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Steeg K, Krombach GA, Friebe MH. A Review of Needle Navigation Technologies in Minimally Invasive Cardiovascular Surgeries-Toward a More Effective and Easy-to-Apply Process. Diagnostics (Basel) 2025; 15:197. [PMID: 39857081 PMCID: PMC11763737 DOI: 10.3390/diagnostics15020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/13/2025] [Accepted: 01/14/2025] [Indexed: 01/27/2025] Open
Abstract
Background: This review evaluates needle navigation technologies in minimally invasive cardiovascular surgery (MICS), identifying their strengths and limitations and the requirements for an ideal needle navigation system that features optimal guidance and easy adoption in clinical practice. Methods: A systematic search of PubMed, Web of Science, and IEEE databases up until June 2024 identified original studies on needle navigation in MICS. Eligible studies were those published within the past decade and that performed MICS requiring needle navigation technologies in adult patients. Animal studies, case reports, clinical trials, or laboratory experiments were excluded to focus on actively deployed techniques in clinical practice. Extracted data included the study year, modalities used, procedures performed, and the reported strengths and limitations, from which the requirements for an optimal needle navigation system were derived. Results: Of 36 eligible articles, 21 used ultrasound (US) for real-time imaging despite depth and needle visibility challenges. Computer tomography (CT)-guided fluoroscopy, cited in 19 articles, enhanced deep structure visualization but involved radiation risks. Magnetic resonance imaging (MRI), though excellent for soft-tissue contrast, was not used due to metallic tool incompatibility. Multimodal techniques, like US-fluoroscopy fusion, improved accuracy but added cost and workflow complexity. No single technology meets all the criteria for an ideal needle navigation system, which should combine real-time imaging, 3D spatial awareness, and tissue integrity feedback while being cost-effective and easily integrated into existing workflows. Conclusions: This review derived the criteria and obstacles an ideal needle navigation system must address before its clinical adoption, along with novel technological approaches that show potential to overcome those challenges. For instance, fusion technologies overlay information from multiple visual approaches within a single interface to overcome individual limitations. Additionally, emerging diagnostic methods like vibroacoustic sensing or optical fiber needles offer information from complementary sensory channels, augmenting visual approaches with insights into tissue integrity and structure, thereby paving the way for enhanced needle navigation systems in MICS.
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Affiliation(s)
- Katharina Steeg
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Michael Horst Friebe
- Faculty of Computer Science, AGH University Kraków, 30-059 Kraków, Poland;
- INKA Innovation Lab, Faculty of Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
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2
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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3
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Rogers T, Campbell-Washburn AE, Ramasawmy R, Yildirim DK, Bruce CG, Grant LP, Stine AM, Kolandaivelu A, Herzka DA, Ratnayaka K, Lederman RJ. Interventional cardiovascular magnetic resonance: state-of-the-art. J Cardiovasc Magn Reson 2023; 25:48. [PMID: 37574552 PMCID: PMC10424337 DOI: 10.1186/s12968-023-00956-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 4B01, Washington, DC, 20011, USA.
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Laurie P Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
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4
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Amin EK, Campbell-Washburn A, Ratnayaka K. MRI-Guided Cardiac Catheterization in Congenital Heart Disease: How to Get Started. Curr Cardiol Rep 2022; 24:419-429. [PMID: 35107702 PMCID: PMC8979923 DOI: 10.1007/s11886-022-01659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Cardiac magnetic resonance imaging provides radiation-free, 3-dimensional soft tissue visualization with adjunct hemodynamic data, making it a promising candidate for image-guided transcatheter interventions. This review focuses on the benefits and background of real-time magnetic resonance imaging (MRI)-guided cardiac catheterization, guidance on starting a clinical program, and recent research developments. RECENT FINDINGS Interventional cardiac magnetic resonance (iCMR) has an established track record with the first entirely MRI-guided cardiac catheterization for congenital heart disease reported nearly 20 years ago. Since then, many centers have embarked upon clinical iCMR programs primarily performing diagnostic MRI-guided cardiac catheterization. There have also been limited reports of successful real-time MRI-guided transcatheter interventions. Growing experience in performing cardiac catheterization in the magnetic resonance environment has facilitated practical workflows appropriate for efficiency-focused cardiac catheterization laboratories. Most exciting developments in imaging technology, MRI-compatible equipment and MRI-guided novel transcatheter interventions have been limited to preclinical research. Many of these research developments are ready for clinical translation. With increasing iCMR clinical experience and translation of preclinical research innovations, the time to make the leap to radiation-free procedures is now.
