MR fluoroscopy in vascular and cardiac interventions (review)

Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image–guided surgeries that offer improved patient management and cost effectiveness

Delayed complete recovery of graft dysfunction after cardiac transplantation

Primary graft dysfunction is a major cause of morbidity and mortality early after cardiac transplantation. We present here a case of unspecific graft dysfunction in a 47-year-old female recipient of a heart transplant that could not be attributed to the unusual causes of this disorder. The patient manifested symptoms and signs of heart failure early postoperatively, and echocardiography together with right heart catheterization confirmed the diagnosis. There was no body size mismatch, graft preservation was optimal, pulmonary vascular resistance preoperatively was normal, and rejection episodes could not explain her deterioration. Standard medical therapy for heart failure was initiated, and the patient’s symptoms improved, although graft dysfunction persisted for a period of 1.5 years. Afterward, a gradual spontaneous improvement occurred, resulting in complete recovery of graft function at six years postoperatively. In addition to the case presented, potential contributing factors to this syndrome, together with appropriate treatment options, are discussed