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Uzun D, Yildirim DK, Bruce CG, Halaby RN, Jaimes A, Potersnak A, Ramasawmy R, Campbell-Washburn A, Lederman RJ, Kocaturk O. Interventional device tracking under MRI via alternating current controlled inhomogeneities. Magn Reson Med 2024; 92:346-360. [PMID: 38394163 PMCID: PMC11055668 DOI: 10.1002/mrm.30031] [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: 07/18/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To introduce alternating current-controlled, conductive ink-printed marker that could be implemented with both custom and commercial interventional devices for device tracking under MRI using gradient echo, balanced SSFP, and turbo spin-echo sequences. METHODS Tracking markers were designed as solenoid coils and printed on heat shrink tubes using conductive ink. These markers were then placed on three MR-compatible test samples that are typically challenging to visualize during MRI scans. MRI visibility of markers was tested by applying alternating and direct current to the markers, and the effects of applied current parameters (amplitude, frequency) on marker artifacts were tested for three sequences (gradient echo, turbo spin echo, and balanced SSFP) in a gel phantom, using 0.55T and 1.5T MRI scanners. Furthermore, an MR-compatible current supply circuit was designed, and the performance of the current-controlled markers was tested in one postmortem animal experiment using the current supply circuit. RESULTS Direction and parameters of the applied current were determined to provide the highest conspicuity for all three sequences. Marker artifact size was controlled by adjusting the current amplitude, successfully. Visibility of a custom-designed, 20-gauge nitinol needle was increased in both in vitro and postmortem animal experiments using the current supply circuit. CONCLUSION Current-controlled conductive ink-printed markers can be placed on custom or commercial MR-compatible interventional tools and can provide an easy and effective solution to device tracking under MRI for three sequences by adjusting the applied current parameters with respect to pulse sequence parameters using the current supply circuit.
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Affiliation(s)
- Dogangun Uzun
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Christopher G. Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Rim N. Halaby
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Andi Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Amanda Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
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Nijsink H, Overduin CG, Willems LH, Warlé MC, Fütterer JJ. Current State of MRI-Guided Endovascular Arterial Interventions: A Systematic Review of Preclinical and Clinical Studies. J Magn Reson Imaging 2022; 56:1322-1342. [PMID: 35420239 PMCID: PMC9790618 DOI: 10.1002/jmri.28205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND MRI guidance of arterial endovascular interventions could be beneficial as it does not require radiation exposure, allows intrinsic blood-tissue contrast, and enables three-dimensional and functional imaging, however, clinical applications are still limited. PURPOSE To review the current state of MRI-guided arterial endovascular interventions and to identify the most commonly reported challenges. STUDY TYPE Systematic review. POPULATION Pubmed, Embase, Web of Science, and The Cochrane Library were systematically searched to find relevant articles. The search strategy combined synonyms for vascular pathology, endovascular therapy, and real-time MRI guidance. FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions were applied. ASSESSMENT Two reviewers independently identified and reviewed the original articles and extracted relevant data. STATISTICAL TESTS Results of the included original articles are reported. RESULTS A total of 24,809 studies were identified for screening. Eighty-eight studies were assessed for eligibility, after which data were extracted from 43 articles (6 phantom, 33 animal, and 4 human studies). Reported technical success rates for animal and human studies ranged between 42% to 100%, and the average complication rate was 5.8% (animal studies) and 8.8% (human studies). Main identified challenges were related to spatial and temporal resolution as well as safety, design, and scarcity of current MRI-compatible endovascular devices. DATA CONCLUSION MRI guidance of endovascular arterial interventions seems feasible, however, included articles included mostly small single-center case series. Several hurdles remain to be overcome before larger trials can be undertaken. Main areas of research should focus on adequate imaging protocols with integrated tracking of dedicated endovascular devices.
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Affiliation(s)
- Han Nijsink
- Department of Medical ImagingRadboudumcNijmegenNetherlands
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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: 1.5] [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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Kogure T, Qureshi SA. The Future of Paediatric Heart Interventions: Where Will We Be in 2030? Curr Cardiol Rep 2020; 22:158. [PMID: 33037461 PMCID: PMC7546978 DOI: 10.1007/s11886-020-01404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Purpose of Review Cardiac catheterization therapies to treat or palliate infants, children and adults with congenital heart disease have developed rapidly worldwide in both technical innovation and device development in the previous three decades. By reviewing of current status of novel or development of devices and techniques, we will discuss what is likely to happen in paediatric heart intervention in the next decade. Recent Findings Recently, biodegradable stents and devices, transcatheter pulmonary valve implantation for the native right ventricle outflow tract and MRI-guided interventions have been progressing rapidly with good immediate to early results. These are expected to be introduced and spread in the next decade although there are still challenges to overcome. Summary The future of paediatric heart intervention is very promising with rapid development of technological progress.
