University Hospitals Harrington Heart & Vascular Institute has developed a novel solution for one procedure affected by the nationwide shortage of contrast dye. Cardiologists at the Cleveland hospital recently were the first to report using cardiovascular magnetic resonance imaging (CMR) for left atrial appendage closure preprocedural planning. Left atrial appendage closure (LAAC) is a minimally invasive procedure that reduces the risk of stroke which results from atrial fibrillation (Afib). Afib is a common form of arrhythmia, a condition in which the heart beats out of rhythm. For optimal results, LAAC must include diligent preprocedural planning to accurately predict the size of device needed. Traditionally, this is done by Coronary CT angiography (CTA), which uses contrast dye.
Here is the conclusion from the report, recently published in The Journal of the American College of Cardiology:
Coronary CT angiography (CTA) and transesophageal echocardiogram (TEE) are both accepted imaging modalities for LAAC planning. However, TEE used for structural interventions has been associated with serious complications. While CTA has advantages over TEE for LAAC planning, it is contraindicated in patients with renal dysfunction. Our case report highlights the possibility of using cardiovascular magnetic resonance imaging (CMR) for select patients. Here we present a case in which a patient was unable to tolerate TEE from prior stroke and CTA was contraindicated due to renal dysfunction. CMR provided detailed anatomy of the LAA, without risk of renal injury or radiation exposure, and accurately predicted the appropriately-sized device in our patient.
