Real-time MRI guided cardiovascular intervention

实时 MRI 引导心血管干预

• 批准号: 8557942
• 负责人: Robert J Lederman
• 金额: $ 121.14万
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8557942
• 关键词: Adult; Aorta; Biological; Bioprosthesis device; Cardiac; Cardiac Surgery procedures; Cardiology; Cardiovascular system; Catheterization; Chest wall structure; Child; Childhood; Cicatrix; Complex; Congenital Heart Defects; Custom; Development; Devices; Diagnostic radiologic examination; Environment; Family suidae; Healed; Heart; Human; Implant; Intervention; Left ventricular structure; Magnetic Resonance Imaging; Mechanics; National Heart, Lung, and Blood Institute; Operative Surgical Procedures; Patients; Pericardial body location; Pericardiocentesis; Peripheral arterial disease; Procedures; Pulmonary Artery Catheterization; Pulmonary artery structure; Radiation; Reporting; Research; Research Personnel; Right ventricular structure; Roentgen Rays; Stents; System; Testing; Time; Ventricular septum; Work; clinical application; congenital heart disorder; healing; implantation; mitral valve replacement; novel; novel strategies; pressure; repaired; tool

During the past year we have continued our work applying rapid MRI to guide simple and complex mechanical and biological interventions. We reported the first careful comparison of conventional X-ray and wholly MRI guided transfemoral pulmonary artery catheterization in adults. In this pilot, we found that radiation-free MRI catheterization is safe and feasible. Guidewire-free MRI catheterization was just as successful as X-ray catheterization (more so in specific challenging procedure steps) and took approximately the same time. We continue to perform X-ray-free MRI catheterization in patients whenever possible. We performed the first ever MRI pericardiocentesis procedure in humans. We have developed still another novel access port into the heart across the chest wall, as an alternative to surgery to implant large cardiac appliances such as mitral valve replacements. In this novel approach, we enter the left ventricle across the interventricular septum. This allows the dangerous port to pericardial space to enjoy low pressure, and the right ventricle to serve as the high-pressure pop-off chamber. We found unexpectedly that the interventricular septum closes tightly, immediately, and heals spontaneously as a very small scar. We intend these also to allow direct repair of congenital heart defects on small children who otherwise might require open surgical access. We have begun work on challenges in pediatric cardiology, starting with a non-surgical pulmonary artery resistor device to help reduce the complexity of cardiac surgery for certain congenital heart defects. We are developing other novel catheterization tools, for example, to access the aorta without surgery in patients with severe peripheral artery disease. NHLBI Cardiothoracic Surgery Research Branch investigators have used our interventional MRI system and environment to further test the feasibility and utility of real-time MRI guidance for surgical transapical implantation of a custom aortic stent valve bioprosthesis in swine. Overall we have successfully developed novel applications of real-time MRI for cardiovascular treatments, and we continue to work to clinical applications of these exciting new developments.

在过去的一年中，我们继续使用快速MRI来指导简单而复杂的机械和生物学干预措施。 我们报道了成人传统的X射线和完全MRI引导的转际肺动脉导管的首次仔细比较。 在此飞行员中，我们发现无辐射的MRI导管插入术是安全且可行的。 无指导丝电MRI导管插入术与X射线导管插入术一样成功（在特定的挑战性步骤中更是如此），并且大约同时花费了。 我们将尽可能继续对患者进行无X射线MRI导管插入术。 我们在人类中进行了有史以来的第一个MRI心脏穿刺术程序。 我们已经在胸壁上开发了另一个新型的通道端口，以替代植入大型心脏电器（例如二尖瓣更换）的手术。 在这种新颖的方法中，我们穿过室内隔膜进入左心室。 这使危险的端口可以使心包空间享受低压，右心室可以用作高压弹出室。 我们出乎意料地发现，室内隔膜紧密关闭，立即关闭，并自发地作为很小的疤痕治愈。 我们还打算将这些直接修复对否则可能需要开放手术的小孩的先天性心脏缺陷。 我们已经开始研究小儿心脏病学的挑战，从非手术性肺动脉电阻器械开始，以帮助减少某些先天性心脏缺陷的心脏手术的复杂性。 我们正在开发其他新型导管插入工具，例如，在严重的外周动脉疾病的患者中，无需手术即可进入主动脉。 NHLBI心胸外科手术研究部研究人员使用了我们的介入性MRI系统和环境，进一步测试了实时MRI指南的可行性和实用性，用于对猪的自定义主动脉支架瓣膜生物植物的手术跨膜植入。 总体而言，我们成功地开发了实时MRI的新型应用在心血管治疗中，并且我们继续致力于这些令人兴奋的新发展的临床应用。