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Affiliation(s)
- Tomohito Kogure
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, 162-0054, Japan
| | - Shakeel A Qureshi
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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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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Functionalization of endovascular devices with superparamagnetic iron oxide nanoparticles for interventional cardiovascular magnetic resonance imaging. Biomed Microdevices 2019; 21:38. [DOI: 10.1007/s10544-019-0393-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Ciske BR, Speidel MA, Raval AN. Improving the cardiac cath-lab interventional imaging eco-system. Transl Pediatr 2018; 7:1-4. [PMID: 29441275 PMCID: PMC5803015 DOI: 10.21037/tp.2017.09.03] [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: 11/06/2022] Open
Affiliation(s)
- Benjamin R Ciske
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael A Speidel
- Department of Medicine, University of Wisconsin, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Amish N Raval
- Department of Medicine, University of Wisconsin, Madison, WI, USA
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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: 55] [Impact Index Per Article: 7.9] [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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Velasco Forte MN, Pushparajah K, Schaeffter T, Valverde Perez I, Rhode K, Ruijsink B, Alhrishy M, Byrne N, Chiribiri A, Ismail T, Hussain T, Razavi R, Roujol S. Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterization using partial saturation (pSAT). J Cardiovasc Magn Reson 2017; 19:60. [PMID: 28806996 PMCID: PMC5556659 DOI: 10.1186/s12968-017-0368-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac catheterization is a common procedure in patients with congenital heart disease (CHD). Although cardiovascular magnetic resonance imaging (CMR) represents a promising alternative approach to fluoroscopy guidance, simultaneous high contrast visualization of catheter, soft tissue and the blood pool remains challenging. In this study, a novel passive tracking technique is proposed for enhanced positive contrast visualization of gadolinium-filled balloon catheters using partial saturation (pSAT) magnetization preparation. METHODS The proposed pSAT sequence uses a single shot acquisition with balanced steady-state free precession (bSSFP) readout preceded by a partial saturation pre-pulse. This technique was initially evaluated in five healthy subjects. The pSAT sequence was compared to conventional bSSFP images acquired with (SAT) and without (Non-SAT) saturation pre-pulse. Signal-to-noise ratio (SNR) of the catheter balloon, blood and myocardium and the corresponding contrast-to-noise ratio (CNR) are reported. Subjective assessment of image suitability for CMR-guidance and ideal pSAT angle was performed by three cardiologists. The feasibility of the pSAT sequence is demonstrated in two adult patients undergoing CMR-guided cardiac catheterization. RESULTS The proposed pSAT approach provided better catheter balloon/blood contrast and catheter balloon/myocardium contrast than conventional Non-SAT sequences. It also resulted in better blood and myocardium SNR than SAT sequences. When averaged over all volunteers, images acquired with a pSAT angle of 20° to 40° enabled simultaneous visualization of the catheter balloon and the cardiovascular anatomy (blood and myocardium) and were found suitable for CMR-guidance in >93% of cases. The pSAT sequence was successfully used in two patients undergoing CMR-guided diagnostic cardiac catheterization. CONCLUSIONS The proposed pSAT sequence offers real-time, simultaneous, enhanced contrast visualization of the catheter balloon, soft tissues and blood. This technique provides improved passive tracking capabilities during CMR-guided catheterization in patients.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Medical Physics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Israel Valverde Perez
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kawal Rhode
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Mazen Alhrishy
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tevfik Ismail
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sébastien Roujol
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
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Ultrasound Navigation for Transcatheter Aortic Stent Deployment Using Global and Local Information. APPLIED SCIENCES-BASEL 2016. [DOI: 10.3390/app6120391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thin film based semi-active resonant marker design for low profile interventional cardiovascular MRI devices. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 30:93-101. [PMID: 27605033 DOI: 10.1007/s10334-016-0586-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/05/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES A new microfabrication method to produce low profile radio frequency (RF) resonant markers on catheter shafts was developed. A semi-active RF resonant marker incorporating a solenoid and a plate capacitor was constructed on the distal shaft of a 5 Fr guiding catheter. The resulting device can be used for interventional cardiovascular MRI procedures. MATERIALS AND METHODS Unlike current semi-active device visualization techniques that require rigid and bulky analog circuit components (capacitor and solenoid), we fabricated a low profile RF resonant marker directly on guiding the catheter surface by thin film metal deposition and electroplating processes using a modified physical vapor deposition system. RESULTS The increase of the overall device profile thickness caused by the semi-active RF resonant marker (130 µm thick) was lowered by a factor of 4.6 compared with using the thinnest commercial non-magnetic and rigid circuit components (600 µm thick). Moreover, adequate visibility performance of the RF resonant marker in different orientations and overall RF safety were confirmed through in vitro experiments under MRI successfully. CONCLUSION The developed RF resonant marker on a clinical grade 5 Fr guiding catheter will enable several interventional congenital heart disease treatment procedures under MRI.
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Bowen PK, Shearier ER, Zhao S, Guillory RJ, Zhao F, Goldman J, Drelich JW. Biodegradable Metals for Cardiovascular Stents: from Clinical Concerns to Recent Zn-Alloys. Adv Healthc Mater 2016; 5:1121-40. [PMID: 27094868 PMCID: PMC4904226 DOI: 10.1002/adhm.201501019] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/01/2016] [Indexed: 12/31/2022]
Abstract
Metallic stents are used to promote revascularization and maintain patency of plaqued or damaged arteries following balloon angioplasty. To mitigate the long-term side effects associated with corrosion-resistant stents (i.e., chronic inflammation and late stage thrombosis), a new generation of so-called "bioabsorbable" stents is currently being developed. The bioabsorbable coronary stents will corrode and be absorbed by the artery after completing their task as vascular scaffolding. Research spanning the last two decades has focused on biodegradable polymeric, iron-based, and magnesium-based stent materials. The inherent mechanical and surface properties of metals make them more attractive stent material candidates than their polymeric counterparts. A third class of metallic bioabsorbable materials that are based on zinc has been introduced in the last few years. This new zinc-based class of materials demonstrates the potential for an absorbable metallic stent with the mechanical and biodegradation characteristics required for optimal stent performance. This review compares bioabsorbable materials and summarizes progress towards bioabsorbable stents. It emphasizes the current understanding of physiological and biological benefits of zinc and its biocompatibility. Finally, the review provides an outlook on challenges in designing zinc-based stents of optimal mechanical properties and biodegradation rate.
