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MR Enhancing Implants

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Intraoperative Imaging and Image-Guided Therapy

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Abstract

Implantation of cardiovascular implants such as stents, prosthetic heart valves or vena cava filters (VCF) are usually performed using X-ray-based imaging techniques (fluoroscopy) in a cath lab. Possible migration and intraluminal changes in the implants require a post interventional follow-up diagnostic procedure. For example, restenosis (up to 25 %) and late in-stent thrombosis (up to 2 % by in drug-eluting stents and despite dual anti-platelet therapy with aspirin and thienopyridine up to 6 % in diabetes patients) frequently occur after the implantation of a vascular stent. Vena cava filter is by nature subject of thrombus capturing. For explantation and retrieval, it must be assured that no large blood clot formations are still present in the filter. Prosthetic heart valves and the recently introduced balloon and self-expanding heart valves for transapical and TAVI procedure require follow-up imaging of possible complications such as paravalvular leakages, valve thrombosis or malfunction of the valve leaflets which are made of bovine pericardium or porcine heart valves. Therefore, post interventional non-invasive follow-up diagnostic is needed. Transthoracic ultrasound (TUS) is the method of choice for routine follow-up but due to the sound scattering at the valve scaffold, diagnosis is compromised. More thorough diagnosis can be achieved by invasive techniques such as transesophageal endoscopic ultrasound (TEE) or intravascular ultrasound (IVUS) reveals more information but still the sound scattering leaves gaps in the diagnoses of valve function. X-ray-based invasive imaging with iodinated contrast agents can be applied but the disadvantage of this diagnostic method is, additional to the ionising radiation, adverse reactions to iodinated contrast agents. This includes general (acute and delayed) and organ-specific adverse effects (contrast-induced nephrotoxicity and cardiovascular, pulmonary and neurotoxicity) and occurs, for example, in 17–35 % of patients with history of previous adverse reaction (some of the predisposing factors for an adverse reaction are: infants and elderly, history of asthma or allergy, dehydration and heart disease).

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Acknowledgement

The work has been supported by the Northern Research Partnership, Scottish Government SMART programme, BMBF Germany and the EU FP7 frame work Marie Curie programme, http://www.IIIOS.eu under grant agreement #238802

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Authors and Affiliations

  1. Institute for Medical Science and Technology IMSaT of the Universities Dundee and St Andrews, Dundee, Scotland, UK

    Andreas Melzer MD, DDS

  2. VueKlar Cardiovascular Ltd., Edinburgh, UK

    Andreas Melzer MD, DDS & Richard Boyd

  3. Institute for Medical Science and Technology IMSaT, University of Dundee, Dundee, Scotland, UK

    Erwin Immel PhD

  4. West German Heart Center, University Essen, Essen, Germany

    Daniel Wendt MD

Authors
  1. Andreas Melzer MD, DDS
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  2. Erwin Immel PhD
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  3. Richard Boyd
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  4. Daniel Wendt MD
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Corresponding author

Correspondence to Andreas Melzer MD, DDS .

Editor information

Editors and Affiliations

  1. National Center for Image Guided Therapy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Ferenc A. Jolesz

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Melzer, A., Immel, E., Boyd, R., Wendt, D. (2014). MR Enhancing Implants. In: Jolesz, F. (eds) Intraoperative Imaging and Image-Guided Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7657-3_55

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  • DOI: https://doi.org/10.1007/978-1-4614-7657-3_55

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