetic resonance-guided therapeutic procedures. AIM To describe the feasibility, safety and diagnostic yield of CMR-RHC in consecutive all-comer patients with clinical indications for right heart catheterization. METHODS From December 2018 to May 2021, 35 consecutive patients with prespecified indications for right heart catheterization were scheduled for CMR-RHC via the femoral route under local anaesthesia in a 1.5T cardiac magnetic resonance suite equipped for interventional cardiac magnetic resonance. The duration of various procedural components and safety data were recorded. Success rate (defined by the ability to record all prespecified haemodynamic measurements and imaging metrics), adverse events and patient/physician perprocedural comfort were assessed. RESULTS One patient withdrew his consent before the study, and scanner troubleshooting occurred in one case. Among the 33 remaining patients, prespecified cardiac magnetic resonance imaging metrics were obtained in all patients, whereas full CMR-RHC measurements were obtained in 30 patients (91%). A dedicated cardiac magnetic resonance-compatible wire was used in 25/33 procedures. CMR-RHC was completed in 29±16minutes, and the total duration of the procedure, including conventional cardiac magnetic resonance imaging, was 62±20minutes. There were no adverse events and no femoral haematomas. Procedural comfort was deemed good by the patients and operators for all procedures. CMR-RHC significantly impacted diagnosis or patient management in 28/33 patients (85%). CONCLUSIONS CMR-RHC seems to be a feasible and safe procedure that can be used in routine daily practice in consecutive adults with an impactful clinical yield.
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Affiliation(s)
- Francesca Sanguineti
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Philippe Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthineers, Scientific Partnership, 93210 Saint-Denis, France
| | - Théo Pezel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Yohann Bohbot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Chloé Tawa
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Mathieu Poupineau
- Hôpital Privé Claude Galien, Ramsay Santé, Institut Cardiovasculaire Paris Sud (ICPS), 91480 Quincy-sous-Sénart, France
| | - Victor Boileve
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Valentin Landon
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Suzanne Duhamel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France.
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Frieberg P, Sjöberg P, Hedström E, Carlsson M, Liuba P. In vivo hepatic flow distribution by computational fluid dynamics can predict pulmonary flow distribution in patients with Fontan circulation. Sci Rep 2023; 13:18206. [PMID: 37875552 PMCID: PMC10598063 DOI: 10.1038/s41598-023-45396-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
In Fontan patients, a lung deprived of hepatic blood may develop pulmonary arterio-venous malformations (PAVMs) resulting in shunting, reduced pulmonary vascular resistance (PVR) and decreased oxygenation. To provide guidance for corrective invasive interventions, we aimed to non-invasively determine how the hepatic to pulmonary blood flow balance correlates with pulmonary flow, PVR, and with oxygen saturation. Magnetic resonance imaging (MRI) data from eighteen Fontan patients (eight females, age 3-14 years) was used to construct patient-specific computational fluid dynamics (CFD) models to calculate the hepatic to pulmonary blood flow. This was correlated with pulmonary vein flow, simulated PVR and oxygen saturation. Clinical applicability of the findings was demonstrated with an interventional patient case. The hepatic to pulmonary blood flow balance correlated with right/left pulmonary vein flow (R2 = 0.50), left/right simulated PVR (R2 = 0.47), and oxygen saturation at rest (R2 = 0.56). In the interventional patient, CFD predictions agreed with post-interventional MRI measurements and with regressions in the cohort. The balance of hepatic blood to the lungs has a continuous effect on PVR and oxygen saturation, even without PAVM diagnosis. MRI combined with CFD may help in planning of surgical and interventional designs affecting the hepatic to pulmonary blood flow balance in Fontan patients.
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Affiliation(s)
- Petter Frieberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
| | - Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Department of Clinical Sciences Lund, Pediatric Heart Center, Lund University, Skåne University Hospital, Lund, Sweden
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Neofytou AP, Kowalik GT, Vidya Shankar R, Huang L, Moon T, Mellor N, Razavi R, Neji R, Pushparajah K, Roujol S. Automatic image-based tracking of gadolinium-filled balloon wedge catheters for MRI-guided cardiac catheterization using deep learning. Front Cardiovasc Med 2023; 10:1233093. [PMID: 37745095 PMCID: PMC10513169 DOI: 10.3389/fcvm.2023.1233093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Magnetic Resonance Imaging (MRI) is a promising alternative to standard x-ray fluoroscopy for the guidance of cardiac catheterization procedures as it enables soft tissue visualization, avoids ionizing radiation and provides improved hemodynamic data. MRI-guided cardiac catheterization procedures currently require frequent manual tracking of the imaging plane during navigation to follow the tip of a gadolinium-filled balloon wedge catheter, which unnecessarily prolongs and complicates the procedures. Therefore, real-time automatic image-based detection of the catheter balloon has the potential to improve catheter visualization and navigation through automatic slice tracking. Methods In this study, an automatic, parameter-free, deep-learning-based post-processing pipeline was developed for real-time detection of the catheter balloon. A U-Net architecture with a ResNet-34 encoder was trained on semi-artificial images for the segmentation of the catheter balloon. Post-processing steps were implemented to guarantee a unique estimate of the catheter tip coordinates. This approach was evaluated retrospectively in 7 patients (6M and 1F, age = 7 ± 5 year) who underwent an MRI-guided right heart catheterization procedure with all images acquired in an orientation unseen during training. Results The overall accuracy, specificity and sensitivity of the proposed catheter tracking strategy over all 7 patients were 98.4 ± 2.0%, 99.9 ± 0.2% and 95.4 ± 5.5%, respectively. The computation time of the deep-learning-based segmentation step was ∼10 ms/image, indicating its compatibility with real-time constraints. Conclusion Deep-learning-based catheter balloon tracking is feasible, accurate, parameter-free, and compatible with real-time conditions. Online integration of the technique and its evaluation in a larger patient cohort are now warranted to determine its benefit during MRI-guided cardiac catheterization.
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Affiliation(s)
- Alexander Paul Neofytou
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Grzegorz Tomasz Kowalik
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Rohini Vidya Shankar
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Li Huang
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Tracy Moon
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Nina Mellor
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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Beattie MJ, Sleeper LA, Lu M, Teele SA, Breitbart RE, Esch JJ, Salvin JW, Kapoor U, Oladunjoye O, Emani SM, Banka P. Factors associated with morbidity, mortality, and hemodynamic failure after biventricular conversion in borderline hypoplastic left hearts. J Thorac Cardiovasc Surg 2023; 166:933-942.e3. [PMID: 36803549 DOI: 10.1016/j.jtcvs.2023.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE A subset of patients with borderline hypoplastic left heart may be candidates for single to biventricular conversion, but long-term morbidity and mortality persist. Prior studies have shown conflicting results regarding the association of preoperative diastolic dysfunction and outcome, and patient selection remains challenging. METHODS Patients with borderline hypoplastic left heart undergoing biventricular conversion from 2005 to 2017 were included. Cox regression identified preoperative factors associated with a composite outcome of time to mortality, heart transplant, takedown to single ventricle circulation, or hemodynamic failure (defined as left ventricular end-diastolic pressure >20 mm Hg, mean pulmonary artery pressure >35 mm Hg, or pulmonary vascular resistance >6 international Woods units). RESULTS Among 43 patients, 20 (46%) met the outcome, with a median time to outcome of 5.2 years. On univariate analysis, endocardial fibroelastosis, lower left ventricular end-diastolic volume/body surface area (when <50 mL/m2), lower left ventricular stroke volume/body surface area (when <32 mL/m2), and lower left:right ventricular stroke volume ratio (when <0.7) were associated with outcome; higher preoperative left ventricular end-diastolic pressure was not. Multivariable analysis demonstrated that endocardial fibroelastosis (hazard ratio, 5.1, 95% confidence interval, 1.5-22.7, P = .033) and left ventricular stroke volume/body surface area 28 mL/m2 or less (hazard ratio, 4.3, 95% confidence interval, 1.5-12.3, P = .006) were independently associated with a higher hazard of the outcome. Approximately all patients (86%) with endocardial fibroelastosis and left ventricular stroke volume/body surface area 28 mL/m2 or less met the outcome compared with 10% of those without endocardial fibroelastosis and with higher stroke volume/body surface area. CONCLUSIONS History of endocardial fibroelastosis and smaller left ventricular stroke volume/body surface area are independent factors associated with adverse outcomes among patients with borderline hypoplastic left heart undergoing biventricular conversion. Normal preoperative left ventricular end-diastolic pressure is insufficient to reassure against diastolic dysfunction after biventricular conversion.
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Affiliation(s)
- Meaghan J Beattie
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Sarah A Teele
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Roger E Breitbart
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Jesse J Esch
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Joshua W Salvin
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Urvi Kapoor
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Olubunmi Oladunjoye
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass
| | - Sitaram M Emani
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
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Rogers T, Campbell-Washburn AE, Ramasawmy R, Yildirim DK, Bruce CG, Grant LP, Stine AM, Kolandaivelu A, Herzka DA, Ratnayaka K, Lederman RJ. Interventional cardiovascular magnetic resonance: state-of-the-art. J Cardiovasc Magn Reson 2023; 25:48. [PMID: 37574552 PMCID: PMC10424337 DOI: 10.1186/s12968-023-00956-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 4B01, Washington, DC, 20011, USA.