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Affiliation(s)
- Patrick K Bowen
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Emily R Shearier
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Shan Zhao
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Feng Zhao
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, 49931
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Ratnayaka K, Rogers T, Schenke WH, Mazal JR, Chen MY, Sonmez M, Hansen MS, Kocaturk O, Faranesh AZ, Lederman RJ. Magnetic Resonance Imaging-Guided Transcatheter Cavopulmonary Shunt. JACC Cardiovasc Interv 2016; 9:959-70. [PMID: 27085581 DOI: 10.1016/j.jcin.2016.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that real-time magnetic resonance imaging (MRI) would enable closed-chest percutaneous cavopulmonary anastomosis and shunt by facilitating needle guidance along a curvilinear trajectory, around critical structures, and between a superior vena cava "donor" vessel and a pulmonary artery "target." BACKGROUND Children with single-ventricle physiology require multiple open heart operations for palliation, including sternotomies and cardiopulmonary bypass. The reduced morbidity of a catheter-based approach would be attractive. METHODS Fifteen naive swine underwent transcatheter cavopulmonary anastomosis and shunt creation under 1.5-T MRI guidance. An MRI antenna-needle was advanced from the superior vena cava into the target pulmonary artery bifurcation using real-time MRI guidance. In 10 animals, balloon-expanded off-the-shelf endografts secured a proximal end-to-end caval anastomosis and a distal end-to-side pulmonary anastomosis that preserved blood flow to both branch pulmonary arteries. In 5 animals, this was achieved with a novel, purpose-built, self-expanding device. RESULTS Real-time MRI needle access of target vessels (pulmonary artery), endograft delivery, and superior vena cava shunt to pulmonary arteries were successful in all animals. All survived the procedure without complications. Intraprocedural real-time MRI, post-procedural MRI, x-ray angiography, computed tomography, and necropsy showed patent shunts with bidirectional pulmonary artery blood flow. CONCLUSIONS MRI guidance enabled a complex, closed-chest, beating-heart, pediatric, transcatheter structural heart procedure. In this study, MRI guided trajectory planning and reproducible, reliable bidirectional cavopulmonary shunt creation.
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Affiliation(s)
- Kanishka Ratnayaka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Division of Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - William H Schenke
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Jonathan R Mazal
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Marcus Y Chen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Merdim Sonmez
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Michael S Hansen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Ozgur Kocaturk
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Anthony Z Faranesh
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Robert J Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
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15
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Hascoët S, Warin-Fresse K, Baruteau AE, Hadeed K, Karsenty C, Petit J, Guérin P, Fraisse A, Acar P. Cardiac imaging of congenital heart diseases during interventional procedures continues to evolve: Pros and cons of the main techniques. Arch Cardiovasc Dis 2016; 109:128-42. [DOI: 10.1016/j.acvd.2015.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022]
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16
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Abstract
Interventional cardiovascular magnetic resonance (iCMR) promises to enable radiation-free catheterization procedures and to enhance contemporary image guidance for structural heart and electrophysiological interventions. However, clinical translation of exciting pre-clinical interventions has been limited by availability of devices that are safe to use in the magnetic resonance (MR) environment. We discuss challenges and solutions for clinical translation, including MR-conditional and MR-safe device design, and how to configure an interventional suite. We review the recent advances that have already enabled diagnostic MR right heart catheterization and simple electrophysiologic ablation to be performed in humans and explore future clinical applications.
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17
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Magnetic Resonance-Guided Passive Catheter Tracking for Endovascular Therapy. Magn Reson Imaging Clin N Am 2015; 23:591-605. [PMID: 26499277 DOI: 10.1016/j.mric.2015.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The use of MR guidance for endovascular intervention is appealing because of its lack of ionizing radiation, high-contrast visualization of vessel walls and adjacent soft tissues, multiplanar capabilities, and potential to incorporate functional information such as flow, fluid dynamics, perfusion, and cardiac motion. This review highlights state-of-the-art imaging techniques and hardware used for passive tracking of endovascular devices in interventional MR imaging, including negative contrast, passive contrast, nonproton multispectral, and direct current techniques. The advantages and disadvantages of passive tracking relative to active tracking are also summarized.
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18
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The future of transcatheter pulmonary valvulation. Arch Cardiovasc Dis 2014; 107:635-42. [PMID: 25241221 DOI: 10.1016/j.acvd.2014.07.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
Percutaneous pulmonary valve implantation now has a key role in the setting of dysfunctional right ventricle-to-pulmonary artery conduits or failing bioprosthetic pulmonary valves. However, despite the excellent results obtained with the two devices available currently (the Melody(®) valve [Medtronic Inc., Minneapolis, MN, USA] and the Edwards SAPIEN(®) valve [Edwards Lifesciences, Irvine, CA, USA]), many patients eligible for pulmonary valve replacement remain unsuitable for percutaneous pulmonary valve implantation, mainly because of large native outflow tracts. Accordingly, one of the major challenges for the future is to expand percutaneous pulmonary valve implantation to a broader population of patients. Moving forward, there is important ongoing research that is intended to improve patient outcomes, expand percutaneous pulmonary valve implantation therapy and continue to reduce the number of open-heart surgeries in this population. In this review, we underline the limitations and issues associated with the devices available currently, and we focus on the development of new strategies (such as hybrid approaches or magnetic resonance-guided procedures), new devices (such as right ventricular outflow tract reducers or the novel Native Outflow Tract valved stent from Medtronic) and new technologies (such as tissue-engineered valves), which may help to take up these challenges and represent the future of transcatheter valve implantation.
