Innovative interventional catheterization techniques for congenital heart disease

Zampi, Jeffrey D.; Whiteside, Wendy

doi:10.21037/tp.2017.12.02

Cited by 9 publications

(11 citation statements)

References 117 publications

(122 reference statements)

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“…Real-time magnetic resonance imaging (MRI) provides excellent soft-tissue contrast without radiation exposure [1], and is emerging as a promising alternative to X-ray fluoroscopy for intra-procedural guidance of cardiovascular catheterization [2][3][4] and closed chest percutaneous interventions [5]. MRI-guided catheterization has been carried out using MRI-visible markers on the catheters' tip [6,7] or by inflating the balloon at the catheter tip by air, gadolinium [8][9][10], or carbon dioxide [11,12]. However, during catheterization procedures, the absence of a guidewire may result in procedure difficulties and failure [8].…”

Section: Introductionmentioning

confidence: 99%

Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire

Perotti

Martinez

et al. 2020

PLoS ONE

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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 contrastto-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 gradientecho 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

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Section: Introductionmentioning

confidence: 99%

Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire

Perotti

Martinez

et al. 2020

PLoS ONE

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“…Traditional echocardiography demonstrates cardiac anatomy in two-dimensional (2D) planes, thereby limiting one's ability to fully visualize complex intracardiac structures and spatial relationships. While three-dimensional (3D) printing has been in use since the 1980s, recent application of this technique to the field of CHD has aided in both diagnosis of cardiac defects and pre-procedural planning, and has been shown to be particularly beneficial in guiding treatment of patients with more complex intracardiac anatomy [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

“…3D models have the potential to provide additional anatomic insight and can be used to mimic device or stent implantations prior to the procedure. This is particularly useful for interventional cardiac procedures, as 3D models can be used to ascertain optimal shape and size of the device, understand how the device will fit into a specified location, and simulate the procedure in order to determine the optimal approach [1,2] . These models also enable proceduralists to perform entire procedures beforehand, thereby providing a means to anticipate complications, reduce radiation exposure, and potentially improve patient outcomes [5] .…”

Section: Introductionmentioning

confidence: 99%

3D printing applications for percutaneous structural interventions in congenital heart disease

Tredway¹,

Pasumarti²,

Crystal³

et al. 2020

Mini-invasive Surg

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The past several decades have seen remarkable advancements in percutaneous interventions for treatment of congenital heart disease (CHD). These advancements have been significantly aided by improvements in noninvasive diagnostic imaging. The use of three-dimensional (3D) printed models for planning and simulation of catheter-based procedures has been demonstrated for numerous cardiac defects and has been shown to reduce complications, procedure times, and limit radiation exposure. This paper reviews the process by which patient-specific 3D cardiac models are produced, as well as numerous applications of these models for use in percutaneous interventions in CHD.

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“…There have been significant advances made in wire and balloon technology and in the development of percutaneously implantable occlusion devices and valves. In addition, advances in imaging technology allow magnetic resonance guided cardiac catheterization and 3D rotational angiography wherein 3D computerized tomographic images can be obtained with a standard C‐arm . Interventional catheterization techniques used alone and in conjunction with lesser surgical procedures have been developed to provide alternative treatment strategies for congenital cardiac lesions requiring complex surgical repairs.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, advances in imaging technology allow magnetic resonance guided cardiac catheterization and 3D rotational angiography wherein 3D computerized tomographic images can be obtained with a standard C-arm. 1,2 Interventional catheterization techniques used alone and in conjunction with lesser surgical procedures have been developed to provide alternative treatment strategies for congenital cardiac lesions requiring complex surgical repairs. For example, the "hybrid procedure" for hypoplastic left heart syndrome (HLHS) utilizes percutaneous ductus arteriosus stenting and surgical banding of the branch pulmonary arteries performed in the catheterization laboratory as an alternative to a Stage 1 (Norwood or Sano shunt) surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia for high‐risk procedures in the catheterization laboratory

Daaboul

DiNardo

Nasr

2019

Pediatric Anesthesia

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Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

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Innovative interventional catheterization techniques for congenital heart disease

Cited by 9 publications

References 117 publications

Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire

Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire

3D printing applications for percutaneous structural interventions in congenital heart disease

Anesthesia for high‐risk procedures in the catheterization laboratory

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