Real-time cardiovascular magnetic resonance subxiphoid pericardial access and pericardiocentesis using off-the-shelf devices in swine

Journal of Cardiovascular Magnetic Resonance

Kanishka Ratnayaka¹  Robert J Lederman²  Ozgur Kocaturk²  Christina E Saikus²  Michael S Hansen²  Victor J Wright²  William H Schenke²  Anthony Z Faranesh²  Majdi Halabi² 

[1] Department of Cardiology, Children’s National Medical Center, Washington, DC, USA;Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, Bethesda, MD 20892-1538, USA

关键词: Pericardial disease;    Cardiovascular magnetic resonance;    Interventional magnetic resonance imaging;    Image guided intervention;    Catheterization;    Pericardiocentesis;   

Others  :  812575
DOI  :  10.1186/1532-429X-15-61

 received in 2013-02-07, accepted in 2013-07-04,  发布年份 2013

【 摘 要 】

Background

Needle access or drainage of pericardial effusion, especially when small, entails risk of bystander tissue injury or operator uncertainty about proposed trajectories. Cardiovascular magnetic resonance (CMR) might allow enhanced imaging guidance.

Methods and results

We used real-time CMR to guide subxiphoid pericardial access in naïve swine using commercial 18G titanium puncture needles, which were exchanged for pericardial catheters. To test the value of CMR needle pericardiocentesis, we also created intentional pericardial effusions of a range of volumes, via a separate transvenous-transatrial catheter. We performed these procedures in 12 animals.

Pericardiocentesis was performed in 2:47 ± 1:43 minutes; pericardial access was performed in 1:40 ± 4:34 minutes. The procedure was successful in all animals. Moderate and large effusions required only one needle pass. There were no complications, including pleural, hepatic or myocardial transit.

Conclusions

CMR guided pericardiocentesis is attractive because the large field of view and soft tissue imaging depict global anatomic context in arbitrary planes, and allow the operator to plan trajectories that limit inadvertent bystander tissue injury. More important, CMR provides continuous visualization of the needle and target throughout the procedure. Using even passive needle devices, CMR enabled rapid pericardial needle access and drainage. We believe this experience supports clinical testing of real-time CMR guided needle access or drainage of the pericardial space. We suspect this would be especially helpful in “difficult” pericardial access, for example, in distorted thoracic anatomy or loculated effusion.

【 授权许可】

   
2013 Halabi et al.; licensee BioMed Central Ltd.

【 图 表 】

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