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.

在过去的一年里，我们继续应用快速 MRI 来指导简单和复杂的机械和生物干预。 我们首次对成人传统 X 射线和全 MRI 引导经股肺动脉插管进行仔细比较。 在这次试点中，我们发现无辐射 MRI 导管插入术是安全可行的。 无导丝 MRI 导管插入术与 X 射线导管插入术一样成功（在特定的具有挑战性的手术步骤中更是如此），并且花费的时间大致相同。 只要有可能，我们将继续对患者进行无 X 射线 MRI 导管插入术。 我们对人类进行了首次 MRI 心包穿刺术。 我们还开发了另一种新颖的穿过胸壁进入心脏的端口，作为植入大型心脏器械（例如二尖瓣置换术）手术的替代方案。 在这种新颖的方法中，我们穿过室间隔进入左心室。 这使得心包腔的危险端口能够享受低压，而右心室作为高压弹出室。 我们意外地发现，室间隔立即紧密闭合，并像一个非常小的疤痕一样自然愈合。 我们还希望这些技术能够直接修复可能需要开放手术的幼儿先天性心脏缺陷。 我们已经开始应对儿科心脏病学的挑战，从非手术肺动脉电阻装置开始，以帮助降低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，无需手术即可进入患有严重外周动脉疾病的患者的主动脉。 NHLBI 心胸外科研究分部的研究人员使用我们的介入 MRI 系统和环境，进一步测试实时 MRI 引导在猪体内进行定制主动脉支架瓣膜生物假体手术经心尖植入的可行性和实用性。 总体而言，我们已经成功开发了用于心血管治疗的实时 MRI 的新颖应用，并且我们将继续致力于这些令人兴奋的新发展的临床应用。