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Laurie P Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
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9
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Özen AC, Russe MF, Lottner T, Reiss S, Littin S, Zaitsev M, Bock M. RF-induced heating of interventional devices at 23.66 MHz. MAGMA (NEW YORK, N.Y.) 2023:10.1007/s10334-023-01099-7. [PMID: 37195365 PMCID: PMC10386938 DOI: 10.1007/s10334-023-01099-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Low-field MRI systems are expected to cause less RF heating in conventional interventional devices due to lower Larmor frequency. We systematically evaluate RF-induced heating of commonly used intravascular devices at the Larmor frequency of a 0.55 T system (23.66 MHz) with a focus on the effect of patient size, target organ, and device position on maximum temperature rise. MATERIALS AND METHODS To assess RF-induced heating, high-resolution measurements of the electric field, temperature, and transfer function were combined. Realistic device trajectories were derived from vascular models to evaluate the variation of the temperature increase as a function of the device trajectory. At a low-field RF test bench, the effects of patient size and positioning, target organ (liver and heart) and body coil type were measured for six commonly used interventional devices (two guidewires, two catheters, an applicator and a biopsy needle). RESULTS Electric field mapping shows that the hotspots are not necessarily localized at the device tip. Of all procedures, the liver catheterizations showed the lowest heating, and a modification of the transmit body coil could further reduce the temperature increase. For common commercial needles no significant heating was measured at the needle tip. Comparable local SAR values were found in the temperature measurements and the TF-based calculations. CONCLUSION At low fields, interventions with shorter insertion lengths such as hepatic catheterizations result in less RF-induced heating than coronary interventions. The maximum temperature increase depends on body coil design.
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Affiliation(s)
- Ali Caglar Özen
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lottner
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Reiss
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Littin
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maxim Zaitsev
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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10
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Seemann F, Bruce CG, Khan JM, Ramasawmy R, Potersnak AG, Herzka DA, Kakareka JW, Jaimes AE, Schenke WH, O'Brien KJ, Lederman RJ, Campbell-Washburn AE. Dynamic pressure-volume loop analysis by simultaneous real-time cardiovascular magnetic resonance and left heart catheterization. J Cardiovasc Magn Reson 2023; 25:1. [PMID: 36642713 PMCID: PMC9841727 DOI: 10.1186/s12968-023-00913-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Left ventricular (LV) contractility and compliance are derived from pressure-volume (PV) loops during dynamic preload reduction, but reliable simultaneous measurements of pressure and volume are challenging with current technologies. We have developed a method to quantify contractility and compliance from PV loops during a dynamic preload reduction using simultaneous measurements of volume from real-time cardiovascular magnetic resonance (CMR) and invasive LV pressures with CMR-specific signal conditioning. METHODS Dynamic PV loops were derived in 16 swine (n = 7 naïve, n = 6 with aortic banding to increase afterload, n = 3 with ischemic cardiomyopathy) while occluding the inferior vena cava (IVC). Occlusion was performed simultaneously with the acquisition of dynamic LV volume from long-axis real-time CMR at 0.55 T, and recordings of invasive LV and aortic pressures, electrocardiogram, and CMR gradient waveforms. PV loops were derived by synchronizing pressure and volume measurements. Linear regression of end-systolic- and end-diastolic- pressure-volume relationships enabled calculation of contractility. PV loops measurements in the CMR environment were compared to conductance PV loop catheter measurements in 5 animals. Long-axis 2D LV volumes were validated with short-axis-stack images. RESULTS Simultaneous PV acquisition during IVC-occlusion was feasible. The cardiomyopathy model measured lower contractility (0.2 ± 0.1 mmHg/ml vs 0.6 ± 0.2 mmHg/ml) and increased compliance (12.0 ± 2.1 ml/mmHg vs 4.9 ± 1.1 ml/mmHg) compared to naïve animals. The pressure gradient across the aortic band was not clinically significant (10 ± 6 mmHg). Correspondingly, no differences were found between the naïve and banded pigs. Long-axis and short-axis LV volumes agreed well (difference 8.2 ± 14.5 ml at end-diastole, -2.8 ± 6.5 ml at end-systole). Agreement in contractility and compliance derived from conductance PV loop catheters and in the CMR environment was modest (intraclass correlation coefficient 0.56 and 0.44, respectively). CONCLUSIONS Dynamic PV loops during a real-time CMR-guided preload reduction can be used to derive quantitative metrics of contractility and compliance, and provided more reliable volumetric measurements than conductance PV loop catheters.
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Affiliation(s)
- Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA.
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Amanda G Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - John W Kakareka
- Instrumentation Development and Engineering Application Solutions, Division of Intramural Research, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andrea E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Kendall J O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
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11
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Kilbride BF, Narsinh KH, Jordan CD, Mueller K, Moore T, Martin AJ, Wilson MW, Hetts SW. MRI-guided endovascular intervention: current methods and future potential. Expert Rev Med Devices 2022; 19:763-778. [PMID: 36373162 PMCID: PMC9869980 DOI: 10.1080/17434440.2022.2141110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Image-guided endovascular interventions, performed using the insertion and navigation of catheters through the vasculature, have been increasing in number over the years, as minimally invasive procedures continue to replace invasive surgical procedures. Such endovascular interventions are almost exclusively performed under x-ray fluoroscopy, which has the best spatial and temporal resolution of all clinical imaging modalities. Magnetic resonance imaging (MRI) offers unique advantages and could be an attractive alternative to conventional x-ray guidance, but also brings with it distinctive challenges. AREAS COVERED In this review, the benefits and limitations of MRI-guided endovascular interventions are addressed, systems and devices for guiding such interventions are summarized, and clinical applications are discussed. EXPERT OPINION MRI-guided endovascular interventions are still relatively new to the interventional radiology field, since significant technical hurdles remain to justify significant costs and demonstrate safety, design, and robustness. Clinical applications of MRI-guided interventions are promising but their full potential may not be realized until proper tools designed to function in the MRI environment are available. Translational research and further preclinical studies are needed before MRI-guided interventions will be practical in a clinical interventional setting.
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Affiliation(s)
- Bridget F. Kilbride
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Kazim H. Narsinh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Teri Moore
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Alastair J. Martin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Mark W. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Steven W. Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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12
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Greer JS, Hussein MA, Vamsee R, Arar Y, Krueger S, Weiss S, Dillenbeck J, Greil G, Veeram Reddy SR, Hussain T. Improved catheter tracking during cardiovascular magnetic resonance-guided cardiac catheterization using overlay visualization. J Cardiovasc Magn Reson 2022; 24:32. [PMID: 35650624 PMCID: PMC9161533 DOI: 10.1186/s12968-022-00863-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/06/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Cardiovascular magnetic resonance (CMR)-guided cardiac catheterization is becoming more widespread due to the ability to acquire both functional CMR measurements and diagnostic catheterization data without exposing patients to ionizing radiation. However, the real-time imaging sequences used for catheter guidance during these procedures are limited in resolution and the anatomical detail they can provide. In this study, we propose a passive catheter tracking approach which simultaneously improves catheter tracking and visualization of the anatomy. METHODS 60 patients with congenital heart disease underwent CMR-guided cardiac catheterization on a 1.5T CMR scanner (Ingenia, Philips Healthcare, Best the Netherlands) using the Philips iSuite system. The proposed T1-overlay technique uses a commercially available heavily T1-weighted sequence to image the catheter, and overlays it on a high-resolution 3D dataset within iSuite in real-time. Suppressed tissue in the real-time images enables the use of a thick imaging slab to assist in tracking of the catheter. Improvement in catheter visualization time was compared between T1-overlay and the conventional invasive CMR (iCMR) balanced steady state free precession (bSSFP) sequence. This technique also enabled selective angiography visualization for real-time evaluation of blood flow dynamics (such as pulmonary transit time), similar to direct contrast injection under standard fluoroscopy. Estimates of pulmonary transit time using iCMR were validated using x-ray fluoroscopy in 16 patients. RESULTS The T1-overlay approach significantly increased the time that the catheter tip was kept in view by the technologist compared to the bSSFP sequence conventionally used for iCMR. The resulting images received higher ratings for blood/balloon contrast, anatomy visualization, and overall suitability for iCMR guidance by three cardiologists. iCMR selective angiography using T1-overlay also provided accurate estimates of pulmonary transit time that agreed well with x-ray fluoroscopy. CONCLUSION We demonstrate a new passive catheter tracking technique using the iSuite platform that improves visualization of the catheter and cardiac anatomy. These improvements significantly increase the time that the catheter tip is seen throughout the procedure. We also demonstrate the feasibility of iCMR selective angiography for the measurement of pulmonary transit time.
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Affiliation(s)
- Joshua S Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Children's Medical Center Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA.
| | - Mohamed Abdelghafar Hussein
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Pediatric Department, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - Ravi Vamsee
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Sascha Krueger
- Philips Research Laboratories, Philips GmbH Innovative Technologies, Hamburg, Germany
| | - Steffen Weiss
- Philips Research Laboratories, Philips GmbH Innovative Technologies, Hamburg, Germany
| | - Jeanne Dillenbeck
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Surendranath R Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Brown JT, Saigal A, Karia N, Patel RK, Razvi Y, Constantinou N, Steeden JA, Mandal S, Kotecha T, Fontana M, Goldring J, Muthurangu V, Knight DS. Ongoing Exercise Intolerance Following COVID-19: A Magnetic Resonance-Augmented Cardiopulmonary Exercise Test Study. J Am Heart Assoc 2022; 11:e024207. [PMID: 35470679 PMCID: PMC9238618 DOI: 10.1161/jaha.121.024207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Ongoing exercise intolerance of unclear cause following COVID-19 infection is well recognized but poorly understood. We investigated exercise capacity in patients previously hospitalized with COVID-19 with and without self-reported exercise intolerance using magnetic resonance-augmented cardiopulmonary exercise testing. Methods and Results Sixty subjects were enrolled in this single-center prospective observational case-control study, split into 3 equally sized groups: 2 groups of age-, sex-, and comorbidity-matched previously hospitalized patients following COVID-19 without clearly identifiable postviral complications and with either self-reported reduced (COVIDreduced) or fully recovered (COVIDnormal) exercise capacity; a group of age- and sex-matched healthy controls. The COVIDreducedgroup had the lowest peak workload (79W [Interquartile range (IQR), 65-100] versus controls 104W [IQR, 86-148]; P=0.01) and shortest exercise duration (13.3±2.8 minutes versus controls 16.6±3.5 minutes; P=0.008), with no differences in these parameters between COVIDnormal patients and controls. The COVIDreduced group had: (1) the lowest peak indexed oxygen uptake (14.9 mL/minper kg [IQR, 13.1-16.2]) versus controls (22.3 mL/min per kg [IQR, 16.9-27.6]; P=0.003) and COVIDnormal patients (19.1 mL/min per kg [IQR, 15.4-23.7]; P=0.04); (2) the lowest peak indexed cardiac output (4.7±1.2 L/min per m2) versus controls (6.0±1.2 L/min per m2; P=0.004) and COVIDnormal patients (5.7±1.5 L/min per m2; P=0.02), associated with lower indexed stroke volume (SVi:COVIDreduced 39±10 mL/min per m2 versus COVIDnormal 43±7 mL/min per m2 versus controls 48±10 mL/min per m2; P=0.02). There were no differences in peak tissue oxygen extraction or biventricular ejection fractions between groups. There were no associations between COVID-19 illness severity and peak magnetic resonance-augmented cardiopulmonary exercise testing metrics. Peak indexed oxygen uptake, indexed cardiac output, and indexed stroke volume all correlated with duration from discharge to magnetic resonance-augmented cardiopulmonary exercise testing (P<0.05). Conclusions Magnetic resonance-augmented cardiopulmonary exercise testing suggests failure to augment stroke volume as a potential mechanism of exercise intolerance in previously hospitalized patients with COVID-19. This is unrelated to disease severity and, reassuringly, improves with time from acute illness.
