During the past year we have continued our work applying rapid MRI to guide simple and complex mechanical and biological interventions. We reported the first careful comparison of conventional X-ray and wholly MRI guided transfemoral pulmonary artery catheterization in adults. In this pilot, we found that radiation-free MRI catheterization is safe and feasible. Guidewire-free MRI catheterization was just as successful as X-ray catheterization (more so in specific challenging procedure steps) and took approximately the same time. We continue to perform X-ray-free MRI catheterization in patients whenever possible. We performed the first ever MRI pericardiocentesis procedure in humans. We have developed still another novel access port into the heart across the chest wall, as an alternative to surgery to implant large cardiac appliances such as mitral valve replacements. In this novel approach, we enter the left ventricle across the interventricular septum. This allows the dangerous port to pericardial space to enjoy low pressure, and the right ventricle to serve as the high-pressure pop-off chamber. We found unexpectedly that the interventricular septum closes tightly, immediately, and heals spontaneously as a very small scar. We intend these also to allow direct repair of congenital heart defects on small children who otherwise might require open surgical access. We have begun work on challenges in pediatric cardiology, starting with a non-surgical pulmonary artery resistor device to help reduce the complexity of cardiac surgery for certain congenital heart defects. We are developing other novel catheterization tools, for example, to access the aorta without surgery in patients with severe peripheral artery disease. NHLBI Cardiothoracic Surgery Research Branch investigators have used our interventional MRI system and environment to further test the feasibility and utility of real-time MRI guidance for surgical transapical implantation of a custom aortic stent valve bioprosthesis in swine. Overall we have successfully developed novel applications of real-time MRI for cardiovascular treatments, and we continue to work to clinical applications of these exciting new developments.

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Campbell-Washburn, Adrienne E; Tavallaei, Mohammad A; Pop, Mihaela et al. (2017) Real-time MRI guidance of cardiac interventions. J Magn Reson Imaging 46:935-950
Rogers, Toby; Ratnayaka, Kanishka; Khan, Jaffar M et al. (2017) CMR fluoroscopy right heart catheterization for cardiac output and pulmonary vascular resistance: results in 102 patients. J Cardiovasc Magn Reson 19:54
Ratnayaka, Kanishka; Moore, John W; Rios, Rodrigo et al. (2017) First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis. J Am Coll Cardiol 70:745-752
Rogers, Toby; Lederman, Robert J (2016) Exercise Magnetic Resonance Imaging Is a Gas. Circ Cardiovasc Imaging 9:
Rogers, Toby; Mahapatra, Srijoy; Kim, Steven et al. (2016) Transcatheter Myocardial Needle Chemoablation During Real-Time Magnetic Resonance Imaging: A New Approach to Ablation Therapy for Rhythm Disorders. Circ Arrhythm Electrophysiol 9:e003926
Rogers, Toby; Ratnayaka, Kanishka; Karmarkar, Parag et al. (2016) Real-time magnetic resonance imaging guidance improves the diagnostic yield of endomyocardial biopsy. JACC Basic Transl Sci 1:376-383
Campbell-Washburn, Adrienne E; Xue, Hui; Lederman, Robert J et al. (2016) Real-time distortion correction of spiral and echo planar images using the gradient system impulse response function. Magn Reson Med 75:2278-85
Khan, Jaffar M; Rogers, Toby; Schenke, William H et al. (2016) Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter MitralĀ Valve Replacement: Pre-Clinical Findings. JACC Cardiovasc Interv 9:1835-43
Ratnayaka, Kanishka; Rogers, Toby; Schenke, William H et al. (2016) Magnetic Resonance Imaging-Guided Transcatheter Cavopulmonary Shunt. JACC Cardiovasc Interv 9:959-70
McGuirt, Delaney; Mazal, Jonathan; Rogers, Toby et al. (2016) X-ray Fused With Magnetic Resonance Imaging to Guide Endomyocardial Biopsy of a Right Ventricular Mass. Radiol Technol 87:622-6

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