title: Magnetic resonance-guided cardiac interventions using magnetic resonance-compatible devices: a preclinical study and first-in-man congenital interventions.
abstract: BACKGROUND
  Percutaneous cardiac interventions are currently performed under x-ray guidance. Magnetic resonance imaging (MRI) has been used to guide intravascular interventions in the past, but mainly in animals. Translation of MR-guided interventions into humans has been limited by the lack of MR-compatible and safe equipment, such as MR guide wires with mechanical characteristics similar to standard guide wires. The aim of the present study was to evaluate the safety and efficacy of a newly developed MR-safe and compatible passive guide wire in aiding MR-guided cardiac interventions in a swine model and describe the 2 first-in-man solely MR-guided interventions.
  
  
  RESULTS
  In the preclinical trial, the new MR-compatible wire aided the performance of 20 interventions in 5 swine. These consisted of balloon dilation of nondiseased pulmonary and aortic valves, aortic arch, and branch pulmonary arteries. After ethics and regulatory authority approval, the 2 first-in-man MR-guided interventions were performed in a child and an adult, both with elements of valvar pulmonary stenosis. Catheter manipulations were monitored with real-time MRI sequence with interactive modification of imaging plane and slice position. Temporal resolution was 11 to 12 frames/s. Catheterization procedure times were 110 and 80 minutes, respectively. Both patients had successful relief of the valvar stenosis and no procedural complications.
  
  
  CONCLUSIONS
  The described preclinical study and case reports are encouraging that with the availability of the new MR-compatible and safe guide wire, certain percutaneous cardiac interventions will become feasible to perform solely under MR guidance in the future. A clinical trial is underway in our institution.
authors.affiliation: King's College London BHF Centre, Division of Imaging Sciences, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Aphrodite
authors.initials: A
authors.lastname: Tzifa
authors.forename: Gabriele A
authors.initials: GA
authors.lastname: Krombach
authors.forename: Nils
authors.initials: N
authors.lastname: Krämer
authors.forename: Sascha
authors.initials: S
authors.lastname: Krüger
authors.forename: Adrian
authors.initials: A
authors.lastname: Schütte
authors.forename: Matthias
authors.initials: M
authors.lastname: von Walter
authors.forename: Tobias
authors.initials: T
authors.lastname: Schaeffter
authors.forename: Shakeel
authors.initials: S
authors.lastname: Qureshi
authors.forename: Thomas
authors.initials: T
authors.lastname: Krasemann
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Schwartz
authors.forename: Gopal
authors.initials: G
authors.lastname: Varma
authors.forename: Alexandra
authors.initials: A
authors.lastname: Buhl
authors.forename: Antonia
authors.initials: A
authors.lastname: Kohlmeier
authors.forename: Arno
authors.initials: A
authors.lastname: Bücker
authors.forename: Rolf W
authors.initials: RW
authors.lastname: Günther
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation*; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional / Q000295:instrumentation*; D011666:Pulmonary Valve Stenosis / Q000628:therapy*; D013552:Swine