Author + information
- Received September 5, 2008
- Accepted September 15, 2008
- Published online March 1, 2009.
- Kanishka Ratnayaka, MD⁎,†,
- Venkatesh K. Raman, MD, FACC⁎,
- Anthony Z. Faranesh, PhD⁎,
- Merdim Sonmez, MS⁎,‡,§,
- June-Hong Kim, MD⁎,
- Luis F. Gutiérrez, PhD⁎,
- Cengizhan Ozturk, MD, PhD⁎,§,
- Elliot R. McVeigh, PhD⁎,
- Michael C. Slack, MD, FACC⁎,† and
- Robert J. Lederman, MD, FACC⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Robert J. Lederman, Translational Medicine Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC1538, Bethesda, Maryland 20892-1538
Objectives We hypothesized that X-ray fused with magnetic resonance imaging (XFM) roadmaps might permit direct antegrade crossing and delivery of a ventricular septal defect (VSD) closure device and thereby reduce procedure time and radiation exposure.
Background Percutaneous device closure of membranous VSD is cumbersome and time-consuming. The procedure requires crossing the defect retrograde, snaring and exteriorizing a guidewire to form an arteriovenous loop, then delivering antegrade a sheath and closure device.
Methods Magnetic resonance imaging roadmaps of cardiac structures were obtained from miniature swine with spontaneous VSD and registered with live X-ray using external fiducial markers. We compared antegrade XFM-guided VSD crossing with conventional retrograde X-ray–guided crossing for repair.
Results Antegrade XFM crossing was successful in all animals. Compared with retrograde X-ray, antegrade XFM was associated with shorter time to crossing (167 ± 103 s vs. 284 ± 61 s; p = 0.025), shorter time to sheath delivery (71 ± 32 s vs. 366 ± 145 s; p = 0.001), shorter fluoroscopy time (158 ± 95 s vs. 390 ± 137 s; p = 0.003), and reduced radiation dose–area product (2,394 ± 1,522 mG·m2 vs. 4,865 ± 1,759 mG·m2; p = 0.016).
Conclusions XFM facilitates antegrade access to membranous VSD from the right ventricle in swine. The simplified procedure is faster and reduces radiation exposure compared with the conventional retrograde approach.
- image-guided intervention
- interventional magnetic resonance imaging
- congenital heart disease
- multimodality image fusion
- heart septal defects
This work was supported by the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health (grant Z01-HL005062-04 CVB). AGA Medical Corporation provided Amplatzer membranous ventricular septal defect occluder devices and delivery systems. Merdim Sonmez was an employee of Siemens Corporate Research. Dr. Slack receives compensation as a physician training proctor for Amplatzer Medical Corporation. Siemens Corporate Research and National Heart, Lung, and Blood Institute have a collaborative research and development agreement for specific registration modules to be used in hybrid X-ray-magnetic resonance imaging systems.
- Received September 5, 2008.
- Accepted September 15, 2008.
- American College of Cardiology Foundation