Published Online
on February 20, 2006

A more recent version of this article appeared on February 28, 2006

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Submitted on July 25, 2005
Revised on November 10, 2005
Accepted on November 14, 2005

Magnetic Resonance Imaging-Guided Balloon Angioplasty of Coarctation of the Aorta. A Pilot Study

Julia J. Krueger MD, Peter Ewert MD, Sevim Yilmaz MD, Dinah Gelernter MD, Björn Peters MD, Klaus Pietzner MD, Axel Bornstedt PhD, Bernhard Schnackenburg PhD, Hashim Abdul-Khaliq MD, Eckart Fleck MD, Eike Nagel MD, Felix Berger MD, and Titus Kuehne MD^*

From the Departments of Congenital Heart Disease and Pediatric Cardiology (J.J.K., P.E., S.Y., D.G., B.P., K.P., H.A.-K., F.B., T.K.) and Cardiology (A.B., E.F., E.N.), Deutsches Herzzentrum Berlin, Berlin, Germany, and Clinical Science Philips (B.S.), Hamburg, Germany.

^* To whom correspondence should be addressed. E-mail: kuehne{at}dhzb.de.

Background--MRI guidance of percutaneous transluminal balloon angioplasty (PTA) of aortic coarctation (CoA) would be desirable for continuous visualization of anatomy and to eliminate x-ray exposure. The aim of this study was (1) to determine the suitability of MRI-controlled PTA using the iron oxide-based contrast medium Resovist (ferucarbotran) for catheter visualization and (2) to subsequently apply this technique in a pilot study with patients with CoA.

Methods and Results--The MRI contrast-to-noise ratio and artifact behavior of Resovist-treated balloon catheters was optimized in in vitro and animal experiments (pigs). In 5 patients, anatomy of the CoA was evaluated before and after intervention with high-resolution respiratory-navigated 3D MRI and multiphase cine MRI. Position monitoring of Resovist-treated catheters was realized with interactive real-time MRI. Aortic pressures were continuously recorded. Conventional catheterization was performed before and after MRI to confirm interventional success. During MRI, catheters filled with 25 µmol of iron particles per milliliter of Resovist produced good signal contrast between catheters and their background anatomy but no image distortion due to susceptibility artifacts. All MRI procedures were performed successfully in the patient study. There was excellent agreement between the diameters of CoA and pressure gradients as measured during MRI and conventional catheterization. In 4 patients, PTA resulted in substantial widening of the CoA and a decrease in pressure gradients. In 1 patient, PTA was ineffective.

Conclusions--The MRI method described represents a potential alternative to conventional x-ray fluoroscopy for catheter-based treatment of patients with CoA.

Key words: angioplasty • balloon • coarctation • contrast media • magnetic resonance imaging

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