Published Online
on September 29, 2003

A more recent version of this article appeared on October 14, 2003

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Submitted on January 27, 2003
Revised on June 10, 2003
Accepted on June 11, 2003

Magnetic Resonance-Guided Cardiac Catheterization in a Swine Model of Atrial Septal Defect

Simon Schalla MD, Maythem Saeed DVM, PhD, Charles B. Higgins MD^*, Alastair Martin PhD, Oliver Weber PhD, and Phillip Moore MD

From the Departments of Radiology (S.S., M.S., C.B.H., A.M., O.W.) and Pediatric Cardiology (P.M.), University of California San Francisco, San Francisco, and Philips Medical System, Best, Netherlands (A.M.).

^* To whom correspondence should be addressed. E-mail: charles.higgins{at}radiology.ucsf.edu.

Background--Radiation exposure during cardiac catheterization, limited image planes, and poor soft tissue definition are disadvantages of x-ray fluoroscopy that could be overcome with the use of MRI. This study evaluates the feasibility of real-time MRI (MR fluoroscopy) to guide left and right heart catheterization.

Methods and Results--Anesthetized pigs (n=7) with defects of the atrial septum were catheterized using venous and arterial access. A prototype active tracking catheter was used to obtain blood pressures and samples from cardiac chambers and great vessels using antegrade, transseptal, and retrograde approaches. MR fluoroscopy was used for catheter steering. Velocity-encoded cine MRI was used to measure pulmonary and aortic blood flow to calculate vascular resistances. Image planes used during catheter manipulation used rapid sequencing to planes directed by the operator to include the tip of the catheter and the chamber to be entered. All areas of interest were effectively entered, and samples were obtained. In the presence of an acute atrial septal defect, a Q_p/Q_s ratio of 1.3±0.2 was measured, and no significant differences in pressure between inferior vena cava, right atrium, and left atrium were found. Pulmonary and aortic flow were 4.9±0.6 and 3.7±0.4 L/min, and pulmonary and systemic vascular resistance were 312±134 and 2006±336 dyne · s · cm^-5.

Conclusions--Left and right heart catheterization using MR guidance is feasible. The combination of hemodynamic catheterization data with anatomic and functional MRI may significantly improve the evaluation of patients with congenital heart disease while avoiding radiation exposure.

Key words: magnetic resonance imaging • catheterization • pressure

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