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Affiliation(s)
- Elena K Amin
- Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA.
| | - Adrienne Campbell-Washburn
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, 3020 Children's Way, San Diego, CA, USA
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5
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Rier SC, Vreemann S, Nijhof WH, van Driel VJHM, van der Bilt IAC. Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives. Ther Adv Cardiovasc Dis 2022; 16:17539447221119624. [PMID: 36039865 PMCID: PMC9434707 DOI: 10.1177/17539447221119624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) provides excellent temporal and spatial resolution, tissue characterization, and flow measurements. This enables major advantages when guiding cardiac invasive procedures compared with X-ray fluoroscopy or ultrasound guidance. However, clinical implementation is limited due to limited availability of technological advancements in magnetic resonance imaging (MRI) compatible equipment. A systematic review of the available literature on past and present applications of interventional MR and its technology readiness level (TRL) was performed, also suggesting future applications. METHODS A structured literature search was performed using PubMed. Search terms were focused on interventional CMR, cardiac catheterization, and other cardiac invasive procedures. All search results were screened for relevance by language, title, and abstract. TRL was adjusted for use in this article, level 1 being in a hypothetical stage and level 9 being widespread clinical translation. The papers were categorized by the type of procedure and the TRL was estimated. RESULTS Of 466 papers, 117 papers met the inclusion criteria. TRL was most frequently estimated at level 5 meaning only applicable to in vivo animal studies. Diagnostic right heart catheterization and cavotricuspid isthmus ablation had the highest TRL of 8, meaning proven feasibility and efficacy in a series of humans. CONCLUSION This article shows that interventional CMR has a potential widespread application although clinical translation is at a modest level with TRL usually at 5. Future development should be directed toward availability of MR-compatible equipment and further improvement of the CMR techniques. This could lead to increased TRL of interventional CMR providing better treatment.
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Affiliation(s)
- Sophie C Rier
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Suzan Vreemann
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
| | - Wouter H Nijhof
- Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
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6
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Arar Y, Hussain T, Abou Zahr R, Gooty V, Greer JS, Huang R, Hernandez J, King J, Greil G, Veeram Reddy SR. Fick versus flow: a real-time invasive cardiovascular magnetic resonance (iCMR) reproducibility study. J Cardiovasc Magn Reson 2021; 23:95. [PMID: 34275477 PMCID: PMC8287667 DOI: 10.1186/s12968-021-00784-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac catheterization and cardiovascular magnetic resonance (CMR) imaging have distinct diagnostic roles in the congenital heart disease (CHD) population. Invasive CMR (iCMR) allows for a more thorough assessment of cardiac hemodynamics at the same time under the same conditions. It is assumed but not proven that iCMR gives an incremental value by providing more accurate flow quantification. METHODS Subjects with CHD underwent real-time 1.5 T iCMR using a passive catheter tracking technique with partial saturation pulse of 40° to visualize the gadolinium-filled balloon, CMR-conditional guidewire, and cardiac structures simultaneously to aid in completion of right (RHC) and left heart catheterization (LHC). Repeat iCMR and catheterization measurements were performed to compare reliability by the Pearson (PCC) and concordance correlation coefficients (CCC). RESULTS Thirty CHD (20 single ventricle and 10 bi-ventricular) subjects with a median age and weight of 8.3 years (2-33) and 27.7 kg (9.2-80), respectively, successfully underwent iCMR RHC and LHC. No catheter related complications were encountered. Time taken for first pass RHC and LHC/aortic pull back was 5.1, and 2.9 min, respectively. Total success rate to obtain required data points to complete Fick principle calculations for all patients was 321/328 (98%). One patient with multiple shunts was an outlier and excluded from further analysis. The PCC for catheter-derived pulmonary blood flow (Qp) (0.89, p < 0.001) is slightly lower than iCMR-derived Qp (0.96, p < 0.001), whereas catheter-derived systemic blood flow (Qs) (0.62, p = < 0.001) was considerably lower than iCMR-derived Qs (0.94, p < 0.001). CCC agreement for Qp at baseline (C1-CCC = 0.65, 95% CI 0.41-0.81) and retested conditions (C2-CCC = 0.78, 95% CI 0.58-0.89) were better than for Qs at baseline (C1-CCC = 0.22, 95% CI - 0.15-0.53) and retested conditions (C2-CCC = 0.52, 95% CI 0.17-0.76). CONCLUSION This study further validates hemodynamic measurements obtained via iCMR. iCMR-derived flows have considerably higher test-retest reliability for Qs. iCMR evaluations allow for more reproducible hemodynamic assessments in the CHD population.