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Innovative procedure for diagnosing and monitoring pulmonary hypertension

Researchers at the Royal Free Hospital have performed cardiac catheterisation under MRI-guidance to provide better diagnosis and monitoring of pulmonary hypertension. This is the first time in the UK that this has been done in a standard clinical MRI scanner without a combined cardiac catheterisation laboratory.

Diagnosing and monitoring pulmonary hypertension using this single approach offers a new platform to drive novel research into the rare disease. Combining cardiac MRI with catheterisation provides more accurate information and makes the diagnostic pathway easier for patients. This approach to the procedure usually requires a specialist combined catheterization and MRI ‘hybrid’ laboratory, but MRI and cardiac catheterisation have been successfully combined using a simple clinical MRI scanner at the Royal Free Hospital.

The MRI scanner is used to help guide the catheter to the heart and lungs, with measurements of heart size and function being made at the same time. The monitor used throughout the procedure to measure pressures in the heart and lungs was funded by the BRC.

The technique, carried out by Dr Dan Knight and his team, has now been performed in 19 cases since December 2017. A patient who underwent the right heart catheter method said: “It was much better than having the two tests separately.”

The procedure has attracted global interest, with groups from Amsterdam and Greece having already visited the Royal Free to learn the technique. Further visits from teams in the United States have also been planned for this summer.

Pulmonary hypertension is a rare disorder of raised pressure in the lung arteries. The heart chamber that pushes blood to the lungs, called the right ventricle, has to pump against abnormally high pressures. As a result, right heart failure can develop and the patient experiences breathlessness. The current method to diagnose pulmonary hypertension involves directly measuring the pressures in the heart and lungs using a catheter. However, measuring how the right heart functions against these raised pressures has to be investigated by a separate test, a cardiac MRI scan.