title: Real-time cardiovascular magnetic resonance subxiphoid pericardial access and pericardiocentesis using off-the-shelf devices in swine.
abstract: BACKGROUND
  Needle access or drainage of pericardial effusion, especially when small, entails risk of bystander tissue injury or operator uncertainty about proposed trajectories. Cardiovascular magnetic resonance (CMR) might allow enhanced imaging guidance.
  
  
  RESULTS
  We used real-time CMR to guide subxiphoid pericardial access in naïve swine using commercial 18G titanium puncture needles, which were exchanged for pericardial catheters. To test the value of CMR needle pericardiocentesis, we also created intentional pericardial effusions of a range of volumes, via a separate transvenous-transatrial catheter. We performed these procedures in 12 animals.
  
  
  CONCLUSIONS
  CMR guided pericardiocentesis is attractive because the large field of view and soft tissue imaging depict global anatomic context in arbitrary planes, and allow the operator to plan trajectories that limit inadvertent bystander tissue injury. More important, CMR provides continuous visualization of the needle and target throughout the procedure. Using even passive needle devices, CMR enabled rapid pericardial needle access and drainage. We believe this experience supports clinical testing of real-time CMR guided needle access or drainage of the pericardial space. We suspect this would be especially helpful in "difficult" pericardial access, for example, in distorted thoracic anatomy or loculated effusion.
authors.forename: Majdi
authors.initials: M
authors.lastname: Halabi
authors.forename: Anthony Z
authors.initials: AZ
authors.lastname: Faranesh
authors.forename: William H
authors.initials: WH
authors.lastname: Schenke
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Wright
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hansen
authors.forename: Christina E
authors.initials: CE
authors.lastname: Saikus
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kocaturk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.forename: Kanishka
authors.initials: K
authors.lastname: Ratnayaka
mesh_terms: D000818:Animals; D057785:Catheters; D004195:Disease Models, Animal; D004867:Equipment Design; D006439:Hemodynamics; D053783:Magnetic Resonance Imaging, Interventional; D009339:Needles; D010490:Pericardial Effusion / Q000503:physiopathology / Q000628:therapy*; D020519:Pericardiocentesis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011677:Punctures; D013552:Swine; D013997:Time Factors