Catheter-based endomyocardial injection with real-time magnetic resonance imaging.
BACKGROUND
We tested the feasibility of targeted left ventricular (LV) mural injection using real-time MRI (rtMRI).


RESULTS
A 1.5T MRI scanner was customized with a fast reconstruction engine, transfemoral guiding catheter-receiver coil (GCC), MRI-compatible needle, and tableside consoles. Commercial real-time imaging software was customized to facilitate catheter navigation and visualization of injections at 4 completely refreshed frames per second. The aorta was traversed and the left ventricular cavity was entered under direct rtMRI guidance. Pigs underwent multiple injections with dilute gadolinium-DTPA. All myocardial segments were readily accessed. The active GCC and the passive Stiletto needle injector were readily visualized. More than 50 endomyocardial injections were performed with the aid of rtMRI; 81% were successful with this first-generation prototype.


CONCLUSIONS
Percutaneous endomyocardial drug delivery is feasible with the aid of rtMRI, which permits precise 3-dimensional localization of injection within the LV wall.
Lederman
Robert J
RJ
Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md 20892-1061, USA. Lederman@nih.gov
Guttman
Michael A
MA
Peters
Dana C
DC
Thompson
Richard B
RB
Sorger
Jonathan M
JM
Dick
Alexander J
AJ
Raman
Venkatesh K
VK
McVeigh
Elliot R
ER
D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D005240:Feasibility Studies; D005263:Femoral Artery / Q000502:physiology; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006346:Heart Septum / Q000502:physiology; D007267:Injections; D019028:Magnetic Resonance Imaging, Cine / Q000295:instrumentation* / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013552:Swine; D016276:Ventricular Function
C103761:gadolinium-DTPA bis-glucosamide; D019786:Gadolinium DTPA