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Joshua S. Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Rong Huang
- Research Administration, Children’s Medical Center, Dallas, TX USA
| | - Jennifer Hernandez
- Anesthesiology and Pain Management, Children’s Medical Center, Dallas, TX USA
| | - Jamie King
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
| | - Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235 USA
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7
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El-Sabrout HR, Ryan JR, Hegde SR, El-Said HG, Nigro JJ, Moore JW, Ratnayaka K. Purpose-built transcatheter cavopulmonary anastomosis device requirements: Multi-modality imaging evaluation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:128-133. [PMID: 33526391 DOI: 10.1016/j.carrev.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/PURPOSE Patients with a functional single ventricle undergo multiple, palliative open-heart surgeries. This includes a superior cavopulmonary anastomosis or bidirectional Glenn shunt. A less-invasive transcatheter approach may reduce morbidity. METHODS/MATERIALS We analyzed pre-Glenn X-ray contrast angiography (XA), cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) studies. RESULTS Over an eleven-year period (1/2007 - 6/2017), 139 Glenn surgeries were performed at our institution. The typical age range at surgery was 59 - 371 days (median = 163; IQR = 138 - 203). Eight-nine XA, ten CT, and ten CMR studies obtained from these patients were analyzed. Cephalad SVC measurements (millimeters) were 7.3 ± 1.7 (XA), 7.7 ± 1.6 (CT) and 6.9 ± 1.8 (CMR). RPA measurements were 7.3 ± 1.9 (XA), 7.4 ± 1.6 (CT) and 6.6 ± 1.9 (CMR). Potential device lengths were 10.9 ± 6 - 17.4 ± 6.4 (XA), 10.1 ± 2.1 - 17.7 ± 2.4 (CT) and 17.3 ± 4. - 23.7 ± 5.5 (CMR). SVC-RPA angle (degrees) was 132.9 ± 13.2 (CT) and 140 ± 10.2 (MRI). Image quality of all CT (100%), almost all XA (SVC 100%, RPA 99%), and most MRI (SVC 80%, RPA 90%) were deemed sufficient. Parametric modeling virtual fit device with 10 mm diameter and 20 - 25 mm length was ideal. CONCLUSIONS Ideal transcatheter cavopulmonary shunt device for the typical patient would be 10 mm in diameter and 20-25 mm in length.
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Affiliation(s)
- Hannah R El-Sabrout
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA
| | - Justin R Ryan
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA; Division of Cardiovascular Surgery, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA
| | - Sanjeet R Hegde
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA
| | - Howaida G El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA
| | - John J Nigro
- Division of Cardiovascular Surgery, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA
| | - John W Moore
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, San Diego, CA, USA.
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8
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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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9
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Tannous P, Popescu A, Forbess L, Nugent A. Transcatheter biventricular conversion in an adult patient with a 1.5 ventricle Glenn palliation and superior vena cava syndrome. Catheter Cardiovasc Interv 2020; 96:633-637. [PMID: 32343465 DOI: 10.1002/ccd.28920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/09/2022]
Abstract
Covered stents have a continually expanding spectrum of applications for patients with congenital heart disease. Here we report use of covered stents to successfully perform a first-in-human percutaneous biventricular conversion of a 1.5 ventricle Glenn palliation in an adult born with pulmonary atresia. This case demonstrates that in patients considered borderline for biventricular repair, surgery can potentially be modified to promote growth of underdeveloped structures and setup for transcatheter biventricular conversion.
