TY - JOUR
T1 - Closed-chest transthoracic magnetic resonance imaging-guided ventricular septal defect closure in swine
AU - Ratnayaka, Kanishka
AU - Saikus, Christina E.
AU - Faranesh, Anthony Z.
AU - Bell, Jamie A.
AU - Barbash, Israel M.
AU - Kocaturk, Ozgur
AU - Reyes, Christine A.
AU - Sonmez, Merdim
AU - Schenke, William H.
AU - Wright, Victor J.
AU - Hansen, Michael S.
AU - Slack, Michael C.
AU - Lederman, Robert J.
N1 - Funding Information:
This work was supported by the Division of Intramural Research ( Z01-HL005062-08 , Z01-HL006039-01 , Z01-HL006041-01 ), National Heart, Lung, and Blood Institute, National Institutes of Health (NIH).
PY - 2011/12
Y1 - 2011/12
N2 - The aim of this study was to close ventricular septal defects (VSDs) directly through the chest wall using magnetic resonance imaging (MRI) guidance, without cardiopulmonary bypass, sternotomy, or radiation exposure. Surgical, percutaneous, and hybrid management of VSD each have limitations and known morbidity. Percutaneous muscular VSDs were created in 10 naive Yorkshire swine using a transjugular laser catheter. Under real-time MRI guidance, a direct transthoracic vascular access sheath was introduced through the chest into the heart along a trajectory suitable for VSD access and closure. Through this transthoracic sheath, muscular VSDs were occluded using a commercial nitinol device. Finally, the right ventricular free wall was closed using a commercial collagen plug intended for arterial closure. Anterior, posterior, and mid-muscular VSDs (6.8 ± 1.8 mm) were created. VSDs were closed successfully in all animals. The transthoracic access sheath was displaced in 2, both fatal. Thereafter, we tested an intracameral retention sheath to prevent this complication. Right ventricular access ports were closed successfully in all, and after as many as 30 days, healed successfully. Real-time MRI guidance allowed closed-chest transthoracic perventricular muscular VSD closure in a clinically meaningful animal model. Once applied to patients, this approach may avoid traditional surgical, percutaneous, or open-chest transcatheter ("hybrid") risks.
AB - The aim of this study was to close ventricular septal defects (VSDs) directly through the chest wall using magnetic resonance imaging (MRI) guidance, without cardiopulmonary bypass, sternotomy, or radiation exposure. Surgical, percutaneous, and hybrid management of VSD each have limitations and known morbidity. Percutaneous muscular VSDs were created in 10 naive Yorkshire swine using a transjugular laser catheter. Under real-time MRI guidance, a direct transthoracic vascular access sheath was introduced through the chest into the heart along a trajectory suitable for VSD access and closure. Through this transthoracic sheath, muscular VSDs were occluded using a commercial nitinol device. Finally, the right ventricular free wall was closed using a commercial collagen plug intended for arterial closure. Anterior, posterior, and mid-muscular VSDs (6.8 ± 1.8 mm) were created. VSDs were closed successfully in all animals. The transthoracic access sheath was displaced in 2, both fatal. Thereafter, we tested an intracameral retention sheath to prevent this complication. Right ventricular access ports were closed successfully in all, and after as many as 30 days, healed successfully. Real-time MRI guidance allowed closed-chest transthoracic perventricular muscular VSD closure in a clinically meaningful animal model. Once applied to patients, this approach may avoid traditional surgical, percutaneous, or open-chest transcatheter ("hybrid") risks.
KW - hybrid surgical procedures
KW - imaging in the catheterization laboratory
KW - interventional MRI
KW - interventional cardiology
KW - perventricular
KW - ventriculoseptal defect
UR - http://www.scopus.com/inward/record.url?scp=84255183951&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2011.09.012
DO - 10.1016/j.jcin.2011.09.012
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C2 - 22192373
AN - SCOPUS:84255183951
SN - 1936-8798
VL - 4
SP - 1326
EP - 1334
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 12
ER -