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Affiliation(s)
- James T. Brown
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Anita Saigal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Nina Karia
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Rishi K. Patel
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Yousuf Razvi
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Natalie Constantinou
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | | | - Swapna Mandal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Tushar Kotecha
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Marianna Fontana
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - James Goldring
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Vivek Muthurangu
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Daniel S. Knight
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
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14
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Arar Y, Divekar A, Clark S, Hussain T, Sebastian R, Hoda M, King J, Zellers TM, Reddy SRV. Role of Cross-Sectional Imaging in Pediatric Interventional Cardiac Catheterization. CHILDREN 2022; 9:children9030300. [PMID: 35327672 PMCID: PMC8947056 DOI: 10.3390/children9030300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Management of congenital heart disease (CHD) has recently increased utilization of cross-sectional imaging to plan percutaneous interventions. Cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) imaging have become indispensable tools for pre-procedural planning prior to intervention in the pediatric cardiac catheterization lab. In this article, we review several common indications for referral and the impact of cross-sectional imaging on procedural planning, success, and patient surveillance.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Correspondence:
| | - Abhay Divekar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Stephen Clark
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Roby Sebastian
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Mehar Hoda
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Jamie King
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Thomas M. Zellers
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
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15
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Amin EK, Campbell-Washburn A, Ratnayaka K. MRI-Guided Cardiac Catheterization in Congenital Heart Disease: How to Get Started. Curr Cardiol Rep 2022; 24:419-429. [PMID: 35107702 PMCID: PMC8979923 DOI: 10.1007/s11886-022-01659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Cardiac magnetic resonance imaging provides radiation-free, 3-dimensional soft tissue visualization with adjunct hemodynamic data, making it a promising candidate for image-guided transcatheter interventions. This review focuses on the benefits and background of real-time magnetic resonance imaging (MRI)-guided cardiac catheterization, guidance on starting a clinical program, and recent research developments. RECENT FINDINGS Interventional cardiac magnetic resonance (iCMR) has an established track record with the first entirely MRI-guided cardiac catheterization for congenital heart disease reported nearly 20 years ago. Since then, many centers have embarked upon clinical iCMR programs primarily performing diagnostic MRI-guided cardiac catheterization. There have also been limited reports of successful real-time MRI-guided transcatheter interventions. Growing experience in performing cardiac catheterization in the magnetic resonance environment has facilitated practical workflows appropriate for efficiency-focused cardiac catheterization laboratories. Most exciting developments in imaging technology, MRI-compatible equipment and MRI-guided novel transcatheter interventions have been limited to preclinical research. Many of these research developments are ready for clinical translation. With increasing iCMR clinical experience and translation of preclinical research innovations, the time to make the leap to radiation-free procedures is now.
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Affiliation(s)
- Elena K Amin
- Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA.
| | - Adrienne Campbell-Washburn
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, 3020 Children's Way, San Diego, CA, USA
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16
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Ciliberti P, Ciancarella P, Bruno P, Curione D, Bordonaro V, Lisignoli V, Panebianco M, Chinali M, Secinaro A, Galletti L, Guccione P. Cardiac Imaging in Patients After Fontan Palliation: Which Test and When? Front Pediatr 2022; 10:876742. [PMID: 35652057 PMCID: PMC9149285 DOI: 10.3389/fped.2022.876742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
The Fontan operation represents the final stage of a series of palliative surgical procedures for children born with complex congenital heart disease, where a "usual" biventricular physiology cannot be restored. The palliation results in the direct connection of the systemic venous returns to the pulmonary arterial circulation without an interposed ventricle. In this unique physiology, systemic venous hypertension and intrathoracic pressures changes due to respiratory mechanics play the main role for propelling blood through the pulmonary vasculature. Although the Fontan operation has dramatically improved survival in patients with a single ventricle congenital heart disease, significant morbidity is still a concern. Patients with Fontan physiology are in fact suffering from a multitude of complications mainly due to the increased systemic venous pressure. Consequently, these patients need close clinical and imaging monitoring, where cardiac exams play a key role. In this article, we review the main cardiac imaging modalities available, summarizing their main strengths and limitations in this peculiar setting. The main purpose is to provide a practical approach for all clinicians involved in the care of these patients, even for those less experienced in cardiac imaging.
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Affiliation(s)
- Paolo Ciliberti
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciancarella
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasqualina Bruno
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Veronica Bordonaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Veronica Lisignoli
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Mario Panebianco
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
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17
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Rier SC, Vreemann S, Nijhof WH, van Driel VJHM, van der Bilt IAC. Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives. Ther Adv Cardiovasc Dis 2022; 16:17539447221119624. [PMID: 36039865 PMCID: PMC9434707 DOI: 10.1177/17539447221119624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) provides excellent temporal and spatial resolution, tissue characterization, and flow measurements. This enables major advantages when guiding cardiac invasive procedures compared with X-ray fluoroscopy or ultrasound guidance. However, clinical implementation is limited due to limited availability of technological advancements in magnetic resonance imaging (MRI) compatible equipment. A systematic review of the available literature on past and present applications of interventional MR and its technology readiness level (TRL) was performed, also suggesting future applications. METHODS A structured literature search was performed using PubMed. Search terms were focused on interventional CMR, cardiac catheterization, and other cardiac invasive procedures. All search results were screened for relevance by language, title, and abstract. TRL was adjusted for use in this article, level 1 being in a hypothetical stage and level 9 being widespread clinical translation. The papers were categorized by the type of procedure and the TRL was estimated. RESULTS Of 466 papers, 117 papers met the inclusion criteria. TRL was most frequently estimated at level 5 meaning only applicable to in vivo animal studies. Diagnostic right heart catheterization and cavotricuspid isthmus ablation had the highest TRL of 8, meaning proven feasibility and efficacy in a series of humans. CONCLUSION This article shows that interventional CMR has a potential widespread application although clinical translation is at a modest level with TRL usually at 5. Future development should be directed toward availability of MR-compatible equipment and further improvement of the CMR techniques. This could lead to increased TRL of interventional CMR providing better treatment.
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Affiliation(s)
- Sophie C Rier
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Suzan Vreemann
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
| | - Wouter H Nijhof
- Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
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18
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Meierhofer C, Belker K, Shehu N, Latus H, Mkrtchyan N, Naumann S, Martinoff S, Stern H, Eicken A, Ewert P. Real-time CMR guidance for intracardiac and great vessel pressure mapping in patients with congenital heart disease using an MR conditional guidewire-results of 25 patients. Cardiovasc Diagn Ther 2021; 11:1356-1366. [PMID: 35070804 PMCID: PMC8748488 DOI: 10.21037/cdt-20-575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2024]
Abstract
BACKGROUND The aim of this study was to test a CE-certified MR-conditional guidewire to facilitate blood pressure measurement in cardiovascular magnetic resonance (CMR) using fluid-filled catheters in patients with congenital heart disease (CHD). The main purpose was to determine procedural success in a post market clinical follow-up (PMCF) for routine procedure in a diagnostic and interventional workflow. Real-time CMR provides high quality imaging without the risk of exposing the patient to X-rays, especially for patients with irregular heart anatomy and patients who are susceptible to radiation and iodinated contrast media. To date, the assessment of blood pressure gradients is not a common feature of CMR, as these gradients cannot be accurately evaluated in routine CMR. METHODS Twenty-five CHD patients who were planned for combined clinical CMR and diagnostic and/or interventional catheterization were enrolled in the trial. Prior to inclusion, a specific procedure for catheterization in CMR was defined, encompassing the assessment of pressure and pressure gradients in the heart and great vessels. RESULTS By the use of an MR-conditional guidewire we successfully measured specific pressure and pressure gradients in up to 92% of cases with liquid-filled catheters which were guided exclusively under CMR guidance. There were no guidewire-related adverse events, and guidewire guidance and manipulation of catheters were successful. CONCLUSIONS Using a MR-conditional guidewire assists in easily reaching targets in the heart and great vessels and makes the catheter itself visible, so that invasive blood pressure assessment by CMR guidance with liquid-filled catheters can be improved. KEYWORDS Cardiovascular magnetic resonance (CMR); congenital heart disease (CHD); cardiac catheterization; magnetic resonance; pressure; guidewire.