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19
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Pushparajah K, Tzifa A, Razavi R. Cardiac MRI catheterization: a 10-year single institution experience and review. Interv Cardiol 2014. [DOI: 10.2217/ica.14.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Abstract
Diagnosis and prognostication in patients with complex cardiopulmonary disease can be a clinical challenge. A new procedure, MRI catheterization, involves invasive right-sided heart catheterization performed inside the MRI scanner using MRI instead of traditional radiographic fluoroscopic guidance. MRI catheterization combines simultaneous invasive hemodynamic and MRI functional assessment in a single radiation-free procedure. By combining both modalities, the many individual limitations of invasive catheterization and noninvasive imaging can be overcome, and additional clinical questions can be addressed. Today, MRI catheterization is a clinical reality in specialist centers in the United States and Europe. Advances in medical device design for the MRI environment will enable not only diagnostic but also interventional MRI procedures to be performed within the next few years.
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Affiliation(s)
- Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Kanishka Ratnayaka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington, DC
| | - Robert J Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD.
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21
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McElhinney DB. Recent progress in the understanding and management of postoperative right ventricular outflow tract dysfunction in patients with congenital heart disease. Circulation 2012; 125:e595-9. [PMID: 22529069 DOI: 10.1161/circulationaha.112.108456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Doff B McElhinney
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
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22
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Tzifa A, Schaeffter T, Razavi R. MR imaging-guided cardiovascular interventions in young children. Magn Reson Imaging Clin N Am 2012; 20:117-28. [PMID: 22118596 DOI: 10.1016/j.mric.2011.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Diagnostic cardiac catheterization procedures in children have been largely replaced by magnetic resonance (MR) imaging studies. However, when invasive catheterization is required, MR imaging has a significant role to play, when combined with invasive pressure measurements. Beyond the established reduction to the radiation dose involved, solely MR image-guided or MR image-assisted catheterization procedures can accurately address clinical questions, such as estimation of pulmonary vascular resistance and cardiac output response to stress, without needing to perform laborious measurements that are prone to errors. This article describes MR image-guided or MR image-assisted cardiac catheterization procedures for diagnosis and intervention in children.
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Affiliation(s)
- Aphrodite Tzifa
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' Hospital NHS Foundation Trust, UK.
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23
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Valverde I, Hussain T, Razavi R. Novel imaging techniques for the diagnosis and treatment of congenital heart defects: MR-guided interventions and beyond. Future Cardiol 2012; 8:149-52. [PMID: 22413973 DOI: 10.2217/fca.11.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Saeed M, Hetts SW, English J, Wilson M. MR fluoroscopy in vascular and cardiac interventions (review). Int J Cardiovasc Imaging 2012; 28:117-37. [PMID: 21359519 PMCID: PMC3275732 DOI: 10.1007/s10554-010-9774-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/13/2010] [Indexed: 12/22/2022]
Abstract
Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image-guided surgeries that offer improved patient management and cost effectiveness.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107-1701, USA.
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25
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Myerson SG, Holloway CJ, Francis JM, Neubauer S. Cardiovascular magnetic resonance (CMR)--an update and review. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2011; 59:213-222. [PMID: 21920218 DOI: 10.1016/j.pnmrs.2010.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/11/2010] [Indexed: 05/31/2023]
Affiliation(s)
- Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
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26
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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27
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Figtree GA, Lønborg J, Grieve SM, Ward MR, Bhindi R. Cardiac magnetic resonance imaging for the interventional cardiologist. JACC Cardiovasc Interv 2011; 4:137-48. [PMID: 21349451 DOI: 10.1016/j.jcin.2010.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/10/2010] [Accepted: 09/17/2010] [Indexed: 01/04/2023]
Abstract
Cardiac magnetic resonance imaging is a noninvasive technique for assessing heart structure and function without the need for ionizing radiation. Its ability to precisely outline regions of myocardial ischemia and infarction gives it an important role in guiding interventional cardiologists in revascularization. Its ability to characterize and precisely quantify abnormal regurgitant flow volumes or abnormal shunts also makes it a valuable tool for many noncoronary interventions. This review will discuss the evidence for cardiac magnetic resonance in guiding complex therapies in the catheter laboratory, as well as practical issues that need to be addressed to allow the application of this powerful tool to an increasing number of our patients.
