Real-time MRI guided cardiovascular intervention

在过去的一年中，我们继续应用快速MRI指导简单和复杂的机械和生物干预。 我们已经在NIH临床中心将MRI导管插入术引入标准临床实践，这是基于我们早期对成人常规X线和完全MRI引导的经股肺动脉导管插入术进行的仔细的初步研究比较。 我们将继续加强MRI导管插入术的能力，以表征患者的心脏功能。 我们继续在人体中测试MRI心包穿刺术。 我们正在开发新的方法来连接不同的心脏腔室，而无需手术治疗先天性心脏病患者。我们还继续致力于直接修复幼儿的先天性心脏缺陷，否则他们可能需要开放手术。 我们已经完成了一个战略项目，以实现非手术解剖外旁路（双向格伦上级腔肺分流）的动物，并期望能够在未来几年内将其转化为儿童的护理。 我们正在开发其他新的导管插入工具，例如，在小腿动脉患者（特别是女性）和严重外周动脉疾病患者中，无需手术即可进入主动脉。 这一关键进展已在美国多个地点的临床采用的第一年中转化为40多名患者，在许多情况下，它已被证明可以挽救生命。 我们现在已经开始赞助一项多中心试验，在没有其他良好选择的患者中采用这种经腔静脉方法进行经导管主动脉瓣置换术。 同时，我们正在为这些腔静脉-主动脉入口开发专用闭合装置。 我们正在帮助其他美国医疗中心开发自己的介入性MRI项目。 总的来说，我们已经成功地开发了实时MRI在心血管治疗中的新应用，我们将继续致力于这些令人兴奋的新发展的临床应用。

During the past year we have continued our work applying rapid MRI to guide simple and complex mechanical and biological interventions. We have introduced MRI catheterization into standard clinical practice at the NIH clinical center, based on our earlier careful pilot research comparison of conventional X-ray and wholly MRI guided transfemoral pulmonary artery catheterization in adults. We continue to enhance the capabilities of MRI catheterization to characterize heart function in patients. We continue to test MRI pericardiocentesis procedure in humans. We are developing new approaches to connect different heart chambers without surgery in patients with congenital heart disease. We also continue work towards direct repair of congenital heart defects on small children who otherwise might require open surgical access. We have completed a strategic project to accomplish non-surgical extra-anatomic bypass (a bidirectional Glenn superior cavo-pulmonary shunt) in animals, and expect to be able to translate this into the care of children in upcoming years. We are developing other novel catheterization tools, for example, to access the aorta without surgery in patients with small leg arteries (especially women) and patients with severe peripheral artery disease. This key advance has been translated into over 40 patients in its first year of clinical adoption at multiple sites across the United States, where it has proven lifesaving in many cases. We have now begun to sponsor a multi-center trial of this transcaval approach to transcatheter aortic valve replacement in patients without other good options. Simultaneously we are developing a purpose-built closure device for these caval-aortic access ports. We are helping other US medical centers develop their own interventional MRI programs. 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.