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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2010 | Research

Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

Authors: Philipp Kahlert, Holger Eggebrecht, Björn Plicht, Oliver Kraff, Ian McDougall, Brad Decker, Raimund Erbel, Mark E Ladd, Harald H Quick

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2010

Abstract

Background

Cardiovascular magnetic resonance (CMR) is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI) featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve^®) including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve^® prosthesis as an initial step towards real-time CMR-guided TAVI.

Methods

The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T₁-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding.

Results

CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve^® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences.

Conclusions

The present study shows that the Medtronic CoreValve^® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested design modifications of the delivery system.

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Title: Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices
Authors: Philipp Kahlert
Holger Eggebrecht
Björn Plicht
Oliver Kraff
Ian McDougall
Brad Decker
Raimund Erbel
Mark E Ladd
Harald H Quick
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2010
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/1532-429X-12-58

At a glance: The STEP trials

Springer Medicine

Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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