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Affiliation(s)
- Gemma A Figtree
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Sydney, Australia
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28
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Shih MCP, Rogers WJ, Bonatti H, Hagspiel KD. Real-time MR-guided retrieval of inferior vena cava filters: an in vitro and animal model study. J Vasc Interv Radiol 2011; 22:843-50. [PMID: 21482139 DOI: 10.1016/j.jvir.2011.01.428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 12/16/2010] [Accepted: 01/02/2011] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop interventional magnetic resonance (MR) guidance techniques for inferior vena cava (IVC) filter retrieval in vitro and demonstrate feasibility in vivo. MATERIALS AND METHODS Three optional IVC filters and their retrieval systems were investigated. Experiments were performed on a 1.5-T MR system. Real-time MR imaging was optimized by using a custom-built IVC phantom. A three-dimensional (3D) contrast-enhanced MR venography sequence was optimized in vitro for improved detection of thrombus trapped within the filters. Filters were then retrieved in vitro and in vivo in a swine model under MR guidance. In-vivo retrieval procedure time was measured. RESULTS The combination of one of the nitinol filters and a loop snare was suitable for real-time MR procedures. With a 90° flip angle, 3D MR venography allowed detection of simulated thrombus within the filter. A radial true fast imaging sequence with steady-state precession allowed visualization of the loop snare and IVC filter hook and successful retrieval of the filter in vivo and in vitro. In-vivo MR fluoroscopy time for retrieval was 97 seconds ± 51 (mean ± SD). CONCLUSIONS MR-guided retrieval of a nitinol-based IVC filter by using a loop snare is feasible with the use of optimized sequences and passive device tracking.
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Affiliation(s)
- Ming-Chen Paul Shih
- Department of Radiology and Medical Imaging, University of Virginia Health System, Lee Street, Charlottesville, VA 22908, USA
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29
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Tzifa A, Krombach GA, Krämer N, Krüger S, Schütte A, von Walter M, Schaeffter T, Qureshi S, Krasemann T, Rosenthal E, Schwartz CA, Varma G, Buhl A, Kohlmeier A, Bücker A, Günther RW, Razavi R. Magnetic Resonance–Guided Cardiac Interventions Using Magnetic Resonance–Compatible Devices. Circ Cardiovasc Interv 2010; 3:585-92. [DOI: 10.1161/circinterventions.110.957209] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Percutaneous cardiac interventions are currently performed under x-ray guidance. Magnetic resonance imaging (MRI) has been used to guide intravascular interventions in the past, but mainly in animals. Translation of MR-guided interventions into humans has been limited by the lack of MR-compatible and safe equipment, such as MR guide wires with mechanical characteristics similar to standard guide wires. The aim of the present study was to evaluate the safety and efficacy of a newly developed MR-safe and compatible passive guide wire in aiding MR-guided cardiac interventions in a swine model and describe the 2 first-in-man solely MR-guided interventions.
Methods and Results—
In the preclinical trial, the new MR-compatible wire aided the performance of 20 interventions in 5 swine. These consisted of balloon dilation of nondiseased pulmonary and aortic valves, aortic arch, and branch pulmonary arteries. After ethics and regulatory authority approval, the 2 first-in-man MR-guided interventions were performed in a child and an adult, both with elements of valvar pulmonary stenosis. Catheter manipulations were monitored with real-time MRI sequence with interactive modification of imaging plane and slice position. Temporal resolution was 11 to 12 frames/s. Catheterization procedure times were 110 and 80 minutes, respectively. Both patients had successful relief of the valvar stenosis and no procedural complications.
Conclusions—
The described preclinical study and case reports are encouraging that with the availability of the new MR-compatible and safe guide wire, certain percutaneous cardiac interventions will become feasible to perform solely under MR guidance in the future. A clinical trial is underway in our institution.
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Affiliation(s)
- Aphrodite Tzifa
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Gabriele A. Krombach
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Nils Krämer
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Sascha Krüger
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Adrian Schütte
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Matthias von Walter
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Tobias Schaeffter
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Shakeel Qureshi
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Thomas Krasemann
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Eric Rosenthal
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Claudia A. Schwartz
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Gopal Varma
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Alexandra Buhl
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Antonia Kohlmeier
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Arno Bücker
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Rolf W. Günther
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Reza Razavi
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
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30
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Kahlert P, Eggebrecht H, Plicht B, Kraff O, McDougall I, Decker B, Erbel R, Ladd ME, Quick HH. Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: in vitro evaluation and modification of existing devices. J Cardiovasc Magn Reson 2010; 12:58. [PMID: 20942968 PMCID: PMC2964701 DOI: 10.1186/1532-429x-12-58] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 10/13/2010] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI) featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve®) including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. METHODS The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. RESULTS CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. CONCLUSIONS The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested design modifications of the delivery system.
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Affiliation(s)
- Philipp Kahlert
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Holger Eggebrecht
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Björn Plicht
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Oliver Kraff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Ian McDougall
- Evasc Medical Systems, 107-1099 West 8th Avenue, Vancouver, BC V6H 1C3, Canada
| | - Brad Decker
- Evasc Medical Systems, 107-1099 West 8th Avenue, Vancouver, BC V6H 1C3, Canada
| | - Raimund Erbel
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Mark E Ladd
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Harald H Quick
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052 Erlangen, Germany
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Neizel M, Krämer N, Bönner F, Schütte A, Krüger S, Kelm M, Günther RW, Kühl HP, Krombach GA. Rapid Right Ventricular Pacing with MR-compatible Pacemaker Lead for MR-guided Aortic Balloon Valvuloplasty in Swine. Radiology 2010; 255:799-804. [DOI: 10.1148/radiol.10091419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The field of interventional cardiology has developed at an unprecedented pace on account of the visual and imaging power provided by constantly improving biomedical technologies. Transcatheter-based technology is now routinely used for coronary revascularization and noncoronary interventions using balloon angioplasty, stents, and many other devices. In the early days of interventional practice, the operating physician had to manually navigate catheters and devices under fluoroscopic imaging and was exposed to radiation, with its comcomitant necessity for wearing heavy lead aprons for protection. Until recently, very little has changed in the way procedures have been carried out in the catheterization laboratory. The technological capacity to remotely manipulate devices, using robotic arms and computational tools, has been developed for surgery and other medical procedures. This has brought to practice the powerful combination of the abilities afforded by imaging, navigational tools, and remote control manipulation. This review covers recent developments in navigational tools for catheter positioning, electromagnetic mapping, magnetic resonance imaging (MRI)-based cardiac electrophysiological interventions, and navigation tools through coronary arteries.