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Affiliation(s)
- Paul Tannous
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Andrada Popescu
- Department of Pediatrics, Northwestern University, Chicago, Illinois.,Division of Pediatric Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lisa Forbess
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Alan Nugent
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
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10
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Salavitabar A, Figueroa CA, Lu JC, Owens ST, Axelrod DM, Zampi JD. Emerging 3D technologies and applications within congenital heart disease: teach, predict, plan and guide. Future Cardiol 2020; 16:695-709. [PMID: 32628520 DOI: 10.2217/fca-2020-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
3D visualization technologies have evolved to become a mainstay in the management of congenital heart disease (CHD) with a growing presence within multiple facets. Printed and virtual 3D models allow for a more comprehensive approach to educating trainees and care team members. Computational fluid dynamics can take 3D modeling to the next level, by predicting post-procedural outcomes and helping to determine surgical approach. 3D printing and extended reality are developing resources for pre-procedural planning and intra-procedural guidance with the potential to revolutionize decision-making and procedural success. Challenges still remain within existing technologies and their applications to the CHD field. Addressing these gaps, both by those within and outside of CHD, will transform education and patient care within our field.
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Affiliation(s)
- Arash Salavitabar
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
| | - C Alberto Figueroa
- Departments of Biomedical Engineering & Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jimmy C Lu
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
| | - Sonal T Owens
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
| | - David M Axelrod
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
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11
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Tanase D, Georgiev S, Eicken A, Ewert P. Transcatheter creation of bidirectional cavopulmonary connections by needle punctures in two patients. Catheter Cardiovasc Interv 2020; 95:1305-1309. [PMID: 32043804 DOI: 10.1002/ccd.28771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 11/06/2022]
Abstract
We report on two patients who received a transcatheter cavopulmonary connection by a needle puncture under deep conscious sedation. In both patients, the vessel-to-vessel connection was achieved by a venous access into the superior caval vein and direct needle puncture of the pulmonary artery. The two cavopulmonary anastomoses were held open by a covered stent and a bare-metal stent, respectively.
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Affiliation(s)
- Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
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12
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Khan JM, Rogers T, Greenbaum AB, Babaliaros VC, Yildirim DK, Bruce CG, Herzka DA, Schenke WH, Ratnayaka K, Lederman RJ. Transcatheter Electrosurgery: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1455-1470. [PMID: 32216915 PMCID: PMC7184929 DOI: 10.1016/j.jacc.2020.01.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 01/28/2023]
Abstract
Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the "Flying V" configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; UCSD Rady Children's Hospital, San Diego, California
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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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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Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire. PLoS One 2020; 15:e0229711. [PMID: 32102092 PMCID: PMC7043930 DOI: 10.1371/journal.pone.0229711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Real-time magnetic resonance imaging (MRI) is a promising alternative to X-ray fluoroscopy for guiding cardiovascular catheterization procedures. Major challenges, however, include the lack of guidewires that are compatible with the MRI environment, not susceptible to radiofrequency-induced heating, and reliably visualized. Preclinical evaluation of new guidewire designs has been conducted at 1.5T. Here we further evaluate the safety (device heating), device visualization, and procedural feasibility of 3T MRI-guided cardiovascular catheterization using a novel MRI-visible glass-fiber epoxy-based guidewire in phantoms and porcine models. METHODS To evaluate device safety, guidewire tip heating (GTH) was measured in phantom experiments with different combinations of catheters and guidewires. In vivo cardiovascular catheterization procedures were performed in both healthy (N = 5) and infarcted (N = 5) porcine models under real-time 3T MRI guidance using a glass-fiber epoxy-based guidewire. The times for each procedural step were recorded separately. Guidewire visualization was assessed by measuring the dimensions of the guidewire-induced signal void and contrast-to-noise ratio (CNR) between the guidewire tip signal void and the blood signal in real-time gradient-echo MRI (specific absorption rate [SAR] = 0.04 W/kg). RESULTS In the phantom experiments, GTH did not exceed 0.35°C when using the real-time gradient-echo sequence (SAR = 0.04 W/kg), demonstrating the safety of the glass-fiber epoxy-based guidewire at 3T. The catheter was successfully placed in the left ventricle (LV) under real-time MRI for all five healthy subjects and three out of five infarcted subjects. Signal void dimensions and CNR values showed consistent visualization of the glass-fiber epoxy-based guidewire in real-time MRI. The average time (minutes:seconds) for the catheterization procedure in all subjects was 4:32, although the procedure time varied depending on the subject's specific anatomy (standard deviation = 4:41). CONCLUSIONS Real-time 3T MRI-guided cardiovascular catheterization using a new MRI-visible glass-fiber epoxy-based guidewire is feasible in terms of visualization and guidewire navigation, and safe in terms of radiofrequency-induced guidewire tip heating.
