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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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