title: Magnetic resonance image-guided trans-septal puncture in a swine heart.
abstract: OBJECTIVE
  To test the feasibility of performing magnetic resonance (MR)-guided trans-septal punctures in the swine heart.
  
  
  METHODS
  All procedures were performed in a 1.5-T MR scanner. A novel, active MR intravascular needle system was utilized for needle tracking and septal punctures. Trans-septal punctures were performed in five swine using electrocardiogram (ECG)-gated high resolution and non-ECG-gated, real-time MR imaging techniques. The intravascular needle was advanced over a guidewire from the femoral vein. Once the needle was in proper position, trans-septal punctures were made.
  
  
  RESULTS
  Active tracking of the needle traversing the septum was possible. The location of the catheter tip was confirmed using real time gradient recalled echo (GRE). After a confirmatory ventriculogram with gadolinium-DTPA, a 0.014-inch guidewire was advanced into the left atrium and left ventricle. All punctures were made with no change in cardiac rhythm or rate; postmortem analysis was performed on all animals and demonstrated that 18/19 (95%) punctures were directly through the fossa ovalis.
  
  
  CONCLUSIONS
  Using only MR guidance and a novel active intravascular needle system, we were able to repeatedly puncture the fossa ovalis in a swine heart from a transfemoral approach, with direct visualization of all components, including the needle, the atria, the fossa ovalis, and the surrounding vasculature.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. aarepal@jhmi.edu
authors.forename: Aravind
authors.initials: A
authors.lastname: Arepally
authors.forename: Parag V
authors.initials: PV
authors.lastname: Karmarkar
authors.forename: Clifford
authors.initials: C
authors.lastname: Weiss
authors.forename: E Rene
authors.initials: ER
authors.lastname: Rodriguez
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.forename: Ergin
authors.initials: E
authors.lastname: Atalar
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods; D006346:Heart Septum / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation; D011677:Punctures / Q000379:methods*; D013552:Swine