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Zampi JD, Whiteside W. Innovative interventional catheterization techniques for congenital heart disease. Transl Pediatr 2018; 7:104-119. [PMID: 29770292 PMCID: PMC5938250 DOI: 10.21037/tp.2017.12.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/01/2017] [Indexed: 11/06/2022] Open
Abstract
Since 1929, when the first cardiac catheterization was safely performed in a human by Dr. Werner Forssmann (on himself), there has been a rapid progression of cardiac catheterization techniques and technologies. Today, these advances allow us to treat a wide variety of patients with congenital heart disease using minimally invasive techniques; from fetus to infants to adults, and from simple to complex congenital cardiac lesions. In this article, we will explore some of the exciting advances in cardiac catheterization for the treatment of congenital heart disease, including transcatheter valve implantation, hybrid procedures, biodegradable technologies, and magnetic resonance imaging (MRI)-guided catheterization. Additionally, we will discuss innovations in imaging in the catheterization laboratory, including 3D rotational angiography (3DRA), fusion imaging, and 3D printing, which help to make innovative interventional approaches possible.
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Affiliation(s)
- Jeffrey D Zampi
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Wendy Whiteside
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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16
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Kenny D. Interventional Cardiology for Congenital Heart Disease. Korean Circ J 2018; 48:350-364. [PMID: 29671282 PMCID: PMC5940641 DOI: 10.4070/kcj.2018.0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien Kenny
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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17
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Sizarov A, Raimondi F, Bonnet D, Boudjemline Y. Cardiovascular anatomy in children with bidirectional Glenn anastomosis, regarding the transcatheter Fontan completion. Arch Cardiovasc Dis 2017; 111:257-269. [PMID: 29146107 DOI: 10.1016/j.acvd.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/14/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transcatheter stent-secured completion of total cavopulmonary connection (TCPC) after surgical preparations during the Glenn anastomosis procedure has been reported, but complications from this approach have precluded its clinical acceptance. AIMS To analyse cardiovascular morphology and dimensions in children with bidirectional Glenn anastomosis, regarding the optimal device design for transcatheter Fontan completion without special surgical "preconditionings". METHODS We retrospectively analysed 60 thoracic computed tomography and magnetic resonance angiograms performed in patients with a median age of 4.1 years (range: 1.8-17.1 years). Additionally, we simulated TCPC completion using different intra-atrial stent-grafts in a three-dimensional model of the representative anatomy, and performed calculations to determine the optimal stent-graft dimensions, using measured distances. RESULTS Two types of cardiovascular arrangement were identified: left atrium interposing between the right pulmonary artery (RPA) and inferior vena cava, with the right upper pulmonary vein (RUPV) orifice close to the intercaval axis (65%); and intercaval axis traversing only the right(-sided) atrial cavity, with the RUPV located posterior to the atrial wall (35%). In the total population, the shortest median RPA-to-atrial wall distance was 1.9mm (range: 0.6-13.8mm), while the mean intra-atrial distance along the intercaval axis was 50.1±11.2mm. Regardless of the arrangement, 83% of all patients required a deviation of at least 5.9±2.4mm (range: 1.2-12.7mm) of the stent-graft centre at the RUPV level anteriorly to the intercaval axis to avoid covering or compressing this vein. Fixing the anterior deviation of the curved stent-graft centre at 10mm significantly decreased the range of bend angle per every given RUPV-RPA distance. CONCLUSIONS For both types of cardiovascular arrangement, after conventional bidirectional Glenn anastomosis, the intra-atrial curved stent-graft seemed most suitable for achieving uncomplicated TCPC completion percutaneously without previous surgical "preconditionings" in the majority of children. Experimental study is necessary to validate this conclusion.
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Affiliation(s)
- Aleksander Sizarov
- Service de cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes - M3C, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France
| | - Francesca Raimondi
- Service de cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes - M3C, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Service de radiologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - Damien Bonnet
- Service de cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes - M3C, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris V Descartes, 75006 Paris, France
| | - Younes Boudjemline
- Service de cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes - M3C, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris V Descartes, 75006 Paris, France.
