ORAL PRESENTATION Open Access MR guided right heart ...
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ORAL PRESENTATION Open Access MR guided right heart catheterization - the NIH experience Toby Rogers 1* , Kanishka Ratnayaka 1,2 , Annette Stine 1 , Laurie Grant 1 , William Schenke 1 , Jonathan R Mazal 1 , Michael Hansen 1 , Anthony Z Faranesh 1 , Robert J Lederman 1 From 18th Annual SCMR Scientific Sessions Nice, France. 4-7 February 2015 Background Realtime MR enables radiation free guidance for right heart catheterization (RHC). In addition to catheter navigation for sampling of invasive pressures and blood oxygen saturations, MR permits concomitant assessment of cardiac chamber volumes and cardiac output with phase contrast flow measurements. By performing repeat measurements under different physiological pro- vocations (e.g. saline volume challenge, inhaled nitric oxide, or exercise), diagnostic yield increases by reveal- ing symptoms and pathologic findings not apparent at rest. Herein we present the NIH experience of MR RHC to date. Methods All consecutive patients referred for invasive left or right heart catheterization at our institution were invited to undergo MR RHC unless a clear contraindication was present. Informed consent was obtained. Vascular access was obtained outside the MR room and patients were transferred into the MR bore (Figure 1). After baseline MR scanning, a gadolinium-filled balloon-tip end hole catheter was navigated through the right heart under realtime MR guidance (Figure 2). Measurements were repeated under physiological provocation with saline challenge or inhaled nitric oxide in latter patients. Results 79 patients consented and, after exclusions, 72 patients underwent MR RHC. Median age was 56yrs (range 26-83 yrs) and 51% were female. RHC was completed with MR guidance only in 96% of patients. Only 3/72 required a guidewire and X-ray guidance to complete the procedure, all of which occurred early in our experi- ence. Median procedure time from sheath entry to exit was 26min (range 11-63min). There was a definite learning curve, which permitted completion of repeated measurements under additional physiological provoca- tion with a small increase on total procedure time (mean procedure time 23min vs. 38min, for the first 36 vs. the last 36 patients respectively). No serious compli- cations occurred in any patient. Conclusions We have demonstrated that a comprehensive RHC can be performed under MR guidance in almost all patients without the need for additional X-ray imaging. Furthermore, with procedural streamlining, it is possi- ble to perform a comprehensive baseline examination followed by repeat measurements under physiological provocation in under 40min. Superior clinical informa- tion is obtained and as a result, MR RHC has been reclassified as a standard clinical procedure at our institution. Funding This work was supported by the Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health (Z01-HL005062). 1 National Heart Lung and Blood Institute, National Institues of Health, Bethesda, MD, USA Full list of author information is available at the end of the article Rogers et al. Journal of Cardiovascular Magnetic Resonance 2015, 17(Suppl 1):O20 http://www.jcmr-online.com/content/17/S1/O20 © 2015 Rogers et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Transcript of ORAL PRESENTATION Open Access MR guided right heart ...
ORAL PRESENTATION Open Access
MR guided right heart catheterization - the NIHexperienceToby Rogers1*, Kanishka Ratnayaka1,2, Annette Stine1, Laurie Grant1, William Schenke1, Jonathan R Mazal1,Michael Hansen1, Anthony Z Faranesh1, Robert J Lederman1
From 18th Annual SCMR Scientific SessionsNice, France. 4-7 February 2015
BackgroundRealtime MR enables radiation free guidance for rightheart catheterization (RHC). In addition to catheternavigation for sampling of invasive pressures and bloodoxygen saturations, MR permits concomitant assessmentof cardiac chamber volumes and cardiac output withphase contrast flow measurements. By performingrepeat measurements under different physiological pro-vocations (e.g. saline volume challenge, inhaled nitricoxide, or exercise), diagnostic yield increases by reveal-ing symptoms and pathologic findings not apparent atrest. Herein we present the NIH experience of MR RHCto date.
MethodsAll consecutive patients referred for invasive left or rightheart catheterization at our institution were invited toundergo MR RHC unless a clear contraindication waspresent. Informed consent was obtained. Vascular accesswas obtained outside the MR room and patients weretransferred into the MR bore (Figure 1). After baselineMR scanning, a gadolinium-filled balloon-tip end holecatheter was navigated through the right heart underrealtime MR guidance (Figure 2). Measurements wererepeated under physiological provocation with salinechallenge or inhaled nitric oxide in latter patients.
Results79 patients consented and, after exclusions, 72 patientsunderwent MR RHC. Median age was 56yrs (range
26-83 yrs) and 51% were female. RHC was completedwith MR guidance only in 96% of patients. Only 3/72required a guidewire and X-ray guidance to completethe procedure, all of which occurred early in our experi-ence. Median procedure time from sheath entry to exitwas 26min (range 11-63min). There was a definitelearning curve, which permitted completion of repeatedmeasurements under additional physiological provoca-tion with a small increase on total procedure time(mean procedure time 23min vs. 38min, for the first 36vs. the last 36 patients respectively). No serious compli-cations occurred in any patient.
ConclusionsWe have demonstrated that a comprehensive RHC canbe performed under MR guidance in almost allpatients without the need for additional X-ray imaging.Furthermore, with procedural streamlining, it is possi-ble to perform a comprehensive baseline examinationfollowed by repeat measurements under physiologicalprovocation in under 40min. Superior clinical informa-tion is obtained and as a result, MR RHC has beenreclassified as a standard clinical procedure at ourinstitution.
FundingThis work was supported by the Division of IntramuralResearch, National Heart Lung and Blood Institute,National Institutes of Health (Z01-HL005062).
1National Heart Lung and Blood Institute, National Institues of Health,Bethesda, MD, USAFull list of author information is available at the end of the article
Rogers et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):O20http://www.jcmr-online.com/content/17/S1/O20
© 2015 Rogers et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Figure 1 (A) If required X-ray coronary angiography is performed before MR RHC. (B) The patient is transferred to MRI maintaining sterility of thefield. (C) View from X-ray into the MR room. (D) MR RHC performed from the femoral vein. Images are projected onto a screen for the operator.Noise-suppression headsets are used for communication between staff and with the patient.
Figure 2 Gadolinium-filled balloon at the tip of the catheter (arrow) in the (A) inferior vena cava, (B) superior vena cava, (C) right ventricle, (D)right pulmonary artery.
Rogers et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):O20http://www.jcmr-online.com/content/17/S1/O20
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Authors’ details1National Heart Lung and Blood Institute, National Institues of Health,Bethesda, MD, USA. 2Department of Cardiology, Children’s National MedicalCenter, Washington, DC, USA.
Published: 3 February 2015
doi:10.1186/1532-429X-17-S1-O20Cite this article as: Rogers et al.: MR guided right heart catheterization -the NIH experience. Journal of Cardiovascular Magnetic Resonance 2015 17(Suppl 1):O20.
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Rogers et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):O20http://www.jcmr-online.com/content/17/S1/O20
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