Real-time MRI guided cardiovascular intervention

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。 我们将MRI导管术引入美国国立卫生研究院临床中心的标准临床实践中，基于我们早期对成人常规X线片和完全MRI导引的经股动脉插管的仔细的先导性研究比较。我们继续增强MRI插管的能力，以表征患者的心功能。 我们继续在人类身上测试核磁共振心包穿刺术。 我们正在开发新的方法来连接不同的心腔，而不需要手术治疗先天性心脏病患者。我们还继续致力于直接修复儿童的先天性心脏缺陷，否则他们可能需要开放的手术通道。我们已经完成了一个战略性项目，在动物身上实现非手术的解剖外搭桥(双向Glenn上腔静脉-肺分流术)，并有望在未来几年将其转化为儿童护理。 我们正在开发其他新的插管工具，例如，对于小腿动脉患者(尤其是女性)和患有严重外周动脉疾病的患者，无需手术即可进入主动脉。这一关键进展在美国多个地点临床采用的第一年已转化为40多名患者，在许多情况下证明是拯救生命的。我们现在已经开始赞助一项多中心试验，对没有其他好选择的患者采用这种经下腔静脉途径进行经导管主动脉瓣置换术。同时，我们正在为这些腔静脉-主动脉通路开发一种专门设计的关闭装置。 我们正在帮助其他美国医疗中心开发自己的介入性核磁共振项目。 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。

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.