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Campbell-Washburn AE, Tavallaei MA, Pop M, Grant EK, Chubb H, Rhode K, Wright GA. Real-time MRI guidance of cardiac interventions. J Magn Reson Imaging 2017; 46:935-950. [PMID: 28493526 PMCID: PMC5675556 DOI: 10.1002/jmri.25749] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is appealing to guide complex cardiac procedures because it is ionizing radiation-free and offers flexible soft-tissue contrast. Interventional cardiac MR promises to improve existing procedures and enable new ones for complex arrhythmias, as well as congenital and structural heart disease. Guiding invasive procedures demands faster image acquisition, reconstruction and analysis, as well as intuitive intraprocedural display of imaging data. Standard cardiac MR techniques such as 3D anatomical imaging, cardiac function and flow, parameter mapping, and late-gadolinium enhancement can be used to gather valuable clinical data at various procedural stages. Rapid intraprocedural image analysis can extract and highlight critical information about interventional targets and outcomes. In some cases, real-time interactive imaging is used to provide a continuous stream of images displayed to interventionalists for dynamic device navigation. Alternatively, devices are navigated relative to a roadmap of major cardiac structures generated through fast segmentation and registration. Interventional devices can be visualized and tracked throughout a procedure with specialized imaging methods. In a clinical setting, advanced imaging must be integrated with other clinical tools and patient data. In order to perform these complex procedures, interventional cardiac MR relies on customized equipment, such as interactive imaging environments, in-room image display, audio communication, hemodynamic monitoring and recording systems, and electroanatomical mapping and ablation systems. Operating in this sophisticated environment requires coordination and planning. This review provides an overview of the imaging technology used in MRI-guided cardiac interventions. Specifically, this review outlines clinical targets, standard image acquisition and analysis tools, and the integration of these tools into clinical workflow. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:935-950.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Laboratory of Imaging Technology, Biochemistry and Biophysics Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohammad A Tavallaei
- Physical Sciences Platform and Schulich Heart Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mihaela Pop
- Physical Sciences Platform and Schulich Heart Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Elena K Grant
- Laboratory of Imaging Technology, Biochemistry and Biophysics Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Kawal Rhode
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Graham A Wright
- Physical Sciences Platform and Schulich Heart Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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19
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First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis. J Am Coll Cardiol 2017; 70:745-752. [PMID: 28774381 DOI: 10.1016/j.jacc.2017.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive. OBJECTIVES The authors sought to show the feasibility of catheter-only, closed-chest, large-vessel anastomosis (superior vena cava and pulmonary artery [PA] or bidirectional Glenn operation equivalent) in a patient. METHODS In preclinical testing over a decade, the authors developed the techniques and technology needed for nonsurgical crossing from a donor (superior vena cava) to a recipient (PA) vessel and endovascular stent-based anastomosis of those blood vessels. The authors undertook this transcatheter approach for an adult with untreated congenital heart disease with severe cyanosis and significant surgical risk. They rehearsed the procedure step by step using contrast-enhanced cardiac computed tomography and a patient-specific 3-dimensional printed heart model. RESULTS The authors describe a first-in-human, fully percutaneous superior cavopulmonary anastomosis (bidirectional Glenn operation equivalent). The patient, a 35-year-old woman, was homebound due to dyspnea and worsening cyanosis. She was diagnosed with functional single ventricle and very limited pulmonary blood flow. The heart team believed surgical palliation conferred high operative risk due to the patient's complete condition. With the percutaneous procedure, the patient recovered uneventfully and remained improved clinically after 6 months. CONCLUSIONS This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease.
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20
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Sizarov A, Raimondi F, Bonnet D, Boudjemline Y. Vascular anatomy in children with univentricular hearts regarding transcatheter bidirectional Glenn anastomosis. Arch Cardiovasc Dis 2017; 110:223-233. [DOI: 10.1016/j.acvd.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/27/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
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Kenny DP, Hijazi ZM. Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res 2017; 120:1015-1026. [DOI: 10.1161/circresaha.116.309185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth. Data collection tools are emerging but remain behind adult cardiology and cardiac surgery and leading to partial blindness as to the longer-term consequences of our interventions. Tail coating on the back of developments in other fields of adult intervention will soon fail to meet the expanding needs for more precise interventions and biological materials. Increasing collaboration with surgical colleagues will require development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure that children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia, and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien P. Kenny
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M. Hijazi
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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22
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Kraitchman DL, Kramer CM. Interventions in Complex Congenital Heart Disease. JACC Cardiovasc Interv 2016; 9:971-2. [DOI: 10.1016/j.jcin.2016.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
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