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

Abstract

Objectives To determine whether X‐ray fused with MRI (XFM) is beneficial for select transcatheter congenital heart disease interventions. Background Complex transcatheter interventions often require three‐dimensional (3D) soft tissue imaging guidance. Fusion imaging with live X‐ray fluoroscopy can potentially improve and simplify procedures. Methods Patients referred for select congenital heart disease interventions were prospectively enrolled. Cardiac MRI data was overlaid on live fluoroscopy for procedural guidance. Likert scale operator assessments of value were recorded. Fluoroscopy time, radiation exposure, contrast dose, and procedure time were compared to matched cases from our institutional experience. Results Forty‐six patients were enrolled. Pre‐catheterization, same day cardiac MRI findings indicated intervention should be deferred in nine patients. XFM‐guided cardiac catheterization was performed in 37 (median age 8.7 years [0.5–63 years]; median weight 28 kg [5.6–110 kg]) with the following prespecified indications: pulmonary artery (PA) stenosis (n = 13), aortic coarctation (n = 12), conduit stenosis/insufficiency (n = 9), and ventricular septal defect (n = 3). Diagnostic catheterization showed intervention was not indicated in 12 additional cases. XFM‐guided intervention was performed in the remaining 25. Fluoroscopy time was shorter for XFM‐guided intervention cases compared to matched controls. There was no significant difference in radiation dose area product, contrast volume, or procedure time. Operator Likert scores indicated XFM provided useful soft tissue guidance in all cases and was never misleading. Conclusions XFM provides operators with meaningful three‐dimensional soft tissue data and reduces fluoroscopy time in select congenital heart disease interventions.

MRI-Guided Cardiac Catheterization in Congenital Heart Disease: How to Get Started

“…Another starting point for iCMR programs is embracing 3D CMR-derived overlay. Ideally obtained immediately before same setting X-ray cardiac catheterization, CMR overlays directly onto live X-ray fluoroscopy serve as a roadmap with the potential to simplify complex transcatheter interventions, decrease radiation exposure/contrast burden/procedure time, add diagnostic value, increase operator confidence, and enable novel procedures [40][41][42][43].…”

Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives

“…Intracardiac electrograms were successfully recorded and simple programmed stimulation maneuvers were performed. In this case, commercially available MR-compatible catheters were used (Vision™, Imricor Medical 4 Atrial septal defect closure TRL 5 Ratnayaka et al, 29 Rickers et al 30 Cavopulmonary shunt TRL 5 Ratnayaka et al 31 Valvular procedures…”

“…Although X-ray fluoroscopy is the primary modality in cardiac interventions due to its widespread availability and good visualization of versatile catheters and interventional devices, which are commercially available, 8 use of CMR to guide procedures pre-, intra-, and postprocedurally is increasing because of its many advantages. 1 – 7 However, clinical translation is hindered by the lack of technological advancements in MR compatible equipment.…”

“…Use of cardiac magnetic resonance (CMR) has increased dramatically due to its many advantages. [1][2][3][4][5][6][7] CMR is the gold standard for quantifying heart chamber dimensions, volumes and ejection fraction due to its excellent temporal and spatial resolution. It provides soft tissue characterisation, perfusion imaging for detecting ischemia, and flow measurements for quantifying shunt volumes or valve regurgitation fractions.…”