This Article Full Text Full Text (PDF) All Versions of this Article: 113/8/1093    most recent CIRCULATIONAHA.105.578112v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Krueger, J. J. Articles by Kuehne, T. Search for Related Content PubMed PubMed Citation Articles by Krueger, J. J. Articles by Kuehne, T. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Angioplasty MRI Scans Hazardous Substances DB IRON Related Collections Cardiovascular imaging agents/Techniques Other Treatment CT and MRI Related Article

(Circulation. 2006;113:1093-1100.)
© 2006 American Heart Association, Inc.

Imaging

Magnetic Resonance Imaging–Guided Balloon Angioplasty of Coarctation of the Aorta

A Pilot Study

Julia J. Krueger, MD; Peter Ewert, MD; Sevim Yilmaz, MD; Dinah Gelernter, MD; Björn Peters, MD; Klaus Pietzner, MD; Axel Bornstedt, PhD; Bernhard Schnackenburg, PhD; Hashim Abdul-Khaliq, MD; Eckart Fleck, MD; Eike Nagel, MD; Felix Berger, MD; Titus Kuehne, MD

From the Departments of Congenital Heart Disease and Pediatric Cardiology (J.J.K., P.E., S.Y., D.G., B.P., K.P., H.A.-K., F.B., T.K.) and Cardiology (A.B., E.F., E.N.), Deutsches Herzzentrum Berlin, Berlin, Germany, and Clinical Science Philips (B.S.), Hamburg, Germany.

Correspondence to Titus Kuehne, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail kuehne{at}dhzb.de

Received July 25, 2005; revision received November 10, 2005; accepted November 14, 2005.

Background— MRI guidance of percutaneous transluminal balloon angioplasty (PTA) of aortic coarctation (CoA) would be desirable for continuous visualization of anatomy and to eliminate x-ray exposure. The aim of this study was (1) to determine the suitability of MRI-controlled PTA using the iron oxide–based contrast medium Resovist (ferucarbotran) for catheter visualization and (2) to subsequently apply this technique in a pilot study with patients with CoA.

Methods and Results— The MRI contrast-to-noise ratio and artifact behavior of Resovist-treated balloon catheters was optimized in in vitro and animal experiments (pigs). In 5 patients, anatomy of the CoA was evaluated before and after intervention with high-resolution respiratory-navigated 3D MRI and multiphase cine MRI. Position monitoring of Resovist-treated catheters was realized with interactive real-time MRI. Aortic pressures were continuously recorded. Conventional catheterization was performed before and after MRI to confirm interventional success. During MRI, catheters filled with 25 µmol of iron particles per milliliter of Resovist produced good signal contrast between catheters and their background anatomy but no image distortion due to susceptibility artifacts. All MRI procedures were performed successfully in the patient study. There was excellent agreement between the diameters of CoA and pressure gradients as measured during MRI and conventional catheterization. In 4 patients, PTA resulted in substantial widening of the CoA and a decrease in pressure gradients. In 1 patient, PTA was ineffective.

Conclusions— The MRI method described represents a potential alternative to conventional x-ray fluoroscopy for catheter-based treatment of patients with CoA.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 113: 1045. [Extract] [Full Text]

This article has been cited by other articles:

				B. Schmitt, P. Steendijk, K. Lunze, S. Ovroutski, J. Falkenberg, P. Rahmanzadeh, N. Maarouf, P. Ewert, F. Berger, and T. Kuehne Integrated Assessment of Diastolic and Systolic Ventricular Function Using Diagnostic Cardiac Magnetic Resonance Catheterization: Validation in Pigs and Application in a Clinical Pilot Study J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1271 - 1281. [Abstract] [Full Text] [PDF]

				C. E. Saikus and R. J. Lederman Interventional Cardiovascular Magnetic Resonance Imaging: A New Opportunity for Image-Guided Interventions J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1321 - 1331. [Abstract] [Full Text] [PDF]

				A. Crean Cardiovascular MR and CT in congenital heart disease Heart, December 1, 2007; 93(12): 1637 - 1647. [Full Text] [PDF]

				T. Geva and A. C. Marshall Magnetic Resonance Imaging-Guided Catheter Interventions in Congenital Heart Disease Circulation, February 28, 2006; 113(8): 1051 - 1052. [Full Text] [PDF]