MR guided right heart catheterization - the NIH experience
© Rogers et al; licensee BioMed Central Ltd. 2015
Published: 3 February 2015
Realtime MR enables radiation free guidance for right heart catheterization (RHC). In addition to catheter navigation for sampling of invasive pressures and blood oxygen saturations, MR permits concomitant assessment of cardiac chamber volumes and cardiac output with phase contrast flow measurements. By performing repeat measurements under different physiological provocations (e.g. saline volume challenge, inhaled nitric oxide, or exercise), diagnostic yield increases by revealing symptoms and pathologic findings not apparent at rest. Herein we present the NIH experience of MR RHC to date.
79 patients consented and, after exclusions, 72 patients underwent MR RHC. Median age was 56yrs (range 26-83yrs) and 51% were female. RHC was completed with MR guidance only in 96% of patients. Only 3/72 required a guidewire and X-ray guidance to complete the procedure, all of which occurred early in our experience. Median procedure time from sheath entry to exit was 26min (range 11-63min). There was a definite learning curve, which permitted completion of repeated measurements under additional physiological provocation with a small increase on total procedure time (mean procedure time 23min vs. 38min, for the first 36 vs. the last 36 patients respectively). No serious complications occurred in any patient.
We have demonstrated that a comprehensive RHC can be performed under MR guidance in almost all patients without the need for additional X-ray imaging. Furthermore, with procedural streamlining, it is possible to perform a comprehensive baseline examination followed by repeat measurements under physiological provocation in under 40min. Superior clinical information is obtained and as a result, MR RHC has been reclassified as a standard clinical procedure at our institution.
This work was supported by the Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health (Z01-HL005062).
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.