title: Magnetic Resonance Imaging-Guided Transcatheter Cavopulmonary Shunt.
abstract: The aim of this study was to test the hypothesis that real-time magnetic resonance imaging (MRI) would enable closed-chest percutaneous cavopulmonary anastomosis and shunt by facilitating needle guidance along a curvilinear trajectory, around critical structures, and between a superior vena cava "donor" vessel and a pulmonary artery "target."
  
  
  
  Children with single-ventricle physiology require multiple open heart operations for palliation, including sternotomies and cardiopulmonary bypass. The reduced morbidity of a catheter-based approach would be attractive.
  
  
  
  Fifteen naive swine underwent transcatheter cavopulmonary anastomosis and shunt creation under 1.5-T MRI guidance. An MRI antenna-needle was advanced from the superior vena cava into the target pulmonary artery bifurcation using real-time MRI guidance. In 10 animals, balloon-expanded off-the-shelf endografts secured a proximal end-to-end caval anastomosis and a distal end-to-side pulmonary anastomosis that preserved blood flow to both branch pulmonary arteries. In 5 animals, this was achieved with a novel, purpose-built, self-expanding device.
  
  
  
  Real-time MRI needle access of target vessels (pulmonary artery), endograft delivery, and superior vena cava shunt to pulmonary arteries were successful in all animals. All survived the procedure without complications. Intraprocedural real-time MRI, post-procedural MRI, x-ray angiography, computed tomography, and necropsy showed patent shunts with bidirectional pulmonary artery blood flow.
  
  
  
  MRI guidance enabled a complex, closed-chest, beating-heart, pediatric, transcatheter structural heart procedure. In this study, MRI guided trajectory planning and reproducible, reliable bidirectional cavopulmonary shunt creation.
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Division of Cardiology, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Kanishka
authors.initials: K
authors.lastname: Ratnayaka
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Toby
authors.initials: T
authors.lastname: Rogers
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: William H
authors.initials: WH
authors.lastname: Schenke
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Mazal
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Merdim
authors.initials: M
authors.lastname: Sonmez
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hansen
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kocaturk
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Anthony Z
authors.initials: AZ
authors.lastname: Faranesh
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland. Electronic address: lederman@nih.gov.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation; D062906:Cardiac Catheters; D005240:Feasibility Studies; D018610:Heart Bypass, Right / Q000295:instrumentation / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000295:instrumentation; D023421:Models, Animal; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D015607:Stents; D034421:Sus scrofa; D013997:Time Factors; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*
keywords: congenital heart disease; image-guided intervention; interventional MRI; real-time MRI; sutureless anastomosis; vascular shunt