Published Online
on December 2, 2002

A more recent version of this article appeared on January 7, 2003

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Submitted on June 10, 2002
Revised on September 8, 2002
Accepted on September 9, 2002

Magnetic Resonance Image-Guided Transcatheter Closure of Atrial Septal Defects

Carsten Rickers MD, Michael Jerosch-Herold PhD, Xudong Hu MD, Naveen Murthy MD, Xiaoen Wang MD, Huafu Kong MD, Ravi Teja Seethamraju PhD, Jochen Weil MD, and Norbert M. Wilke MD^*

From the University of Minnesota, Department of Radiology, Minneapolis, Minn (M.J.-H., X.H., N.M., X.W., H.K., R.T.S., N.M.W.); and University Hospital Hamburg-Eppendorf, Pediatric Cardiology, Germany (C.R., J.W.).

^* To whom correspondence should be addressed. E-mail: wilke{at}jax.ufl.edu.

Background—Recent developments in cardiac MRI have extended the potential spectrum of diagnostic and interventional applications. The purpose of this study was to test the ability of MRI to perform transcatheter closures of secundum type atrial septal defects (ASD) and to assess ASD size and changes in right cardiac chamber volumes in the same investigation.

Methods and Results—In 7 domestic swine (body weight, 38±13 kg), an ASD (Q_p:Q_s=1.7±0.2) was created percutaneously by balloon dilation of the fossa ovalis. The ASD was imaged and sized by both conventional radiography and MRI. High-resolution MRI of the ASD diameters correlated well with postmortem examination (r=0.97). Under real-time MR fluoroscopy, the introducer sheath was tracked toward the left atrium with the use of novel miniature MR guide wires. The defect was then closed with an Amplatzer Septal Occluder. In all animals, it was possible to track and interactively control the position of the guide wire within the vessels and the heart, including the successful deployment of the Amplatzer Septal Occluder. Right atrial and ventricular volumes were calculated before and after the intervention by using cine-MRI. Both volumes were found to be significantly reduced after ASD closure (P<0.005).

Conclusions—These in vivo studies demonstrate that catheter tracking and ASD device closure can be performed under real-time MRI guidance with the use of intravascular antenna guide wires. High-resolution imaging allows accurate determination of ASD size before the intervention, and immediate treatment effects such as changes in right cardiac volumes can also be measured.

Key words: pediatrics • heart defects, congenital • magnetic resonance imaging

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