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(Circulation. 2001;104:2363.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Sequential Magnetic Resonance Monitoring of Pulmonary Flow With Endovascular Stents Placed Across the Pulmonary Valve in Growing Swine

Titus Kuehne, MD; Maythem Saeed, DVM PhD; Gautham Reddy, MD; Haydar Akbari, MD; Kelly Gleason, MD; Daniel Turner, MD; David Teitel, MD; Phillip Moore, MD; Charles B. Higgins, MD

From the Department of Radiology and the Division of Pediatric Cardiology, University of California, San Francisco.

Correspondence to Charles B. Higgins, MD, Department of Radiology, University of California San Francisco, 505 Parnassus Ave, L308, San Francisco, CA 94143-0628. E-mail charles.higgins{at}radiology.ucsf.edu

Background— Patients with endovascular stent implantation for the treatment of right ventricular outflow tract obstruction are often left with incomplete relief of the obstruction and significant pulmonary regurgitation. A noninvasive and reproducible method for monitoring such patients is desirable. MRI in the presence of a stent, however, has to overcome the problem of potential metallic artifacts.

Methods and Results— Under x-ray fluoroscopic guidance, endovascular nitinol stents were placed across the pulmonary valve in 6 young pigs to induce pulmonary regurgitation. Five additional pigs served as controls. Initial MRI was performed after 2 days (13.5±1.8 kg) and follow-up after 3 months (32±2.9 kg). Pulmonary flow volumes and regurgitant fraction were quantified by velocity-encoded cine (VEC) MRI through (VEC-TS) and distal to (VEC-DS) the stent. VEC-TS was compared with VEC-DS and volumetric measurements of left and right ventricular stroke volumes provided by cine MRI ("gold standard"). Antegrade and retrograde pulmonary flow volumes by VEC-TS were slightly but significantly less than those with VEC-DS and cine MRI. Excellent correlations (r>0.97) for phasic pulmonary flow volumes as measured by VEC-TS and VEC-DS were shown. Pulmonary regurgitant fraction increased from 32.8±15% to 49.6±17% (P<0.05) over the course of 3 months with VEC-TS.

Conclusions— MRI demonstrates the progression of pulmonary regurgitation in growing swine. VEC MRI has the ability to quantify pulmonary blood flow inside the lumen of nitinol stents. MRI appears to be ideally suited for monitoring patients with endovascular nitinol stents in the pulmonary artery or pulmonary valve position.

Key Words: magnetic resonance imaging • stents • pulmonary heart disease

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