Radiation-free CMR diagnostic heart catheterization in children

Abstract

BackgroundChildren with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety.MethodsWe performed 50 CMR fluoroscopy guided comprehensive transfemoral right heart catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac catheterization. CMR guided catheterizations were assessed by completion (success/failure), procedure time, and safety events (catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected.ResultsDuring a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular heart disease 3%, and other 3%. Radiation-free CMR guided right heart catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left heart catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy heart catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested.ConclusionsComprehensive CMR fluoroscopy guided right heart catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left heart) cardiac catheterization and future CMR guided cardiac intervention.Trial registrationClinicalTrials.gov NCT02739087 registered February 17, 2016Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0374-2) contains supplementary material, which is available to authorized users.

X‐ray fused with MRI guidance of pre‐selected transcatheter congenital heart disease interventions

“…Pre‐catheterization CMR was performed immediately before the elective cardiac catheterization case in our combined interventional CMR (iCMR) suite . Sedation level for CMR was assessed and instituted by anesthesiology as per clinical standard.…”

“…Pre-catheterization CMR was performed immediately before the elective cardiac catheterization case in our combined interventional CMR (iCMR) suite. 7 8 The MRA and 3DSSFP images were inspected for overall quality as well as quality of the region of interest, and the optimal 3D dataset was segmented and used to create the XFM overlay.…”

Innovative interventional catheterization techniques for congenital heart disease

“…In their patients, CMR-guided catheterization has now become the preferred modality for adult patients referred for a right heart catheterization. They have since published on 50 radiation-free transfemoral CMR-guided right heart catheterizations in children (78). All catheterizations were successful with no complications, and given the short procedure time with a realistic workflow, they hope to be able to offer this technology routinely in the pediatric population in the near future (78).…”

Anesthetic considerations for magnetic resonance imaging‐guided right‐heart catheterization in pediatric patients: A single institution experience

“…MRI-guided cardiac catheterization, an alternative to conventional xray-guided catheterization, has been successfully performed in the adult and pediatric population. [8][9][10][11] In addition to standard pressure measurements, the MRI hybrid technique allows volumetric analysis of cardiac function and MRI flow measurements of stroke volume and cardiac output. Furthermore, this technique takes into account intracardiac shunts and, therefore, is more precise.…”