interventional CMR in CHD: booming

The data of the first clinical study (PMCF) performed in 2018 in Munich (German Heart Centre) were published recently by Meierhofer (2020)Meierhofer-CDT-2020-PMCFstudy. Also in 2020 the data from the first 35 patients treated in 2018 with our EmeryGlide in Dallas was published in JCMR, The iCMR procedure was successfully performed to completion in 31/34 (91%) subjects between August 1st, 2017 to December 13th, 2018. Median age and weight were 7.7 years and 25.2 kg (range: 3months – 33 years and 8 – 80 kg). Twenty-one subjects had single ventricle (SV) anatomy: one subject was referred for pre-Glenn evaluation, 11 were pre-Fontan evaluations and 9 post-Fontan evaluations for protein losing enteropathy (PLE) and/or cyanosis.Starting with subject #10, the EmeryGlide was used as MR-conditional guidewire was used in all subsequent subjects (15 SV and 10 BiV) with a success rate of 96% (24/25). Real-time CMR-guided RHC (25/25 subjects, 100%), retrograde and prograde LHC/aortic pull back (24/25 subjects, 96%), CoA crossing (3/4 subjects, 75%) and Fontan fenestration test occlusion (2/3 subjects, 67%) were successfully performed in the majority of subjects when an MR-conditional guidewire was utilized. Reddy-etal2020-JCMR.pdf

The future of MRI guided interventions in CHD

Although first use of CMR for interventional procedures in CHD dates back to 2003, current use is mainly diagnostic such as for accurate pressure/flow measurement in PH and various forms of CHD. The first objective of our current worldwide survey was to describe current use of CMR in CHD and to further details future use and application of interventional and diagnostic CMR by current and interested users.  A second objective was to make an inventory of the main impediments to apply iCMR and the instrumental needs for further progression of the field. An online survey was done among PICS and SCAI members in 2019. A total of 188 responses were obtained, and a sub-group of 132 responders completed all questions, including 103 academic and 11 non-academic centers. Apart from 14 centers that are already active, 72 centers (55%) indicated that they wanted to start later. The major problems they envisage, or encounter are infrastructure (26 %), lack of medical devices (18 %), training (13 %) and need for team extension (12%). The data were presented at PICS september 2019 in San Diego (USA) by dr Suren Reddy.

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