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，我们继续我们的工作，应用快速核磁共振来指导简单和复杂的机械和生物干预。 我们首次报告了成人经股动脉插管的常规X光和完全MRI引导下的仔细比较。在这个试点中，我们发现无辐射MRI插管是安全可行的。无导丝MRI插管与X光插管一样成功(在特定的具有挑战性的操作步骤中更为成功)，并且花费的时间大致相同。只要有可能，我们会继续对患者进行无X射线的MRI插管。 我们在人类身上进行了第一次核磁共振心包穿刺术。 我们还开发了另一个穿过胸壁进入心脏的新通道，作为手术的替代方案，植入大型心脏器械，如二尖瓣置换术。在这种新的方法中，我们跨过室间隔进入左心室。这使得危险的心包腔可以享受到低压力，而右心室则可以作为高压弹出室。我们出乎意料地发现，室间隔立即紧密闭合，并自动愈合，形成一个很小的疤痕。我们还打算允许直接修复儿童先天性心脏缺陷，否则他们可能需要开放的手术通道。 我们已经开始应对儿科心脏病学的挑战，首先是一种非手术的肺动脉阻力装置，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的插管工具，例如，对于患有严重外周动脉疾病的患者，无需手术即可进入主动脉。 NHLBI心胸外科研究分部的研究人员使用我们的介入性MRI系统和环境，进一步测试了实时MRI引导在外科手术经心尖部植入定制的猪主动脉支架生物瓣膜的可行性和实用性。 总体而言，我们已经成功地开发了实时核磁共振在心血管治疗中的新应用，我们将继续努力将这些令人兴奋的新开发应用于临床。