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Affiliation(s)
- Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Kristina Belker
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiner Latus
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Naira Mkrtchyan
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Susanne Naumann
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Andreas Eicken
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Berlin, Germany
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19
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Schuster A, Thiele H, Katus H, Werdan K, Eitel I, Zeiher AM, Baldus S, Rolf A, Kelle S. Kompetenz und Innovation in der kardiovaskulären MRT: Stellungnahme der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung. DER KARDIOLOGE 2021. [PMCID: PMC8361824 DOI: 10.1007/s12181-021-00494-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diese Stellungnahme der Deutschen Gesellschaft für Kardiologie (DGK) beschäftigt sich mit der Bedeutung kardiologischer Kompetenz im Gebiet der kardiovaskulären Magnetresonanztomographie (CMR) und deren Aus- und Wechselwirkungen auf klinisches Management im Bereich der Diagnostik, Therapieplanung und Therapie von kardiologischen Patienten. Zahlreiche Innovationen sowohl im technischen als auch klinischen Bereich der CMR basieren auf Publikationen deutscher und europäischer Kardiologen und haben Einzug in die nationalen, europäischen und auch US-amerikanischen Leitlinien gefunden. Hier sollen Empfehlungen zur sicheren, qualitativ hochwertigen und kompetenten Durchführung von CMR-Untersuchungen gegeben werden, im Sinne einer optimalen Nutzung dieser Technik mit unmittelbarer klinischer Einordnung des Untersuchungsergebnisses für die Planung einer Therapiestrategie des kardiovaskulär erkrankten Patienten.
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Affiliation(s)
- Andreas Schuster
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Deutschland
- Partner Site Göttingen, Deutsches Zentrum für Herz-Kreislauf-Forschung, Göttingen, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig, Klinik für Innere Medizin und Kardiologie, Universität Leipzig, Leipzig, Deutschland
- Leipzig Heart Science gGmbH, Leipzig, Deutschland
| | - Hugo Katus
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Ingo Eitel
- Medizinische Klinik II – Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Stephan Baldus
- Medizinische Klinik III – Abteilung für Kardiologie, Pneumologie, Angiologie und Intensivmedizin, Universität Köln, Köln, Deutschland
| | - Andreas Rolf
- Klinik für Kardiologie, Herz‑, Lungen‑, Gefäß- und Rheumazentrum, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - Sebastian Kelle
- Deutsches Herzzentrum Berlin, Berlin, Deutschland
- Klinik für Innere Medizin und Kardiologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Deutschland
- Partner Site Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Deutschland
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20
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Mahcicek DI, Yildirim KD, Kasaci G, Kocaturk O. Preliminary Evaluation of Hydraulic Needle Delivery System for Magnetic Resonance Imaging-Guided Prostate Biopsy Procedures. J Med Device 2021. [DOI: 10.1115/1.4051610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
In clinical routine, the prostate biopsy procedure is performed with the guidance of transrectal ultrasound (TRUS) imaging to diagnose prostate cancer. However, the TRUS-guided prostate biopsy brings reliability concerns due to the lack of contrast difference between prostate tissue and lesions. In this study, a novel hydraulic needle delivery system that is designed for performing magnetic resonance imaging (MRI)-guided prostate biopsy procedure with transperineal approach is introduced. The feasibility of the overall system was evaluated through in vitro phantom experiments under an MRI guidance. The in vitro experiments performed using a certified prostate phantom (incorporating MRI visible lesions). MRI experiments showed that overall hydraulic biopsy needle delivery system has excellent MRI compatibility (signal to noise ratio (SNR) loss < 3%), provides acceptable targeting accuracy (average 2.05±0.46 mm) and procedure time (average 40 min).
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Affiliation(s)
- Davut Ibrahim Mahcicek
- Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Korel D. Yildirim
- National Institutes of Health Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538; Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Gokce Kasaci
- Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Ozgur Kocaturk
- National Institutes of Health Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538; Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
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21
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Arar Y, Hussain T, Abou Zahr R, Gooty V, Greer JS, Huang R, Hernandez J, King J, Greil G, Veeram Reddy SR. Fick versus flow: a real-time invasive cardiovascular magnetic resonance (iCMR) reproducibility study. J Cardiovasc Magn Reson 2021; 23:95. [PMID: 34275477 PMCID: PMC8287667 DOI: 10.1186/s12968-021-00784-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac catheterization and cardiovascular magnetic resonance (CMR) imaging have distinct diagnostic roles in the congenital heart disease (CHD) population. Invasive CMR (iCMR) allows for a more thorough assessment of cardiac hemodynamics at the same time under the same conditions. It is assumed but not proven that iCMR gives an incremental value by providing more accurate flow quantification. METHODS Subjects with CHD underwent real-time 1.5 T iCMR using a passive catheter tracking technique with partial saturation pulse of 40° to visualize the gadolinium-filled balloon, CMR-conditional guidewire, and cardiac structures simultaneously to aid in completion of right (RHC) and left heart catheterization (LHC). Repeat iCMR and catheterization measurements were performed to compare reliability by the Pearson (PCC) and concordance correlation coefficients (CCC). RESULTS Thirty CHD (20 single ventricle and 10 bi-ventricular) subjects with a median age and weight of 8.3 years (2-33) and 27.7 kg (9.2-80), respectively, successfully underwent iCMR RHC and LHC. No catheter related complications were encountered. Time taken for first pass RHC and LHC/aortic pull back was 5.1, and 2.9 min, respectively. Total success rate to obtain required data points to complete Fick principle calculations for all patients was 321/328 (98%). One patient with multiple shunts was an outlier and excluded from further analysis. The PCC for catheter-derived pulmonary blood flow (Qp) (0.89, p < 0.001) is slightly lower than iCMR-derived Qp (0.96, p < 0.001), whereas catheter-derived systemic blood flow (Qs) (0.62, p = < 0.001) was considerably lower than iCMR-derived Qs (0.94, p < 0.001). CCC agreement for Qp at baseline (C1-CCC = 0.65, 95% CI 0.41-0.81) and retested conditions (C2-CCC = 0.78, 95% CI 0.58-0.89) were better than for Qs at baseline (C1-CCC = 0.22, 95% CI - 0.15-0.53) and retested conditions (C2-CCC = 0.52, 95% CI 0.17-0.76). CONCLUSION This study further validates hemodynamic measurements obtained via iCMR. iCMR-derived flows have considerably higher test-retest reliability for Qs. iCMR evaluations allow for more reproducible hemodynamic assessments in the CHD population.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Joshua S. Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Rong Huang
- Research Administration, Children’s Medical Center, Dallas, TX USA
| | - Jennifer Hernandez
- Anesthesiology and Pain Management, Children’s Medical Center, Dallas, TX USA
| | - Jamie King
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
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22
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Godinez F, Tomi-Tricot R, Delcey M, Williams SE, Mooiweer R, Quesson B, Razavi R, Hajnal JV, Malik SJ. Interventional cardiac MRI using an add-on parallel transmit MR system: In vivo experience in sheep. Magn Reson Med 2021; 86:3360-3372. [PMID: 34286866 DOI: 10.1002/mrm.28931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE We present in vivo testing of a parallel transmit system intended for interventional MR-guided cardiac procedures. METHODS The parallel transmit system was connected in-line with a conventional 1.5 Tesla MRI system to transmit and receive on an 8-coil array. The system used a current sensor for real-time feedback to achieve real-time current control by determining coupling and null modes. Experiments were conducted on 4 Charmoise sheep weighing 33.9-45.0 kg with nitinol guidewires placed under X-ray fluoroscopy in the atrium or ventricle of the heart via the femoral vein. Heating tests were done in vivo and post-mortem with a high RF power imaging sequence using the coupling mode. Anatomical imaging was done using a combination of null modes optimized to produce a useable B1 field in the heart. RESULTS Anatomical imaging produced cine images of the heart comparable in quality to imaging with the quad mode (all channels with the same amplitude and phase). Maximum observed temperature increases occurred when insulation was stripped from the wire tip. These were 4.1℃ and 0.4℃ for the coupling mode and null modes, respectively for the in vivo case; increasing to 6.0℃ and 1.3℃, respectively for the ex vivo case, because cooling from blood flow is removed. Heating < 0.1℃ was observed when insulation was not stripped from guidewire tips. In all tests, the parallel transmit system managed to reduce the temperature at the guidewire tip. CONCLUSION We have demonstrated the first in vivo usage of an auxiliary parallel transmit system employing active feedback-based current control for interventional MRI with a conventional MRI scanner.
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Affiliation(s)
- Felipe Godinez
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Raphael Tomi-Tricot
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Marylène Delcey
- Centre de Recherche Cardio, Thoracique de Bordeaux/IHU Liryc, INSERM U1045-University of Bordeaux, Pessac, France.,Siemens Healthcare, Saint-Denis, France
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ronald Mooiweer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bruno Quesson
- Centre de Recherche Cardio, Thoracique de Bordeaux/IHU Liryc, INSERM U1045-University of Bordeaux, Pessac, France
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Shaihan J Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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23
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Jeng GS, Wang YA, Liu PY, Li PC. Laser-Generated Leaky Acoustic Wave Imaging for Interventional Guidewire Guidance. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2496-2506. [PMID: 33780337 DOI: 10.1109/tuffc.2021.3069474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ultrasound (US) is widely used to visualize both tissue and the positions of surgical instruments in real time during surgery. Previously we proposed a new method to exploit US imaging and laser-generated leaky acoustic waves (LAWs) for needle visualization. Although successful, that method only detects the position of a needle tip, with the location of the entire needle deduced from knowing that the needle is straight. The purpose of the current study was to develop a beamforming-based method for the direct visualization of objects. The approach can be applied to objects with arbitrary shapes, such as the guidewires that are commonly used in interventional guidance. With this method, illumination by a short laser pulse generates photoacoustic waves at the top of the guidewire that propagate down its metal surface. These waves then leak into the surrounding tissue, which can be detected by a US array transducer. The time of flight consists of two parts: 1) the propagation time of the guided waves on the guidewire and 2) the propagation time of the US that leaks into the tissue. In principle, an image of the guidewire can be formed based on array beamforming by taking the propagation time on the metal into consideration. Furthermore, we introduced directional filtering and a matched filter to compress the dispersion signal associated with long propagation times. The results showed that guidewires could be detected at depths of at least 70 mm. The maximum detectable angle was 56.3°. LAW imaging with a 1268-mm-long guidewire was also demonstrated. The proposed method has considerable potential in new clinical applications.
