Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience
Abstract Background Cardiovascular magnetic resonance (CMR) fluoroscopy allows for simultaneous measurement of cardiac function, flow and chamber pressure during diagnostic heart catheterization. To date, commercial metallic guidewires were considered contraindicated during CMR fluoroscopy due to co...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-06-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12968-018-0458-7 |
| _version_ | 1827572194740273152 |
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| author | Adrienne E. Campbell-Washburn Toby Rogers Annette M. Stine Jaffar M. Khan Rajiv Ramasawmy William H. Schenke Delaney R. McGuirt Jonathan R. Mazal Laurie P. Grant Elena K. Grant Daniel A. Herzka Robert J. Lederman |
| author_facet | Adrienne E. Campbell-Washburn Toby Rogers Annette M. Stine Jaffar M. Khan Rajiv Ramasawmy William H. Schenke Delaney R. McGuirt Jonathan R. Mazal Laurie P. Grant Elena K. Grant Daniel A. Herzka Robert J. Lederman |
| author_sort | Adrienne E. Campbell-Washburn |
| collection | DOAJ |
| description | Abstract Background Cardiovascular magnetic resonance (CMR) fluoroscopy allows for simultaneous measurement of cardiac function, flow and chamber pressure during diagnostic heart catheterization. To date, commercial metallic guidewires were considered contraindicated during CMR fluoroscopy due to concerns over radiofrequency (RF)-induced heating. The inability to use metallic guidewires hampers catheter navigation in patients with challenging anatomy. Here we use low specific absorption rate (SAR) imaging from gradient echo spiral acquisitions and a commercial nitinol guidewire for CMR fluoroscopy right heart catheterization in patients. Methods The low-SAR imaging protocol used a reduced flip angle gradient echo acquisition (10° vs 45°) and a longer repetition time (TR) spiral readout (10 ms vs 2.98 ms). Temperature was measured in vitro in the ASTM 2182 gel phantom and post-mortem animal experiments to ensure freedom from heating with the selected guidewire (150 cm × 0.035″ angled-tip nitinol Terumo Glidewire). Seven patients underwent CMR fluoroscopy catheterization. Time to enter each chamber (superior vena cava, main pulmonary artery, and each branch pulmonary artery) was recorded and device visibility and confidence in catheter and guidewire position were scored on a Likert-type scale. Results Negligible heating (< 0.07°C) was observed under all in vitro conditions using this guidewire and imaging approach. In patients, chamber entry was successful in 100% of attempts with a guidewire compared to 94% without a guidewire, with failures to reach the branch pulmonary arteries. Time-to-enter each chamber was similar (p=NS) for the two approaches. The guidewire imparted useful catheter shaft conspicuity and enabled interactive modification of catheter shaft stiffness, however, the guidewire tip visibility was poor. Conclusions Under specific conditions, trained operators can apply low-SAR imaging and using a specific fully-insulated metallic nitinol guidewire (150 cm × 0.035” Terumo Glidewire) to augment clinical CMR fluoroscopy right heart catheterization. Trial registration Clinicaltrials.gov NCT03152773, registered May 15, 2017. |
| first_indexed | 2024-04-24T08:35:27Z |
| format | Article |
| id | doaj.art-444eb3b4a48d4e1e9e830b3287d1e641 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:35:27Z |
| publishDate | 2018-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-444eb3b4a48d4e1e9e830b3287d1e6412024-04-16T16:57:47ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2018-06-012011910.1186/s12968-018-0458-7Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experienceAdrienne E. Campbell-Washburn0Toby Rogers1Annette M. Stine2Jaffar M. Khan3Rajiv Ramasawmy4William H. Schenke5Delaney R. McGuirt6Jonathan R. Mazal7Laurie P. Grant8Elena K. Grant9Daniel A. Herzka10Robert J. Lederman11Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthAbstract Background Cardiovascular magnetic resonance (CMR) fluoroscopy allows for simultaneous measurement of cardiac function, flow and chamber pressure during diagnostic heart catheterization. To date, commercial metallic guidewires were considered contraindicated during CMR fluoroscopy due to concerns over radiofrequency (RF)-induced heating. The inability to use metallic guidewires hampers catheter navigation in patients with challenging anatomy. Here we use low specific absorption rate (SAR) imaging from gradient echo spiral acquisitions and a commercial nitinol guidewire for CMR fluoroscopy right heart catheterization in patients. Methods The low-SAR imaging protocol used a reduced flip angle gradient echo acquisition (10° vs 45°) and a longer repetition time (TR) spiral readout (10 ms vs 2.98 ms). Temperature was measured in vitro in the ASTM 2182 gel phantom and post-mortem animal experiments to ensure freedom from heating with the selected guidewire (150 cm × 0.035″ angled-tip nitinol Terumo Glidewire). Seven patients underwent CMR fluoroscopy catheterization. Time to enter each chamber (superior vena cava, main pulmonary artery, and each branch pulmonary artery) was recorded and device visibility and confidence in catheter and guidewire position were scored on a Likert-type scale. Results Negligible heating (< 0.07°C) was observed under all in vitro conditions using this guidewire and imaging approach. In patients, chamber entry was successful in 100% of attempts with a guidewire compared to 94% without a guidewire, with failures to reach the branch pulmonary arteries. Time-to-enter each chamber was similar (p=NS) for the two approaches. The guidewire imparted useful catheter shaft conspicuity and enabled interactive modification of catheter shaft stiffness, however, the guidewire tip visibility was poor. Conclusions Under specific conditions, trained operators can apply low-SAR imaging and using a specific fully-insulated metallic nitinol guidewire (150 cm × 0.035” Terumo Glidewire) to augment clinical CMR fluoroscopy right heart catheterization. Trial registration Clinicaltrials.gov NCT03152773, registered May 15, 2017.http://link.springer.com/article/10.1186/s12968-018-0458-7Interventional MRI catheterizationRight heart catheterizationGuidewireCardiac cathetersMedical device heatingReal-time MRI |
| spellingShingle | Adrienne E. Campbell-Washburn Toby Rogers Annette M. Stine Jaffar M. Khan Rajiv Ramasawmy William H. Schenke Delaney R. McGuirt Jonathan R. Mazal Laurie P. Grant Elena K. Grant Daniel A. Herzka Robert J. Lederman Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience Journal of Cardiovascular Magnetic Resonance Interventional MRI catheterization Right heart catheterization Guidewire Cardiac catheters Medical device heating Real-time MRI |
| title | Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience |
| title_full | Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience |
| title_fullStr | Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience |
| title_full_unstemmed | Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience |
| title_short | Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience |
| title_sort | right heart catheterization using metallic guidewires and low sar cardiovascular magnetic resonance fluoroscopy at 1 5 tesla first in human experience |
| topic | Interventional MRI catheterization Right heart catheterization Guidewire Cardiac catheters Medical device heating Real-time MRI |
| url | http://link.springer.com/article/10.1186/s12968-018-0458-7 |
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