Real-time CMR guidance for intracardiac and great vessel pressure mapping in patients with congenital heart disease using an MR conditional guidewire—results of 25 patients

Abstract

Background: The aim of this study was to test a CE-certified MR-conditional guidewire to facilitate blood pressure measurement in cardiovascular magnetic resonance (CMR) using fluid-filled catheters in patients with congenital heart disease (CHD). The main purpose was to determine procedural success in a post market clinical follow-up (PMCF) for routine procedure in a diagnostic and interventional workflow. Realtime CMR provides high quality imaging without the risk of exposing the patient to X-rays, especially for patients with irregular heart anatomy and patients who are susceptible to radiation and iodinated contrast media. To date, the assessment of blood pressure gradients is not a common feature of CMR, as these gradients cannot be accurately evaluated in routine CMR.Methods: Twenty-five CHD patients who were planned for combined clinical CMR and diagnostic and/ or interventional catheterization were enrolled in the trial. Prior to inclusion, a specific procedure for catheterization in CMR was defined, encompassing the assessment of pressure and pressure gradients in the heart and great vessels.Results: By the use of an MR-conditional guidewire we successfully measured specific pressure and pressure gradients in up to 92% of cases with liquid-filled catheters which were guided exclusively under CMR guidance. There were no guidewire-related adverse events, and guidewire guidance and manipulation of catheters were successful.Conclusions: Using a MR-conditional guidewire assists in easily reaching targets in the heart and great vessels and makes the catheter itself visible, so that invasive blood pressure assessment by CMR guidance with liquid-filled catheters can be improved.

Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives

“…Meierhofer et al. 28 also describe successful use of MR-conditional guidewires for right and left heart catheterization and pressure measurement in great vessels in 23 out of 25 cases of patients with congenital heart disease.…”

“…While this group used conventional guidewires under X-ray fluoroscopy when necessary, Veeram Reddy et al 23 demonstrated the use of an MR-conditional guidewire for right and left heart catheterization successfully in 24 out of 25 cases. Meierhofer et al 28 also describe successful use of MR-conditional guidewires for right and left heart catheterization and pressure measurement in great vessels in 23 out of 25 cases of patients with congenital heart disease.…”

“…Cardiac procedures divided into subcategories with their respective TRLs. Veeram Reddy et al,23 Ratnayaka et al,24 Pushparajah et al,25 Knight et al,26 Velasco Forte et al,27 Meierhofer et al28 …”