• Catheter Cardiovasc Interv · Sep 2019

    X-ray fused with MRI guidance of pre-selected transcatheter congenital heart disease interventions.

    • Elena K Grant, Joshua P Kanter, Laura J Olivieri, Russell R Cross, Adrienne Campbell-Washburn, Anthony Z Faranesh, Ileen Cronin, Karin S Hamann, Michael L O'Byrne, Michael C Slack, Robert J Lederman, and Kanishka Ratnayaka.
    • Department of Cardiology, Children's National Medical Center, Washington, District of Columbia.
    • Catheter Cardiovasc Interv. 2019 Sep 1; 94 (3): 399-408.

    ObjectivesTo determine whether X-ray fused with MRI (XFM) is beneficial for select transcatheter congenital heart disease interventions.BackgroundComplex transcatheter interventions often require three-dimensional (3D) soft tissue imaging guidance. Fusion imaging with live X-ray fluoroscopy can potentially improve and simplify procedures.MethodsPatients referred for select congenital heart disease interventions were prospectively enrolled. Cardiac MRI data was overlaid on live fluoroscopy for procedural guidance. Likert scale operator assessments of value were recorded. Fluoroscopy time, radiation exposure, contrast dose, and procedure time were compared to matched cases from our institutional experience.ResultsForty-six patients were enrolled. Pre-catheterization, same day cardiac MRI findings indicated intervention should be deferred in nine patients. XFM-guided cardiac catheterization was performed in 37 (median age 8.7 years [0.5-63 years]; median weight 28 kg [5.6-110 kg]) with the following prespecified indications: pulmonary artery (PA) stenosis (n = 13), aortic coarctation (n = 12), conduit stenosis/insufficiency (n = 9), and ventricular septal defect (n = 3). Diagnostic catheterization showed intervention was not indicated in 12 additional cases. XFM-guided intervention was performed in the remaining 25. Fluoroscopy time was shorter for XFM-guided intervention cases compared to matched controls. There was no significant difference in radiation dose area product, contrast volume, or procedure time. Operator Likert scores indicated XFM provided useful soft tissue guidance in all cases and was never misleading.ConclusionsXFM provides operators with meaningful three-dimensional soft tissue data and reduces fluoroscopy time in select congenital heart disease interventions.Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

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