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Int J Cardiol. 2017 Mar 15;231:255-257. doi: 10.1016/j.ijcard.2016.12.147. Epub 2016 Dec 30.

Ferumoxytol MRA for transcatheter aortic valve replacement planning with renal insufficiency.

Author information

1
Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
2
Department of Cardiology, University of California, San Francisco, United States.
3
Department of Cardiology, San Francisco VA Medical Center, United States.
4
Department of Surgery, San Francisco VA Medical Center, United States.
5
Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States. Electronic address: michael.hope@ucsf.edu.

Abstract

BACKGROUND:

Computed tomography angiography (CTA) is the test of choice for pre-procedure imaging of transcatheter aortic valve replacement (TAVR) candidates. The iodinated contrast required, however, increases the risk of renal dysfunction in patients with pre-existing renal failure. Ferumoxytol is a magnetic resonance imaging (MRI) contrast agent that can be used with renal failure. Its long vascular resonance time allows gated MRA sequences that approach CTA in image quality. We present respiratory and cardiac gated MRA enabled by ferumoxytol that can be post-processed in an analogous fashion to CTA.

METHODS:

Seven patients with renal failure presenting for TAVR were imaged with respiratory and cardiac gated MRA at 3T using ferumoxtyol for contrast. Aortic annulus, root and peripheral access dimensions were calculated in a fashion identical to that used for CTA. Of these, 6 patients underwent a TAVR procedure and 5 had intraoperative valve assessment with transesophageal echocardiograph (TEE) using standard clinical protocols that employed both two- and three-dimensional techniques.

RESULTS:

Good correlation between MRA aortic annulus measurements and those from TEE were shown in 5 patients with mean annulus area of 392.4mm2 (290-470 range) versus 374.1mm2 (285-440 range), with a pairwise correlation coefficient of 0.92, p=0.029. All patients received Sapien valve implants (one 20mm, three 23mm, and two 26mm valves). Access decisions were guided by MRA with no complications. Annulus sizing resulted in no greater than trace/mild aortic regurgitation in all patients.

CONCLUSIONS:

Ferumoxytol MRA is a safe alternative to CTA in patients with renal failure for pre-TAVR analysis of the aortic root and peripheral access.

PMID:
28100426
PMCID:
PMC5303665
DOI:
10.1016/j.ijcard.2016.12.147
[Indexed for MEDLINE]
Free PMC Article

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