Pulmonary Hypertension

Pulmonary hypertension (PH) is a condition that can have different causes, including pre-existing lung disease as well as congenital heart disease. PH may lead to cardiac effects such as right ventricle decompensation.  The diagnosis of PH requires a right heart catherization (RHC) with measurement of pulmonary vascular pressure, cardiac output and calculation of the pulmonary vascular resistance (PVR).

Current procedures combine a CMR investigation (for flow and cardiac output) with a subsequent cathlab investigation to do invasive pressure measurement. Several clinical centers now advocate to do all hemodynamic measurements in the MRI as a one-stop-shop approach. Several centers in Europe (Munich, London) and the USA (Bethesda, Washington) have considerable experience in pressure measurements in MRI. Their arguments for using CMR:

  • Pulmonary vascular resistance can be calculated from invasive pressure measurement and MRI-flow derived cardiac output. Fick’s principle is not needed.
  • One-stop shop hemodynamics is alternative for cathlab diagnosis
  • Visibility of heart (right ventricle) and vessels is a major asset for both flow and pressure measurement

All of this is demonstrated in a live stream of an MRI guided RHC by Washington’s children’s hospital done as a live case at SCMR 2017.

 

Key papers

Ratnayka et al (2017) Radiation free CMR right heart catherization in children. Journal of Cardiovascular Magnetic Resonance . DOI 10.1186/s12968-017-0374-2

Rogers et al (2017) Journal of Cardiovascular Magnetic Resonance. CMR fluoroscopy right heart catherization for cardiac output  and pulmonary vascular resistance: results in 102 patients. DOI 10.1186/s12968-017-0366-2.

Pushparajah et al (2015) Cardiovascular magnetic resonance catheterization derived pulmonary vascular resistance and medium-term outcomes in congenital heart disease. J Cardiovasc Magn Reson. 14;17:28. doi: 10.1186/s12968-015-0130-4.

Muthurangu V et al (2004)Novel method of quantifying pulmonary vascular resistance by use of simultaneous invasive pressure monitoring and phase-contrast magnetic resonance flow. Circulation. 2004 Aug 17;110(7):826-34.

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