MRI for Guided Right and Left Heart Cardiac Catheterization: A Prospective Study in Congenital Heart Disease

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Abstract

Background

Improvements in outcomes for patients with congenital heart disease (CHD) have increased the need for diagnostic and interventional procedures. Cumulative radiation risk is a growing concern. MRI‐guided interventions are a promising ionizing radiation‐free, alternative approach.

Purpose

To assess the feasibility of MRI‐guided catheterization in young patients with CHD using advanced visualization passive tracking techniques.

Study Type

Prospective.

Population

A total of 30 patients with CHD referred for MRI‐guided catheterization and pulmonary vascular resistance analysis (median age/weight: 4 years / 15 kg).

Field Strength/Sequence

1.5T; partially saturated (pSAT) real‐time single‐shot balanced steady‐state free‐precession (bSSFP) sequence.

Assessment

Images were visualized by a single viewer on the scanner console (interactive mode) or using a commercially available advanced visualization platform (iSuite, Philips). Image quality for anatomy and catheter visualization was evaluated by three cardiologists with >5 years' experience in MRI‐catheterization using a 1–5 scale (1, poor, 5, excellent). Catheter balloon signal‐to‐noise ratio (SNR), blood and myocardium SNR, catheter balloon/blood contrast‐to‐noise ratio (CNR), balloon/myocardium CNR, and blood/myocardium CNR were measured. Procedure findings, feasibility, and adverse events were recorded. A fraction of time in which the catheter was visible was compared between iSuite and the interactive mode.

Statistical Tests

T‐test for numerical variables. Wilcoxon signed rank test for categorical variables.

Results

Nine patients had right heart catheterization, 11 had both left and right heart catheterization, and 10 had single ventricle circulation. Nine patients underwent solely MRI‐guided catheterization. The mean score for anatomical visualization and contrast between balloon tip and soft tissue was 3.9 ± 0.9 and 4.5 ± 0.7, respectively. iSuite provided a significant improvement in the time during which the balloon was visible in relation to interactive imaging mode (66 ± 17% vs. 46 ± 14%, P < 0.05).

Data Conclusion

MRI‐guided catheterizations were carried out safely and is feasible in children and adults with CHD. The pSAT sequence offered robust and simultaneous high contrast visualization of the catheter and cardiac anatomy.

Level of Evidence

Technical Efficacy Stage

Related collections

Most cited references 22

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Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010.

Ariane J Marelli, Raluca Ionescu-Ittu, Andrew S Mackie … (2014)

Our objective was to obtain contemporary lifetime estimates of congenital heart disease (CHD) prevalence using population-based data sources up to year 2010.

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Changing Landscape of Congenital Heart Disease.

Berto J. Bouma, Barbara Mulder (2017)

Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged. However, a large range of complications raised at the horizon as arrhythmias, endocarditis, pulmonary hypertension, and heart failure, and the need for additional treatment became clear. Technical solutions were sought in perfection and creation of new surgical techniques by developing catheter-based interventions, with elimination of open heart surgery and new electronic devices enabling, for example, multisite pacing and implantation of internal cardiac defibrillators to prevent sudden death. Over time, many pharmaceutical studies were conducted, changing clinical treatment slowly toward evidence-based care, although results were often limited by low numbers and clinical heterogeneity. More attention has been given to secondary issues like sports participation, pregnancy, work, and social-related difficulties. The relevance of these issues was already recognized in the 1970s when the need for specialized centers with multidisciplinary teams was proclaimed. Finally, research has become incorporated in care. Results of intervention studies and registries increased the knowledge on epidemiology of adults with congenital heart disease and their complications during life, and at the end, several guidelines became easily accessible, guiding physicians to deliver care appropriately. Over the past decades, the landscape of adult congenital heart disease has changed dramatically, which has to be continued in the future.

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Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease.

