title: Antegrade percutaneous closure of membranous ventricular septal defect using X-ray fused with magnetic resonance imaging.
abstract: OBJECTIVE
  We hypothesized that X-ray fused with magnetic resonance imaging (XFM) roadmaps might permit direct antegrade crossing and delivery of a ventricular septal defect (VSD) closure device and thereby reduce procedure time and radiation exposure.
  
  
  BACKGROUND
  Percutaneous device closure of membranous VSD is cumbersome and time-consuming. The procedure requires crossing the defect retrograde, snaring and exteriorizing a guidewire to form an arteriovenous loop, then delivering antegrade a sheath and closure device.
  
  
  METHODS
  Magnetic resonance imaging roadmaps of cardiac structures were obtained from miniature swine with spontaneous VSD and registered with live X-ray using external fiducial markers. We compared antegrade XFM-guided VSD crossing with conventional retrograde X-ray-guided crossing for repair.
  
  
  RESULTS
  Antegrade XFM crossing was successful in all animals. Compared with retrograde X-ray, antegrade XFM was associated with shorter time to crossing (167 +/- 103 s vs. 284 +/- 61 s; p = 0.025), shorter time to sheath delivery (71 +/- 32 s vs. 366 +/- 145 s; p = 0.001), shorter fluoroscopy time (158 +/- 95 s vs. 390 +/- 137 s; p = 0.003), and reduced radiation dose-area product (2,394 +/- 1,522 mG.m(2) vs. 4,865 +/- 1,759 mG.m(2); p = 0.016).
  
  
  CONCLUSIONS
  XFM facilitates antegrade access to membranous VSD from the right ventricle in swine. The simplified procedure is faster and reduces radiation exposure compared with the conventional retrograde approach.
authors.affiliation: Translational Medicine Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1538, USA.
authors.forename: Kanishka
authors.initials: K
authors.lastname: Ratnayaka
authors.forename: Venkatesh K
authors.initials: VK
authors.lastname: Raman
authors.forename: Anthony Z
authors.initials: AZ
authors.lastname: Faranesh
authors.forename: Merdim
authors.initials: M
authors.lastname: Sonmez
authors.forename: June-Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Luis F
authors.initials: LF
authors.lastname: Gutiérrez
authors.forename: Cengizhan
authors.initials: C
authors.lastname: Ozturk
authors.forename: Elliot R
authors.initials: ER
authors.lastname: McVeigh
authors.forename: Michael C
authors.initials: MC
authors.lastname: Slack
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D013552:Swine; D013997:Time Factors