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Affiliation(s)
- Rafael Beyar
- Rambam Medical Center and Technion-Israel Institute of Technology, Haifa, Israel.
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Affiliation(s)
- Dudley J. Pennell
- From the Cardiovascular MR Unit, Royal Brompton Hospital, London, UK and Imperial College, London, UK
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Prakash A, Powell AJ, Geva T. Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease. Circ Cardiovasc Imaging 2010; 3:112-25. [PMID: 20086225 DOI: 10.1161/circimaging.109.875021] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ashwin Prakash
- From the Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Andrew J. Powell
- From the Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Tal Geva
- From the Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Mass
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Ratnayaka K, Lederman RJ. Interventional cardiovascular MR—The next stage in pediatric cardiology. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.008] [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: 10/20/2022]
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Saikus CE, Lederman RJ. Interventional cardiovascular magnetic resonance imaging: a new opportunity for image-guided interventions. JACC Cardiovasc Imaging 2009; 2:1321-31. [PMID: 19909937 PMCID: PMC2843404 DOI: 10.1016/j.jcmg.2009.09.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 09/10/2009] [Accepted: 09/11/2009] [Indexed: 01/12/2023]
Abstract
Cardiovascular magnetic resonance (CMR) combines excellent soft-tissue contrast, multiplanar views, and dynamic imaging of cardiac function without ionizing radiation exposure. Interventional cardiovascular magnetic resonance (iCMR) leverages these features to enhance conventional interventional procedures or to enable novel ones. Although still awaiting clinical deployment, this young field has tremendous potential. We survey promising clinical applications for iCMR. Next, we discuss the technologies that allow CMR-guided interventions and, finally, what still needs to be done to bring them to the clinic.
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Affiliation(s)
- Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892-1538, USA
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37
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Kocaturk O, Saikus CE, Guttman MA, Faranesh AZ, Ratnayaka K, Ozturk C, McVeigh ER, Lederman RJ. Whole shaft visibility and mechanical performance for active MR catheters using copper-nitinol braided polymer tubes. J Cardiovasc Magn Reson 2009; 11:29. [PMID: 19674464 PMCID: PMC2743675 DOI: 10.1186/1532-429x-11-29] [Citation(s) in RCA: 21] [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: 03/16/2009] [Accepted: 08/12/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter visualization and tracking remains a challenge in interventional MR.Active guidewires can be made conspicuous in "profile" along their whole shaft exploiting metallic core wire and hypotube components that are intrinsic to their mechanical performance. Polymer-based catheters, on the other hand, offer no conductive medium to carry radio frequency waves. We developed a new "active" catheter design for interventional MR with mechanical performance resembling braided X-ray devices. Our 75 cm long hybrid catheter shaft incorporates a wire lattice in a polymer matrix, and contains three distal loop coils in a flexible and torquable 7Fr device. We explored the impact of braid material designs on radiofrequency and mechanical performance. RESULTS The incorporation of copper wire into in a superelastic nitinol braided loopless antenna allowed good visualization of the whole shaft (70 cm) in vitro and in vivo in swine during real-time MR with 1.5 T scanner. Additional distal tip coils enhanced tip visibility. Increasing the copper:nitinol ratio in braiding configurations improved flexibility at the expense of torquability. We found a 16-wire braid of 1:1 copper:nitinol to have the optimum balance of mechanical (trackability, flexibility, torquability) and antenna (signal attenuation) properties. With this configuration, the temperature increase remained less than 2 degrees C during real-time MR within 10 cm horizontal from the isocenter. The design was conspicuous in vitro and in vivo. CONCLUSION We have engineered a new loopless antenna configuration that imparts interventional MR catheters with satisfactory mechanical and imaging characteristics. This compact loopless antenna design can be generalized to visualize the whole shaft of any general-purpose polymer catheter to perform safe interventional procedures.
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Affiliation(s)
- Ozgur Kocaturk
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Guttman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Z Faranesh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kanishka Ratnayaka
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cengizhan Ozturk
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Elliot R McVeigh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert J Lederman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Ratnayaka K, Faranesh AZ, Guttman MA, Kocaturk O, Saikus CE, Lederman RJ. Interventional cardiovascular magnetic resonance: still tantalizing. J Cardiovasc Magn Reson 2008; 10:62. [PMID: 19114017 PMCID: PMC2637847 DOI: 10.1186/1532-429x-10-62] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/29/2008] [Indexed: 12/30/2022] Open
Abstract
The often touted advantages of MR guidance remain largely unrealized for cardiovascular interventional procedures in patients. Many procedures have been simulated in animal models. We argue these opportunities for clinical interventional MR will be met in the near future. This paper reviews technical and clinical considerations and offers advice on how to implement a clinical-grade interventional cardiovascular MR (iCMR) laboratory. We caution that this reflects our personal view of the "state of the art."