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24
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Cronin IF, Kanter JP, Deutsch N, Hamann K, Olivieri L, Cross RR. Magnetic Resonance Imaging-Guided Cardiac Catheterization Evacuation Drills. Crit Care Nurse 2021; 41:e19-e26. [PMID: 34061187 PMCID: PMC8345020 DOI: 10.4037/ccn2021229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The interventional cardiac magnetic resonance imaging suite combines a cardiac catheterization x-ray laboratory with a magnetic resonance imaging suite. At the study institution, interventional cardiac magnetic resonance imaging procedures (ie, magnetic resonance imaging-guided cardiac catheterizations) have been performed under institutional review board-approved research protocols since 2015. Because the workplace incorporates x-ray and magnetic resonance imaging in a highly technical environment, education about the importance of magnet safety is crucial to ensure the safety of patients and staff. OBJECTIVE To promote magnetic resonance imaging safety and staff preparedness to respond in emergency situations in a specialized interventional cardiac magnetic resonance imaging environment. METHODS Quarterly in situ evacuation drills with a live volunteer were implemented. A retrospective participant survey using a Likert scale was conducted. Evacuations were timed from the cardiac arrest code alert to safe evacuation or defibrillation if appropriate. RESULTS Over 4 years, 14 drills were performed. Twenty-nine of 48 participants responded to the survey, a 60% response rate. Most participants agreed or strongly agreed that the drills were a positive experience (90%) and that the drills increased their confidence in their ability to perform in an evacuation scenario (100%). Room evacuation times improved from 71 to 41 seconds. No patient or staff safety events occurred in the interventional cardiac magnetic resonance imaging environment. CONCLUSION Magnetic resonance imaging-guided cardiac catheterization evacuation drills promote preparedness, ensure patient and staff safety, and improve evacuation time in the interventional cardiac magnetic resonance imaging environment.
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Affiliation(s)
- Ileen F Cronin
- Ileen F. Cronin is a nurse practitioner, pediatric cardiac anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Joshua P Kanter
- Joshua P. Kanter is an associate professor of pediatrics, George Washington University School of Medicine, Washington, District of Columbia, and Director of the cardiac catheterization laboratory and an interventional cardiologist, Division of Cardiology, Children's National Hospital, Washington, District of Columbia
| | - Nina Deutsch
- Nina Deutsch is an associate professor of anesthesiology and pediatrics, George Washington University School of Medicine, and Director of cardiac anesthesiology, Division of Cardiology, Children's National Hospital
| | - Karin Hamann
- Karin Hamann is a clinical research nurse program manager, interventional cardiac magnetic resonance program, Division of Cardiology, Children's National Hospital
| | - Laura Olivieri
- Laura Olivieri is an associate professor of pediatrics, George Washington University School of Medicine, and Director of cardiac MRI/CT and an advanced imaging cardiologist, Division of Cardiology, Children's National Hospital
| | - Russell R Cross
- Russell R. Cross is an associate professor of pediatrics, George Washington University School of Medicine, and Medical Director of inpatient cardiology and an advanced imaging cardiologist, Division of Cardiology, Children's National Hospital
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Le Bloa M, Abadir S, Nair K, Mondésert B, Khairy P. New developments in catheter ablation for patients with congenital heart disease. Expert Rev Cardiovasc Ther 2020; 19:15-26. [PMID: 33153326 DOI: 10.1080/14779072.2021.1847082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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Godinez F, Scott G, Padormo F, Hajnal JV, Malik SJ. Safe guidewire visualization using the modes of a PTx transmit array MR system. Magn Reson Med 2020; 83:2343-2355. [PMID: 31722119 PMCID: PMC7048617 DOI: 10.1002/mrm.28069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE MRI-guided cardiovascular intervention using standard metal guidewires can produce focal tissue heating caused by induced radiofrequency guidewire currents. It has been shown that safe operation is made possible by using parallel transmit radiofrequency coils driven in the null current mode, which does not induce radiofrequency currents and hence allows safe tissue visualization. We propose that the maximum current modes, usually considered unsafe, be used at very low power levels to visualize conductive wires, and we investigate pulse sequences best suited for this application. METHODS Spoiled gradient echo, balanced steady-state free precession, and turbo spin echo sequences were evaluated for their ability to visualize a conductive guidewire embedded in a gel phantom when run in maximum current modes at very low power level. Temperature at the guidewire tip was monitored for safety assessment. RESULTS Excellent guidewire visualization could be achieved using maximum current modes excitation, with the turbo spin echo sequence giving the best image quality. Although turbo spin echo is usually considered to be a high-power sequence, our method reduced all pulses to 1% amplitude (0.01% power), and heating was not detected. In addition, visualization of background tissue can be achieved using null current mode, also with no recorded heating at the guidewire tip even when running at 100% (reported) specific absorption rate. CONCLUSION Parallel transmit is a promising approach for both guidewire and tissue visualization using maximum and null current modes, respectively, for interventional cardiac MRI. Such systems can switch excitation mode instantaneously, allowing for flexible integration into interactive sequences.
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Affiliation(s)
- Felipe Godinez
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUnited Kingdom
| | - Greig Scott
- Magnetic Resonance Systems Research LaboratoryDepartment of Electrical EngineeringStanford UniversityStanfordCaliforniaUSA
| | | | - Joseph V. Hajnal
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUnited Kingdom
| | - Shaihan J. Malik
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUnited Kingdom
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27
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Solely MRI-Guided Cardiac Catheterization for Assessment of Pulmonary Hypertension in a Pregnant Lady with Undiagnosed Congenital Heart Disease. Case Rep Cardiol 2020; 2020:3072869. [PMID: 32551142 PMCID: PMC7277057 DOI: 10.1155/2020/3072869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Pregnancy in women with complex congenital heart disease (CHD) can be poorly tolerated. Amongst pregnant women with CHD and pulmonary hypertension (PH), the mortality rate can be as high as 30%. Cardiac catheterization procedures for assessment of haemodynamics and pulmonary vascular resistance (PVR) are often required in this patient population for risk stratification. However, during the first few weeks of pregnancy, this should better be avoided due to the known adverse effects of the ionizing radiation to the immature fetus. In this setting, a solely MRI-guided catheterization may present as a better alternative.
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Heidt T, Reiss S, Lottner T, Özen AC, Bode C, Bock M, von Zur Mühlen C. Magnetic resonance imaging for pathobiological assessment and interventional treatment of the coronary arteries. Eur Heart J Suppl 2020; 22:C46-C56. [PMID: 32368198 PMCID: PMC7189741 DOI: 10.1093/eurheartj/suaa009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
X-ray-based fluoroscopy is the standard tool for diagnostics and intervention in coronary artery disease. In recent years, computed tomography has emerged as a non-invasive alternative to coronary angiography offering detection of coronary calcification and imaging of the vessel lumen by the use of iodinated contrast agents. Even though currently available invasive or non-invasive techniques can show the degree of vessel stenosis, they are unable to provide information about biofunctional plaque properties, e.g. plaque inflammation. Furthermore, the use of radiation and the necessity of iodinated contrast agents remain unfavourable prerequisites. Magnetic resonance imaging (MRI) is a radiation-free alternative to X-ray which offers anatomical and functional imaging contrasts fostering the idea of non-invasive biofunctional assessment of the coronary vessel wall. In combination with molecular contrast agents that target-specific epitopes of the vessel wall, MRI might reveal unique plaque properties rendering it, for example, ‘vulnerable and prone to rupture’. Early detection of these lesions may allow for early or prophylactic treatment even before an adverse coronary event occurs. Besides diagnostic imaging, advances in real-time image acquisition and motion compensation now provide grounds for MRI-guided coronary interventions. In this article, we summarize our research on MRI-based molecular imaging in cardiovascular disease and feature our advances towards real-time MRI-based coronary interventions in a porcine model.