Ilenia Foffa, Eliseo Vano, Lamia Ait Ali … (2010)

The seventh Committee on "Biological Effects of Ionizing Radiation" (BEIR VII, 2006) underlines "the need of studies of infants who are exposed to diagnostic radiation because catheters have been placed in their hearts". To determine the lifetime attributable risk (LAR) of cancer associated with the estimated cumulative radiological dose in 59 children (42 male, age 2.8+/-3.2 years) with complex congenital heart disease, and to assess chromosomal DNA damage after cardiac catheterisation procedures. Methods In all patients, the cumulative exposure was estimated as effective dose in milliSievert (mSv), and LAR cancer was determined from the BEIR VII report. In a subset of 18 patients (13 male, age 5.2+/-5.7 years) micronucleus as a biomarker of DNA damage and long-term risk predictor of cancer was assayed before and 2 h after catheterisation procedures. Dose-area product (Gy cm(2)) was assessed as a measure of patient dose. The median life time cumulative effective dose was 7.7 mSv per patient (range 4.6-41.2). Cardiac catheterisation procedures and CT were responsible for 95% of the total effective dose. For a 1-year-old child, the LAR cancer was 1 in 382 (25th to 75th centiles: 1 in 531 to 1 in 187) and 1 in 156 (25th to 75th centiles: 1 in 239 to 1 in 83) for male and female patients, respectively. Median micronucleus values increased significantly after the procedure in comparison with baseline (before 6 per thousand vs after 9 per thousand, p=0.02). The median dose-area product value was 20 Gy cm(2) (range 1-277). Children with congenital heart disease are exposed to a significant cumulative dose. Indirect cancer risk estimations and direct DNA data both emphasise the need for strict radiation dose optimisation in children.

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Author and article information

Contributors

Mari Nieves Velasco Forte:

ORCID: https://orcid.org/0000-0003-1830-5673

mnieves.velasco@kcl.ac.uk

Journal

Journal ID (nlm-ta): J Magn Reson Imaging

Journal ID (iso-abbrev): J Magn Reson Imaging

Journal ID (doi): 10.1002/(ISSN)1522-2586

Journal ID (publisher-id): JMRI

Title: Journal of Magnetic Resonance Imaging

Publisher: John Wiley & Sons, Inc. (Hoboken, USA )

ISSN (Print): 1053-1807

ISSN (Electronic): 1522-2586

Publication date (Electronic): 06 November 2020

Publication date (Print): May 2021

Volume: 53

Issue: 5 ( doiID: 10.1002/jmri.v53.5 )

Pages: 1446-1457

Affiliations

[ ¹ ] School of Biomedical Engineering and Imaging Sciences King's College London London UK

[ ² ] Department of Congenital Heart Disease Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust London UK

[ ³ ] Cardiovascular Pathology Unit Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville Seville Spain

[ ⁴ ] Department of Medical Physics Guy's and St. Thomas' NHS Foundation Trust London UK

[ ⁵ ] Philips Research Europe Hamburg Germany

[ ⁶ ] Department of Pediatrics UT Southwestern Medical Center Dallas Texas USA

Author notes

[*] [* ] Address reprint requests to: M.N.V.F., 3rd Floor Lambeth Wing St Thomas' Hospital Westminster Bridge Road, London SE1 7EH, UK. E‐mail: mnieves.velasco@ 123456kcl.ac.uk

Author information

Mari Nieves Velasco Forte https://orcid.org/0000-0003-1830-5673

Article

Publisher ID: JMRI27426

DOI: 10.1002/jmri.27426

PMC ID: 8247035

PubMed ID: 33155758

SO-VID: 4b231a20-4580-46b4-8542-1f0b7dc0af17

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 18 October 2020

Date received : 17 August 2020

Date accepted : 19 October 2020

Page count

Figures: 6, Tables: 2, Pages: 12, Words: 6690

Funding

Funded by: British Heart Foundation , open-funder-registry 10.13039/501100000274;

Award ID: PG/19/11/34243

Funded by: National Institute for Health Research , open-funder-registry 10.13039/501100000272;

Award ID: MRJKAGR

Funded by: Welcome Engineering and Physical Sciences Research Council

Award ID: WT 203148/Z/16/Z

Custom metadata

source-schema-version-number 2.0

cover-date May 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:01.07.2021

ScienceOpen disciplines: Radiology & Imaging

Keywords: congenital heart disease,cardiac catheterization,interventional mr,passive tracking

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: congenital heart disease, cardiac catheterization, interventional mr, passive tracking

MRI for Guided Right and Left Heart Cardiac Catheterization: A Prospective Study in Congenital Heart Disease

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Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Level of Evidence

Technical Efficacy Stage

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 22

Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010.

Changing Landscape of Congenital Heart Disease.

Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease.

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Funding

Categories

Custom metadata

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