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Affiliation(s)
- Kanishka Ratnayaka
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Cardiology Division, Children's National Medical Center, Washington, DC, USA
| | - Anthony Z Faranesh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael A Guttman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ozgur Kocaturk
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J Lederman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Horvath KA, Li M, Mazilu D, Guttman MA, McVeigh ER. Real-time magnetic resonance imaging guidance for cardiovascular procedures. Semin Thorac Cardiovasc Surg 2008; 19:330-5. [PMID: 18395633 DOI: 10.1053/j.semtcvs.2007.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2007] [Indexed: 12/20/2022]
Abstract
Magnetic resonance imaging (MRI) of the cardiovascular system has proven to be an invaluable diagnostic tool. Given the ability to allow for real-time imaging, MRI guidance of intraoperative procedures can provide superb visualization, which can facilitate a variety of interventions and minimize the trauma of the operations as well. In addition to the anatomic detail, MRI can provide intraoperative assessment of organ and device function. Instruments and devices can be marked to enhance visualization and tracking, all of which is an advance over standard X-ray or ultrasonic imaging.
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Affiliation(s)
- Keith A Horvath
- Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD 20892, USA.
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Dukkipati SR, Mallozzi R, Schmidt EJ, Holmvang G, d'Avila A, Guhde R, Darrow RD, Slavin G, Fung M, Malchano Z, Kampa G, Dando JD, McPherson C, Foo TK, Ruskin JN, Dumoulin CL, Reddy VY. Electroanatomic mapping of the left ventricle in a porcine model of chronic myocardial infarction with magnetic resonance-based catheter tracking. Circulation 2008; 118:853-62. [PMID: 18678773 DOI: 10.1161/circulationaha.107.738229] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND X-ray fluoroscopy constitutes the fundamental imaging modality for catheter visualization during interventional electrophysiology procedures. The minimal tissue discriminative capability of fluoroscopy is mitigated in part by the use of electroanatomic mapping systems and enhanced by the integration of preacquired 3-dimensional imaging of the heart with computed tomographic or magnetic resonance (MR) imaging. A more ideal paradigm might be to use intraprocedural MR imaging to directly image and guide catheter mapping procedures. METHODS AND RESULTS An MR imaging-based electroanatomic mapping system was designed to assess the feasibility of navigating catheters to the left ventricle in vivo using MR tracking of microcoils incorporated into the catheters, measuring intracardiac ventricular electrograms, and integrating this information with 3-dimensional MR angiography and myocardial delayed enhancement images to allow ventricular substrate mapping. In all animals (4 normal, and 10 chronically infarcted swine), after transseptal puncture under fluoroscopic guidance, catheters were successfully navigated to the left ventricle with MR tracking (13 to 15 frames per second) by both transseptal and retrograde aortic approaches. Electrogram artifacts related to the MR imaging gradient pulses were successfully removed with analog and digital signal processing. In all animals, it was possible to map the entire left ventricle and to project electrogram voltage amplitude maps to identify the scarred myocardium. CONCLUSIONS It is possible to use MR tracking to navigate catheters to the left ventricle, to measure electrogram activity, and to render accurate 3-dimensional voltage maps in a porcine model of chronic myocardial infarction, completely in the MR imaging environment. Myocardial delayed enhancement guidance provided dense sampling of the proximity of the infarct and accurate localization of complex infarcts.
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Affiliation(s)
- Srinivas R Dukkipati
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Mass., USA
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Real-time MR imaging-guided laser atrial septal puncture in swine. J Vasc Interv Radiol 2008; 19:1347-53. [PMID: 18725098 DOI: 10.1016/j.jvir.2008.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 05/05/2008] [Accepted: 05/12/2008] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The authors performed this study to report their initial preclinical experience with real-time magnetic resonance (MR) imaging-guided atrial septal puncture by using a MR imaging-conspicuous blunt laser catheter that perforates only when energized. MATERIALS AND METHODS The authors customized a 0.9-mm clinical excimer laser catheter with a receiver coil to impart MR imaging visibility at 1.5 T. Seven swine underwent laser transseptal puncture under real-time MR imaging. MR imaging signal-to-noise ratio profiles of the device were obtained in vitro. Tissue traversal force was tested with a calibrated meter. Position was corroborated with pressure measurements, oximetry, angiography, and necropsy. Intentional non-target perforation simulated serious complication. RESULTS Embedded MR imaging antennae accurately reflected the position of the laser catheter tip and profile in vitro and in vivo. Despite having an increased profile from the microcoil, the 0.9-mm laser catheter traversed in vitro targets with similar force (0.22 N +/- 0.03) compared with the unmodified laser. Laser puncture of the atrial septum was successful and accurate in all animals. The laser was activated an average of 3.8 seconds +/- 0.4 before traversal. There were no sequelae after 6 hours of observation. Necropsy revealed 0.9-mm holes in the fossa ovalis in all animals. Intentional perforation of the aorta and atrial free wall was evident immediately. CONCLUSIONS MR imaging-guided laser puncture of the interatrial septum is feasible in swine and offers controlled delivery of perforation energy by using an otherwise blunt catheter. Instantaneous soft tissue imaging provides immediate feedback on safety.