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Affiliation(s)
- Timo Heidt
- Department of Cardiology, Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Simon Reiss
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Thomas Lottner
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Ali C Özen
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,German Cancer Consortium Partner Site Freiburg, German Cancer Research Center (DKFZ), Stefan-Meier-Str. 17, 79104 Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology, Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Michael Bock
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology, Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany
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Veeram Reddy SR, Arar Y, Zahr RA, Gooty V, Hernandez J, Potersnak A, Douglas P, Blair Z, Greer JS, Roujol S, Forte MNV, Greil G, Nugent AW, Hussain T. Invasive cardiovascular magnetic resonance (iCMR) for diagnostic right and left heart catheterization using an MR-conditional guidewire and passive visualization in congenital heart disease. J Cardiovasc Magn Reson 2020; 22:20. [PMID: 32213193 PMCID: PMC7098096 DOI: 10.1186/s12968-020-0605-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Today's standard of care, in the congenital heart disease (CHD) population, involves performing cardiac catheterization under x-ray fluoroscopy and cardiac magnetic resonance (CMR) imaging separately. The unique ability of CMR to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Limiting fluoroscopic radiation exposure remains a challenge for pediatric interventional cardiologists. This pilot study's objective is to establish feasibility of right (RHC) and left heart catheterization (LHC) during invasive CMR (iCMR) procedures at our institution in the CHD population. Furthermore, we aim to improve simultaneous visualization of the catheter balloon tip, MR-conditional guidewire, and cardiac/vessel anatomy during iCMR procedures. METHODS Subjects with CHD were enrolled in a pilot study for iCMR procedures at 1.5 T with an MR-conditional guidewire. The CMR area is located adjacent to a standard catheterization laboratory. Using the interactive scanning mode for real-time control of the imaging location, a dilute gadolinium-filled balloon-tip catheter was used in combination with an MR-conditional guidewire to obtain cardiac saturations and hemodynamics. A recently developed catheter tracking technique using a real-time single-shot balanced steady-state free precession (bSSFP), flip angle (FA) 35-45°, echo time (TE) 1.3 ms, repetition time (TR) 2.7 ms, 40° partial saturation (pSAT) pre-pulse was used to visualize the gadolinium-filled balloon, MR-conditional guidewire, and cardiac structures simultaneously. MR-conditional guidewire visualization was enabled due to susceptibility artifact created by distal markers. Pre-clinical phantom testing was performed to determine the optimum imaging FA-pSAT combination. RESULTS The iCMR procedure was successfully performed to completion in 31/34 (91%) subjects between August 1st, 2017 to December 13th, 2018. Median age and weight were 7.7 years and 25.2 kg (range: 3 months - 33 years and 8 - 80 kg). Twenty-one subjects had single ventricle (SV) anatomy: one subject was referred for pre-Glenn evaluation, 11 were pre-Fontan evaluations and 9 post-Fontan evaluations for protein losing enteropathy (PLE) and/or cyanosis. Thirteen subjects had bi-ventricular (BiV) anatomy, 4 were referred for coarctation of the aorta (CoA) evaluations, 3 underwent vaso-reactivity testing with inhaled nitric oxide, 3 investigated RV volume dimensions, two underwent branch PA stenosis evaluation, and the remaining subject was status post heart transplant. No catheter related complications were encountered. Average time taken for first pass RHC, LHC/aortic pull back, and to cross the Fontan fenestration was 5.2, 3.0, and 6.5 min, respectively. Total success rate to obtain required data points to complete Fick principle calculations for all patients was 331/337 (98%). Subjects were transferred to the x-ray fluoroscopy lab if further intervention was required including Fontan fenestration device closure, balloon angioplasty of pulmonary arteries/conduits, CoA stenting, and/or coiling of aortopulmonary (AP) collaterals. Starting with subject #10, an MR-conditional guidewire was used in all subsequent subjects (15 SV and 10 BiV) with a success rate of 96% (24/25). Real-time CMR-guided RHC (25/25 subjects, 100%), retrograde and prograde LHC/aortic pull back (24/25 subjects, 96%), CoA crossing (3/4 subjects, 75%) and Fontan fenestration test occlusion (2/3 subjects, 67%) were successfully performed in the majority of subjects when an MR-conditional guidewire was utilized. CONCLUSION Feasibility for detailed diagnostic RHC, LHC, and Fontan fenestration test occlusion iCMR procedures in SV and BiV pediatric subjects with complex CHD is demonstrated with the aid of an MR-conditional guidewire. A novel real-time pSAT GRE sequence with optimized FA-pSAT angle has facilitated simultaneous visualization of the catheter balloon tip, MR-conditional guidewire, and cardiac/vessel anatomy during iCMR procedures.
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Affiliation(s)
- Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Jennifer Hernandez
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Amanda Potersnak
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Phillip Douglas
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Zachary Blair
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Joshua S. Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Sébastien Roujol
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Mari Nieves Velasco Forte
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Alan W. Nugent
- Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
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Abstract
In recent years, interventional cardiac magnetic resonance imaging (iCMR) has evolved from attractive theory to clinical routine at several centers. Real-time cardiac magnetic resonance imaging (CMR fluoroscopy) adds value by combining soft-tissue visualization, concurrent hemodynamic measurement, and freedom from radiation. Clinical iCMR applications are expanding because of advances in catheter devices and imaging. In the near future, iCMR promises novel procedures otherwise unsafe under standalone X-Ray guidance.
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31
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Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire. PLoS One 2020; 15:e0229711. [PMID: 32102092 PMCID: PMC7043930 DOI: 10.1371/journal.pone.0229711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Real-time magnetic resonance imaging (MRI) is a promising alternative to X-ray fluoroscopy for guiding cardiovascular catheterization procedures. Major challenges, however, include the lack of guidewires that are compatible with the MRI environment, not susceptible to radiofrequency-induced heating, and reliably visualized. Preclinical evaluation of new guidewire designs has been conducted at 1.5T. Here we further evaluate the safety (device heating), device visualization, and procedural feasibility of 3T MRI-guided cardiovascular catheterization using a novel MRI-visible glass-fiber epoxy-based guidewire in phantoms and porcine models. METHODS To evaluate device safety, guidewire tip heating (GTH) was measured in phantom experiments with different combinations of catheters and guidewires. In vivo cardiovascular catheterization procedures were performed in both healthy (N = 5) and infarcted (N = 5) porcine models under real-time 3T MRI guidance using a glass-fiber epoxy-based guidewire. The times for each procedural step were recorded separately. Guidewire visualization was assessed by measuring the dimensions of the guidewire-induced signal void and contrast-to-noise ratio (CNR) between the guidewire tip signal void and the blood signal in real-time gradient-echo MRI (specific absorption rate [SAR] = 0.04 W/kg). RESULTS In the phantom experiments, GTH did not exceed 0.35°C when using the real-time gradient-echo sequence (SAR = 0.04 W/kg), demonstrating the safety of the glass-fiber epoxy-based guidewire at 3T. The catheter was successfully placed in the left ventricle (LV) under real-time MRI for all five healthy subjects and three out of five infarcted subjects. Signal void dimensions and CNR values showed consistent visualization of the glass-fiber epoxy-based guidewire in real-time MRI. The average time (minutes:seconds) for the catheterization procedure in all subjects was 4:32, although the procedure time varied depending on the subject's specific anatomy (standard deviation = 4:41). CONCLUSIONS Real-time 3T MRI-guided cardiovascular catheterization using a new MRI-visible glass-fiber epoxy-based guidewire is feasible in terms of visualization and guidewire navigation, and safe in terms of radiofrequency-induced guidewire tip heating.
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32
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Pushparajah K, Duong P, Mathur S, Babu-Narayan SV. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Cardiovascular MRI and CT in congenital heart disease. Echo Res Pract 2019; 6:ERP-19-0048. [PMID: 31730044 PMCID: PMC6893312 DOI: 10.1530/erp-19-0048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular MRI and CT are useful imaging modalities complimentary to echocardiography. This review article describes the common indications and consideration for the use of MRI and CT in the management of congenital heart disease.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | | | - Sonya V Babu-Narayan
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
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Knight DS, Kotecha T, Martinez-Naharro A, Brown JT, Bertelli M, Fontana M, Muthurangu V, Coghlan JG. Cardiovascular magnetic resonance-guided right heart catheterization in a conventional CMR environment - predictors of procedure success and duration in pulmonary artery hypertension. J Cardiovasc Magn Reson 2019; 21:57. [PMID: 31495338 PMCID: PMC6732841 DOI: 10.1186/s12968-019-0569-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance imaging (CMR) is valuable for the investigation and management of pulmonary artery hypertension (PAH), but the direct measurement of pulmonary hemodynamics by right heart catheterization is still necessary. CMR-guided right heart catheterization (CMR-RHC) combines the benefits of CMR and invasive cardiac catheterization, but its feasibility in patients with acquired PAH has not been established. The aims of this study are to: (1) demonstrate the feasibility of CMR-RHC in patients being assessed for PAH in a conventional diagnostic CMR scanner room; (2) determine the predictors of (i) procedure duration, and (ii) procedural failure or technical difficulty as determined by the adjunctive need for a guidewire. METHODS Fifty patients investigated for suspected or known PH underwent CMR-RHC. Durations of separate procedural components were recorded, including time taken to pass the catheter from the femoral vein to a stable wedge position (procedure time) and total time the patient spent in the CMR department (department time). Associations between procedural failure/guidewire usage and hemodynamic/CMR measures were assessed using logistic regression. Relationships between procedure times and hemodynamic/CMR measures were evaluated using Spearman's correlation coefficient. RESULTS A full CMR-RHC study was successfully completed in 47 (94%) patients. CMR-conditional guidewires were used in 6 (12%) patients. Metrics associated with guidewire use/procedural failure were higher mean pulmonary artery (PA) pressures (mPAP: OR = 1.125, p = 0.018), right heart dilatation (right ventricular (RV) end-systolic volume (RVESV): OR = 1.028, p = 0.018), RV hypertrophy (OR = 1.050, p = 0.0067) and RV ejection fraction (EF) (OR = 0.914, p = 0.014). Median catheter and department times were 3.6 (2.0-7.7) minutes and 60.0 (54.0-68.5) minutes, respectively. All procedure times became significantly shorter with increasing procedural experience (p < 0.05). Catheterization time was also associated with PH severity (RV systolic pressure: rho = 0.46, p = 0.0013) and increasing RV end-systolic volume (RVESV: rho = 0.41, p = 0.0043), hypertrophy (rho = 0.43, p = 0.0025) and dysfunction (RVEF: rho = - 0.32, p = 0.031). CONCLUSIONS This study demonstrates that CMR-RHC using standard technology can be incorporated into routine clinical practice for the investigation of PAH. Procedural failure was rare but more likely in patients with severe PAH. Procedure time is clinically acceptable and increases with worsening PAH severity.
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Affiliation(s)
- Daniel S Knight
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Tushar Kotecha
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Ana Martinez-Naharro
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - James T Brown
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Michele Bertelli
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marianna Fontana
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, 30 Guilford Street, London, WC1N 1EH, UK.
| | - J Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
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Knowles BR, Friedrich F, Fischer C, Paech D, Ladd ME. Beyond T2 and 3T: New MRI techniques for clinicians. Clin Transl Radiat Oncol 2019; 18:87-97. [PMID: 31341982 PMCID: PMC6630188 DOI: 10.1016/j.ctro.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/12/2022] Open
Abstract
Technological advances in Magnetic Resonance Imaging (MRI) in terms of field strength and hybrid MR systems have led to improvements in tumor imaging in terms of anatomy and functionality. This review paper discusses the applications of such advances in the field of radiation oncology with regards to treatment planning, therapy guidance and monitoring tumor response and predicting outcome.
