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Title: MRI-guided or assisted interventions for congenital heart disease
Author: Tzifa, Aphrodite
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2013
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Congenital heart disease occurs in 0.8-1% of children. A proportion of these patients will require interventional treatment in the form of cardiac catheterisation or surgery, whilst some will only require medical therapy. Echocardiography is the investigation of choice for diagnosis and follow-up of these patients, whilst magnetic resonance imaging (MRI) is now increasingly used in most centres to assess complex congenital cases and to answer specific questions, not possible to address with echocardiography. The ability to obtain anatomical together with quantitative physiological information, such as cardiac function and flows in one examination has led to more detailed assessment and analysis of congenital heart defects and continues to improve our understanding about congenital heart disease and its treatment options. Cardiac MRI scans have now mostly replaced cardiac catheterisation procedures, routinely performed up to a few years ago to aid diagnosis. In parallel, a new form of hybrid catheterisation has emerged by combining MRI with simultaneous pressure measurement in different cardiac chambers and vascular structures. The combination of X-Ray and MRI guided (XMR) catheterisations can address clinical questions, such as estimation of pulmonary vascular resistance and cardiac output response to stress accurately, without the limitation of haemodynamic assumptions during calculations. Further to more accurate physiological information, XMR catheterisation can also offer detailed anatomical information of structures not well seen on echocardiography or MRI alone, and most importantly limit or eliminate the radiation exposure to patient that have been repetitively exposed to X-Ray radiation. The purpose of the research work presented was two-fold: a. to extend the potentials of XMR-guided cardiac catheterisations, particularly in the area of pre-operative and post-interventional evaluation of congenital heart disease and b. to advance our already established programme of solely MR-guided diagnostic cardiac catheterisations in order to materialise the first-in-man solely MR-guided therapeutic cardiac catheterisations. In this way, transcatheter interventional procedures were aimed to be performed in the MR scanner in a similar fashion and with similar equipment to the ones used in the traditional catheterisation suite, without the exposure to ionising radiation. The work towards materialisation of this idea and the world-first clinical trial on solely MRI-guided cardiac interventions for congenital heart disease are being presented in this thesis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available