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Guttman MA, Ozturk C, Raval AN, Raman VK, Dick AJ, DeSilva R, Karmarkar P, Lederman RJ, McVeigh ER. Interventional cardiovascular procedures guided by real-time MR imaging: an interactive interface using multiple slices, adaptive projection modes and live 3D renderings. J Magn Reson Imaging 2008; 26:1429-35. [PMID: 17968897 DOI: 10.1002/jmri.21199] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop and test a novel interactive real-time MRI environment that facilitates image-guided cardiovascular interventions. MATERIALS AND METHODS Color highlighting of device-mounted receiver coils, accelerated imaging of multiple slices, adaptive projection modes, live three-dimensional (3D) renderings and other interactive features were utilized to enhance navigation of devices and targeting of tissue. RESULTS Images are shown from several catheter-based interventional procedures performed in swine that benefit from this custom interventional MRI interface. These include endograft repair of aortic aneurysm, balloon septostomy of the cardiac interatrial septum, angioplasty and stenting, and endomyocardial cell injection, all using active catheters containing MRI receiver coils. CONCLUSION Interactive features not available on standard clinical scanners enhance real-time MRI for guiding cardiovascular interventional procedures.
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Affiliation(s)
- Michael A Guttman
- Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1061, USA.
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Abstract
The purpose of this article is to review the current state of the art with respect to intravascular magnetic resonance imaging, including intravascular coils, their implementation for plaque identification and characterization, and strategies for future approaches to coronary imaging and other cardiovascular applications.
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45
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Abstract
Cardiovascular magnetic resonance (CMR) is an evolving technology with growing indications within the clinical cardiology setting. This review article summarises the current clinical applications of CMR. The focus is on the use of CMR in the diagnosis of coronary artery disease with summaries of validation literature in CMR viability, myocardial perfusion, and dobutamine CMR. Practical uses of CMR in non-coronary diseases are also discussed.
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Affiliation(s)
- W P Bandettini
- Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1061, USA.
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46
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Raman VK, Lederman RJ. Advances in interventional cardiovascular MRI. CURRENT CARDIOVASCULAR RISK REPORTS 2007. [DOI: 10.1007/s12170-007-0050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Magnusson P, Johansson E, Månsson S, Petersson JS, Chai CM, Hansson G, Axelsson O, Golman K. Passive catheter tracking during interventional MRI using hyperpolarized 13C. Magn Reson Med 2007; 57:1140-7. [PMID: 17534914 DOI: 10.1002/mrm.21239] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Interventional procedures in MRI can be performed preclinically using active or passive catheter-tracking methods. A novel passive nonproton technique is suggested that uses a catheter filled with a hyperpolarized (13)C contrast agent. A prototype three-lumen catheter was built with two closed lumens containing a flowing hyperpolarized (13)C contrast agent. Entire-length (13)C catheter projection visualization could be performed in vivo with a catheter SNR of approximately 80, one dual projection frame per approximately 700 ms, and an in-plane resolution of 2 x 2 mm(2) while traveling through the aorta of a pig. The traveling path of the (13)C catheter was visualized after back-projection catheter reconstruction and after image fusion with an anatomical offline proton road map. Catheter length visualization was aided by an oblique planar visualization mode. The high catheter signal demonstrated, together with the entire catheter length visualization and high surrounding soft-tissue contrast, warrants further development into a real-time technique.
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Affiliation(s)
- Peter Magnusson
- Amersham Health R&D AB (part of GE Healthcare), Medeon, Malmö, Sweden
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48
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Martucci G, Mullen M, Landzberg MJ. Care for Adults with Congenital Heart Disease. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50048-6] [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: 11/24/2022] Open
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49
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Gibbons RJ, Araoz PA, Williamson EE. The year in cardiac imaging. J Am Coll Cardiol 2006; 48:2324-39. [PMID: 17161266 DOI: 10.1016/j.jacc.2006.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 06/08/2006] [Indexed: 11/26/2022]
Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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50
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Eggebrecht H, Heusch G, Erbel R, Ladd ME, Quick HH. Real-time vascular interventional magnetic resonance imaging. Basic Res Cardiol 2006; 102:1-8. [PMID: 17006635 DOI: 10.1007/s00395-006-0624-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 08/14/2006] [Indexed: 11/26/2022]
Abstract
Endovascular stent-graft placement is emerging as a promising alternative to medical and surgical treatment of patients with diseases of the descending thoracic and abdominal aorta. Precise placement of the stentgraft, which is currently performed under x-ray control, remains, however, challenging as there are several shortcomings to fluoroscopic guidance beyond that related to the harmful effect of radiation exposure and nephrotoxic contrast media. While transesophageal echocardiography and intravascular ultrasound have been used as adjunct imaging modalities during endovascular stent-graft procedures to overcome the limitations of angiography, these techniques have not mitigated the need for fluoroscopy. Magnetic resonance imaging (MRI) guidance of vascular interventional procedures offers several potential advantages over fluoroscopy-guided techniques, including image acquisition in any desired orientation, superior 3D soft-tissue contrast with simultaneous visualization of the interventional device, absence of ionizing radiation, and avoidance of nephrotoxic contrast media. Magnetic resonance imaging is often used for pre-operative diagnosis of aortic disease and can provide all relevant information for the planning of endovascular stent-graft procedures as well as for accurate and immediate post-interventional evaluation. However, visualization of interventional instruments by MRI has proven to be the chief obstacle. This article will review current approaches that have been developed for depicting vascular instruments by MRI and will also discuss the first experimental experiences with MRI-guided endovascular stent-graft placement in a swine model of aortic dissection.
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Affiliation(s)
- Holger Eggebrecht
- Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Klinikum der Universität Duisburg-Essen, Essen, Germany.
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