Real-time MRI guided percutaneous transthoracic left ventricular access and closure

Abstract

Introduction and objective Percutaneous transthoracic left ventricular (LV) access and closure would be an enabling technology for a wide range of structural heart, electrophysiologic and proximal aorta procedures. We propose a real-time MRI guided approach to access and close the LV using novel active devices. Methods Sixteen Yorkshire swine underwent percutaneous transthoracic LV access and followed up to three months (n=8). All procedures were guided by real-time bSSFP MRI (Espree, Siemens) using two slices along the needle trajectory and a short-axis slice for cardiac monitoring. Transthoracic ventricular puncture was performed using a customized 18G active needle with integrated loop coil. Puncture trajectory was planned using realtime MRI to identify optimal LV puncture target and trajectory with respect to intraventricular and valvular structures (Figure 1A). After needle entry, an 18-French sheath was inserted and anticoagulation begun.