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Affiliation(s)
- Benjamin R. Knowles
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Florian Friedrich
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Carola Fischer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E. Ladd
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
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Dos Reis JE, Soullié P, Oster J, Palmero Soler E, Petitmangin G, Felblinger J, Odille F. Reconstruction of the 12-lead ECG using a novel MR-compatible ECG sensor network. Magn Reson Med 2019; 82:1929-1945. [PMID: 31199011 DOI: 10.1002/mrm.27854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE Current electrocardiography (ECG) devices in MRI use non-conventional electrode placement, have a narrow bandwidth, and suffer from signal distortions including magnetohydrodynamic (MHD) effects and gradient-induced artifacts. In this work a system is proposed to obtain a high-quality 12-lead ECG. METHODS A network of N electrically independent MR-compatible ECG sensors was developed (N = 4 in this study). Each sensor uses a safe technology - short cables, preamplification/digitization close to the patient, and optical transmission - and provides three bipolar voltage leads. A matrix combination is applied to reconstruct a 12-lead ECG from the raw network signals. A subject-specific calibration is performed to identify the matrix coefficients, maximizing the similarity with a true 12-lead ECG, acquired with a conventional 12-lead device outside the scan room. The sensor network was subjected to radiofrequency heating phantom tests at 3T. It was then tested in four subjects, both at 1.5T and 3T. RESULTS Radiofrequency heating at 3T was within the MR-compatibility standards. The reconstructed 12-lead ECG showed minimal MHD artifacts and its morphology compared well with that of the true 12-lead ECG, as measured by correlation coefficients above 93% (respectively, 84%) for the QRS complex shape during steady-state free precession (SSFP) imaging at 1.5T (respectively, 3T). CONCLUSION High-quality 12-lead ECG can be reconstructed by the proposed sensor network at 1.5T and 3T with reduced MHD artifacts compared to previous systems. The system might help improve patient monitoring and triggering and might also be of interest for interventional MRI and advanced cardiac MR applications.
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Affiliation(s)
- Jesús E Dos Reis
- IADI, INSERM and Université de Lorraine, Nancy, France.,Schiller Medical SAS, Wissembourg, France
| | - Paul Soullié
- IADI, INSERM and Université de Lorraine, Nancy, France
| | - Julien Oster
- IADI, INSERM and Université de Lorraine, Nancy, France
| | | | | | - Jacques Felblinger
- IADI, INSERM and Université de Lorraine, Nancy, France.,CIC-IT 1433, INSERM, Université de Lorraine and CHRU Nancy, Nancy, France
| | - Freddy Odille
- IADI, INSERM and Université de Lorraine, Nancy, France.,CIC-IT 1433, INSERM, Université de Lorraine and CHRU Nancy, Nancy, France
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CMR and CT of the Patient With Cardiac Devices. JACC Cardiovasc Imaging 2019; 12:890-903. [DOI: 10.1016/j.jcmg.2018.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
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Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
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Abstract
The treatment of individual patients in cardiology practice increasingly relies on advanced imaging, genetic screening and devices. As the amount of imaging and other diagnostic data increases, paralleled by the greater capacity to personalize treatment, the difficulty of using the full array of measurements of a patient to determine an optimal treatment seems also to be paradoxically increasing. Computational models are progressively addressing this issue by providing a common framework for integrating multiple data sets from individual patients. These models, which are based on physiology and physics rather than on population statistics, enable computational simulations to reveal diagnostic information that would have otherwise remained concealed and to predict treatment outcomes for individual patients. The inherent need for patient-specific models in cardiology is clear and is driving the rapid development of tools and techniques for creating personalized methods to guide pharmaceutical therapy, deployment of devices and surgical interventions.
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Affiliation(s)
- Steven A Niederer
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France
| | - Natalia A Trayanova
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
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Mukherjee RK, Chubb H, Roujol S, Razavi R, O’Neill MD. Advances in Real-Time MRI-Guided Electrophysiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12:6. [PMID: 31501689 PMCID: PMC6733706 DOI: 10.1007/s12410-019-9481-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Theoretical benefits of real-time MRI guidance over conventional electrophysiology include contemporaneous 3D substrate assessment and accurate intra-procedural guidance and evaluation of ablation lesions. We review the unique challenges inherent to MRI-guided electrophysiology and how to translate the potential benefits in the treatment of cardiac arrhythmias. RECENT FINDINGS Over the last 5 years, there has been substantial progress, initially in animal models and more recently in clinical studies, to establish methods and develop workflows within the MR environment that resemble those of conventional electrophysiology laboratories. Real-time MRI-guided systems have been used to perform electroanatomic mapping and ablation in patients with atrial flutter, and there is interest in developing the technology to tackle more complex arrhythmias including atrial fibrillation and ventricular tachycardia. SUMMARY Mainstream adoption of real-time MRI-guided electrophysiology will require demonstration of clinical benefit and will be aided by increased availability of devices suitable for use in the MRI environment.
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Affiliation(s)
- Rahul K. Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, North Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, North Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, North Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, North Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Mark D. O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, North Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, UK
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Silva Vieira M, Arthurs CJ, Hussain T, Razavi R, Figueroa CA. Patient-specific modeling of right coronary circulation vulnerability post-liver transplant in Alagille's syndrome. PLoS One 2018; 13:e0205829. [PMID: 30408044 PMCID: PMC6224049 DOI: 10.1371/journal.pone.0205829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/02/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Cardiac output (CO) response to dobutamine can identify Alagille's syndrome (ALGS) patients at higher risk of cardiovascular complications during liver transplantation. We propose a novel patient-specific computational methodology to estimate the coronary autoregulatory responses during different hemodynamic conditions, including those experienced in a post-reperfusion syndrome (PRS), to aid cardiac risk-assessment. MATERIAL AND METHODS Data (pressure, flow, strain and ventricular volumes) from a 6-year-old ALGS patient undergoing catheter/dobutamine stress MRI (DSMRI) were used to parameterize a closed-loop coupled-multidomain (3D-0D) approach consisting of image-derived vascular models of pulmonary and systemic circulations and a series of 0D-lumped parameter networks (LPN) of the heart chambers and the distal arterial and venous circulations. A coronary microcirculation control model (CMCM) was designed to adjust the coronary resistance to match coronary blood flow (and thus oxygen delivery) with MVO2 requirements during Rest, Stress and a virtual PRS condition. RESULTS In all three simulated conditions, diastolic dominated right coronary artery (RCA) flow was observed, due to high right ventricle (RV) afterload. Despite a measured 45% increase in CO, impaired coronary flow reserve (CFR) (~1.4) at Stress was estimated by the CMCM. During modeled PRS, a marked vasodilatory response was insufficient to match RV myocardial oxygen requirements. Such exhaustion of the RCA autoregulatory response was not anticipated by the DSMRI study. CONCLUSION Impaired CFR undetected by DSMRI resulted in predicted myocardial ischemia in a computational model of PRS. This computational framework may identify ALGS patients at higher risk of complications during liver transplantation due to impaired coronary microvascular responses.
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Affiliation(s)
- Miguel Silva Vieira
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
- * E-mail:
| | - Christopher J. Arthurs
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, United States of America
- Pediatric Cardiology Department, Evelina Children’s Hospital London, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
- Pediatric Cardiology Department, Evelina Children’s Hospital London, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Carlos Alberto Figueroa
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
- Departments of Surgery and Biomedical Engineering, University of Michigan, Michigan, United States of America
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Abstract
Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.
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Di Salvo G, Miller O, Babu Narayan S, Li W, Budts W, Valsangiacomo Buechel ER, Frigiola A, van den Bosch AE, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Baumgartner H, Gatzoulis MA, Delgado V, Haugaa KH, Lancellotti P, Flachskampf F, Cardim N, Gerber B, Masci PG, Donal E, Gimelli A, Muraru D, Cosyns B. Imaging the adult with congenital heart disease: a multimodality imaging approach—position paper from the EACVI. Eur Heart J Cardiovasc Imaging 2018; 19:1077-1098. [DOI: 10.1093/ehjci/jey102] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sonya Babu Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Leuven, Belgium
| | | | - Alessandra Frigiola
- Adult Congenital Heart Disease, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | - Beatrice Bonello
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, 555 University Avenue Toronto, Ontario, Canada
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Sognsvannsveien 20, Oslo, Norvegia
| | - Tal Geva
- Department of Cardiology, 300 Longwood Avenue, Farley, Boston, Massachusetts, USA
| | | | - Michael A Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
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Campbell-Washburn AE, Rogers T, Stine AM, Khan JM, Ramasawmy R, Schenke WH, McGuirt DR, Mazal JR, Grant LP, Grant EK, Herzka DA, Lederman RJ. Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience. J Cardiovasc Magn Reson 2018; 20:41. [PMID: 29925397 PMCID: PMC6011242 DOI: 10.1186/s12968-018-0458-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/10/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) fluoroscopy allows for simultaneous measurement of cardiac function, flow and chamber pressure during diagnostic heart catheterization. To date, commercial metallic guidewires were considered contraindicated during CMR fluoroscopy due to concerns over radiofrequency (RF)-induced heating. The inability to use metallic guidewires hampers catheter navigation in patients with challenging anatomy. Here we use low specific absorption rate (SAR) imaging from gradient echo spiral acquisitions and a commercial nitinol guidewire for CMR fluoroscopy right heart catheterization in patients. METHODS The low-SAR imaging protocol used a reduced flip angle gradient echo acquisition (10° vs 45°) and a longer repetition time (TR) spiral readout (10 ms vs 2.98 ms). Temperature was measured in vitro in the ASTM 2182 gel phantom and post-mortem animal experiments to ensure freedom from heating with the selected guidewire (150 cm × 0.035″ angled-tip nitinol Terumo Glidewire). Seven patients underwent CMR fluoroscopy catheterization. Time to enter each chamber (superior vena cava, main pulmonary artery, and each branch pulmonary artery) was recorded and device visibility and confidence in catheter and guidewire position were scored on a Likert-type scale. RESULTS Negligible heating (< 0.07°C) was observed under all in vitro conditions using this guidewire and imaging approach. In patients, chamber entry was successful in 100% of attempts with a guidewire compared to 94% without a guidewire, with failures to reach the branch pulmonary arteries. Time-to-enter each chamber was similar (p=NS) for the two approaches. The guidewire imparted useful catheter shaft conspicuity and enabled interactive modification of catheter shaft stiffness, however, the guidewire tip visibility was poor. CONCLUSIONS Under specific conditions, trained operators can apply low-SAR imaging and using a specific fully-insulated metallic nitinol guidewire (150 cm × 0.035" Terumo Glidewire) to augment clinical CMR fluoroscopy right heart catheterization. TRIAL REGISTRATION Clinicaltrials.gov NCT03152773 , registered May 15, 2017.
