title: Cardiac catheterisation guided by MRI in children and adults with congenital heart disease.
abstract: BACKGROUND
  Fluoroscopically guided cardiac catheterisation is an essential tool for diagnosis and treatment of congenital heart disease. Drawbacks include poor soft tissue visualisation and exposure to radiation. We describe the first 16 cases of a novel method of cardiac catheterisation guided by MRI with radiographic support.
  
  
  METHODS
  In our cardiac catheterisation laboratory, we combine magnetic resonance and radiographic imaging facilities. We used MRI to measure flow and morphology, and real-time MRI sequences to visualise balloon angiographic catheters. 12 patients underwent diagnostic cardiac catheterisation, two had interventional cardiac catheterisations, and for two patients, MRI was used to plan radiofrequency ablation for treatment of tachyarrhythmias.
  
  
  RESULTS
  In 14 patients, some or all of the cardiac catheterisation was guided by MRI. In two patients undergoing radiofrequency ablation, catheters were manipulated with use of fluoroscopic guidance and outcome was assessed with MRI. All patients received lower amounts of radiation than controls. There was some discrepancy between pulmonary vascular resistance calculated by flow derived from MRI and the traditional Fick method. We were able to superimpose fluoroscopic images of electro physiology electrode catheters on the three dimensional MRI of the cardiac anatomy.
  
  
  CONCLUSIONS
  We have shown that cardiac catheterisation guided by MRI is safe and practical in a clinical setting, allows better soft tissue visualisation, provides more pertinent physiological information, and results in lower radiation exposure than do fluoroscopically guided procedures. MRI guidance could become the method of choice for diagnostic cardiac catheterisation in patients with congenital heart disease, and an important tool in interventional cardiac catheterisation and radiofrequency ablation.
authors.affiliation: Cardiac Magnetic Resonance Research Group, Division of Imaging, King's College London, Thomas Guy House, London, UK. reza.razavi@kcl.ac.uk
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
authors.forename: Derek L G
authors.initials: DL
authors.lastname: Hill
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Keevil
authors.forename: Marc E
authors.initials: ME
authors.lastname: Miquel
authors.forename: Vivek
authors.initials: V
authors.lastname: Muthurangu
authors.forename: Sanjeet
authors.initials: S
authors.lastname: Hegde
authors.forename: Kawal
authors.initials: K
authors.lastname: Rhode
authors.forename: Michael
authors.initials: M
authors.lastname: Barnett
authors.forename: Joop
authors.initials: J
authors.lastname: van Vaals
authors.forename: David J
authors.initials: DJ
authors.lastname: Hawkes
authors.forename: Edward
authors.initials: E
authors.lastname: Baker
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000601:surgery; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation; D002404:Catheterization; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D015642:Radiology, Interventional / Q000379:methods