title: Real-time MRI-guided right heart catheterization in adults using passive catheters.
abstract: OBJECTIVE
  Real-time MRI creates images with superb tissue contrast that may enable radiation-free catheterization. Simple procedures are the first step towards novel interventional procedures. We aim to perform comprehensive transfemoral diagnostic right heart catheterization in an unselected cohort of patients entirely using MRI guidance.
  
  
  RESULTS
  We performed X-ray and MRI-guided transfemoral right heart catheterization in consecutive patients undergoing clinical cardiac catheterization. We sampled both cavae and both pulmonary arteries. We compared success rate, time to perform key steps, and catheter visibility among X-ray and MRI procedures using air-filled or gadolinium-filled balloon-tipped catheters. Sixteen subjects (four with shunt, nine with coronary artery disease, three with other) underwent paired X-ray and MRI catheterization. Complete guidewire-free catheterization was possible in 15 of 16 under both. MRI using gadolinium-filled balloons was at least as successful as X-ray in all procedure steps, more successful than MRI using air-filled balloons, and better than both in entering the left pulmonary artery. Total catheterization time and individual procedure steps required approximately the same amount of time irrespective of image guidance modality. Catheter conspicuity was best under X-ray and next-best using gadolinium-filled MRI balloons.
  
  
  CONCLUSIONS
  In this early experience, comprehensive transfemoral right heart catheterization appears feasible using only MRI for imaging guidance. Gadolinium-filled balloon catheters were more conspicuous than air-filled ones. Further workflow and device enhancement are necessary for clinical adoption.
authors.affiliation: Division of Intramural Research, Cardiovascular and Pulmonary Branch,  National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538,  USA.
authors.forename: Kanishka
authors.initials: K
authors.lastname: Ratnayaka
authors.forename: Anthony Z
authors.initials: AZ
authors.lastname: Faranesh
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hansen
authors.forename: Annette M
authors.initials: AM
authors.lastname: Stine
authors.forename: Majdi
authors.initials: M
authors.lastname: Halabi
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.forename: William H
authors.initials: WH
authors.lastname: Schenke
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Wright
authors.forename: Laurie P
authors.initials: LP
authors.lastname: Grant
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kocaturk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015641:Radiography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media; D005682:Gadolinium