Antegrade percutaneous closure of membranous ventricular septal defect using X-ray fused with magnetic resonance imaging.
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.
Ratnayaka
Kanishka
K
Translational Medicine Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1538, USA.
Raman
Venkatesh K
VK
Faranesh
Anthony Z
AZ
Sonmez
Merdim
M
Kim
June-Hong
JH
Gutiérrez
Luis F
LF
Ozturk
Cengizhan
C
McVeigh
Elliot R
ER
Slack
Michael C
MC
Lederman
Robert J
RJ
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