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Affiliation(s)
- Adrienne E. Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Annette M. Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - William H. Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Delaney R. McGuirt
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Jonathan R. Mazal
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Laurie P. Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Elena K. Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Daniel A. Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2C713, Bethesda, MD 20892-1538 USA
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Experimental validation of robot-assisted cardiovascular catheterization: model-based versus model-free control. Int J Comput Assist Radiol Surg 2018; 13:797-804. [PMID: 29611096 DOI: 10.1007/s11548-018-1757-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE In cardiac electrophysiology, a long and flexible catheter is delivered to a cardiac chamber for the treatment of arrhythmias. Although several robot-assisted platforms have been commercialized, the disorientation in tele-operation is still not well solved. We propose a validation platform for robot-assisted cardiac EP catheterization, integrating a customized MR Safe robot, a standard clinically used EP catheter, and a human-robot interface. Both model-based and model-free control methods are implemented in the platform for quantitative evaluation and comparison. METHODS The model-based and model-free control methods were validated by subject test (ten participants), in which the subjects have to perform a simulated radiofrequency ablation task using both methods. A virtual endoscopic view of the catheter is also provided to enhance hand-to-eye coordination. Assessment indices for targeting accuracy and efficiency were acquired for the evaluation. RESULTS (1) Accuracy: The average distance measured from catheter tip to the closest lesion target during ablation of model-free method was 19.1% shorter than that of model-based control. (2) Efficiency: The model-free control reduced the total missed targets by 35.8% and the maximum continuously missed targets by 46.2%, both indices corresponded to a low p value ([Formula: see text]). CONCLUSION The model-free method performed better in terms of both accuracy and efficiency, indicating the model-free control could adapt to soft interaction with environment, as compared with the model-based control that does not consider contacts.
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45
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Zampi JD, Whiteside W. Innovative interventional catheterization techniques for congenital heart disease. Transl Pediatr 2018; 7:104-119. [PMID: 29770292 PMCID: PMC5938250 DOI: 10.21037/tp.2017.12.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/01/2017] [Indexed: 11/06/2022] Open
Abstract
Since 1929, when the first cardiac catheterization was safely performed in a human by Dr. Werner Forssmann (on himself), there has been a rapid progression of cardiac catheterization techniques and technologies. Today, these advances allow us to treat a wide variety of patients with congenital heart disease using minimally invasive techniques; from fetus to infants to adults, and from simple to complex congenital cardiac lesions. In this article, we will explore some of the exciting advances in cardiac catheterization for the treatment of congenital heart disease, including transcatheter valve implantation, hybrid procedures, biodegradable technologies, and magnetic resonance imaging (MRI)-guided catheterization. Additionally, we will discuss innovations in imaging in the catheterization laboratory, including 3D rotational angiography (3DRA), fusion imaging, and 3D printing, which help to make innovative interventional approaches possible.
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Affiliation(s)
- Jeffrey D Zampi
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Wendy Whiteside
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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46
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Linte CA, Camp JJ, Rettmann ME, Haemmerich D, Aktas MK, Huang DT, Packer DL, Holmes DR. Lesion modeling, characterization, and visualization for image-guided cardiac ablation therapy monitoring. J Med Imaging (Bellingham) 2018; 5:021218. [PMID: 29531966 PMCID: PMC5831757 DOI: 10.1117/1.jmi.5.2.021218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
In spite of significant efforts to improve image-guided ablation therapy, a large number of patients undergoing ablation therapy to treat cardiac arrhythmic conditions require repeat procedures. The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation, in turn leading to the arrhythmia recurrence. Ongoing research efforts aim to better characterize and visualize RF delivery to monitor the induced tissue damage during therapy. Here, we propose a method that entails modeling and visualization of the lesions in real-time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression are quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using ex vivo bovine tissue samples undergoing ex vivo clinically relevant ablation protocols. The studies demonstrated less than 5°C difference between the model-predicted and experimentally measured end-ablation temperatures. The model predicted lesion patterns were within 0.5 to 1 mm from the observed lesion patterns, suggesting sufficiently accurate modeling of the ablation lesions. Lastly, our proposed method enables therapy delivery feedback with no significant workflow latency. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.
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Affiliation(s)
- Cristian A. Linte
- Rochester Institute of Technology, Biomedical Engineering and Chester F. Carlson Center for Imaging Science, Rochester, New York, United States
| | - Jon J. Camp
- Mayo Clinic, Biomedical Imaging Resource, Rochester, Minnesota, United States
| | - Maryam E. Rettmann
- Mayo Clinic, Division of Cardiology, Rochester, Minnesota, United States
| | - Dieter Haemmerich
- Medical University of South Carolina, Department of Pediatrics, Charleston, South Carolina, United States
| | - Mehmet K. Aktas
- University of Rochester Medical Center, Division of Cardiology, Rochester, New York, United States
| | - David T. Huang
- University of Rochester Medical Center, Division of Cardiology, Rochester, New York, United States
| | - Douglas L. Packer
- Mayo Clinic, Division of Cardiology, Rochester, Minnesota, United States
| | - David R. Holmes
- Mayo Clinic, Biomedical Imaging Resource, Rochester, Minnesota, United States
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Zhou XY, Yang GZ, Lee SL. A real-time and registration-free framework for dynamic shape instantiation. Med Image Anal 2018; 44:86-97. [DOI: 10.1016/j.media.2017.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022]
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Recent Advances and Trends in Pediatric Cardiac Imaging. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:9. [DOI: 10.1007/s11936-018-0599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Campbell-Washburn AE, Tavallaei MA, Pop M, Grant EK, Chubb H, Rhode K, Wright GA. Real-time MRI guidance of cardiac interventions. J Magn Reson Imaging 2017; 46:935-950. [PMID: 28493526 PMCID: PMC5675556 DOI: 10.1002/jmri.25749] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is appealing to guide complex cardiac procedures because it is ionizing radiation-free and offers flexible soft-tissue contrast. Interventional cardiac MR promises to improve existing procedures and enable new ones for complex arrhythmias, as well as congenital and structural heart disease. Guiding invasive procedures demands faster image acquisition, reconstruction and analysis, as well as intuitive intraprocedural display of imaging data. Standard cardiac MR techniques such as 3D anatomical imaging, cardiac function and flow, parameter mapping, and late-gadolinium enhancement can be used to gather valuable clinical data at various procedural stages. Rapid intraprocedural image analysis can extract and highlight critical information about interventional targets and outcomes. In some cases, real-time interactive imaging is used to provide a continuous stream of images displayed to interventionalists for dynamic device navigation. Alternatively, devices are navigated relative to a roadmap of major cardiac structures generated through fast segmentation and registration. Interventional devices can be visualized and tracked throughout a procedure with specialized imaging methods. In a clinical setting, advanced imaging must be integrated with other clinical tools and patient data. In order to perform these complex procedures, interventional cardiac MR relies on customized equipment, such as interactive imaging environments, in-room image display, audio communication, hemodynamic monitoring and recording systems, and electroanatomical mapping and ablation systems. Operating in this sophisticated environment requires coordination and planning. This review provides an overview of the imaging technology used in MRI-guided cardiac interventions. Specifically, this review outlines clinical targets, standard image acquisition and analysis tools, and the integration of these tools into clinical workflow. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:935-950.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Laboratory of Imaging Technology, Biochemistry and Biophysics Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohammad A Tavallaei
- Physical Sciences Platform and Schulich Heart Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mihaela Pop
- Physical Sciences Platform and Schulich Heart Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Elena K Grant
- Laboratory of Imaging Technology, Biochemistry and Biophysics Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Kawal Rhode
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Graham A Wright
- Physical Sciences Platform and Schulich Heart Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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50
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Ratnayaka K, Kanter JP, Faranesh AZ, Grant EK, Olivieri LJ, Cross RR, Cronin IF, Hamann KS, Campbell-Washburn AE, O’Brien KJ, Rogers T, Hansen MS, Lederman RJ. Radiation-free CMR diagnostic heart catheterization in children. J Cardiovasc Magn Reson 2017; 19:65. [PMID: 28874164 PMCID: PMC5585983 DOI: 10.1186/s12968-017-0374-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Children with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. METHODS We performed 50 CMR fluoroscopy guided comprehensive transfemoral right heart catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac catheterization. CMR guided catheterizations were assessed by completion (success/failure), procedure time, and safety events (catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. RESULTS During a twenty-two month period (3/2015 - 12/2016), enrolled subjects had the following clinical indications: post-heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular heart disease 3%, and other 3%. Radiation-free CMR guided right heart catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left heart catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy heart catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. CONCLUSIONS Comprehensive CMR fluoroscopy guided right heart catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left heart) cardiac catheterization and future CMR guided cardiac intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT02739087 registered February 17, 2016.
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Affiliation(s)
- Kanishka Ratnayaka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
- Division of Cardiology, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA 92123 USA
| | - Joshua P. Kanter
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Anthony Z. Faranesh
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Elena K. Grant
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Laura J. Olivieri
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Russell R. Cross
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Ileen F. Cronin
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Karin S. Hamann
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Adrienne E. Campbell-Washburn
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Kendall J. O’Brien
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Michael S. Hansen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Robert J. Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
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