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. 2022 Nov 9;8(1):37–50. doi: 10.1016/j.jacbts.2022.07.002

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This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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Traversal of Chronic Myocardial Fibrosis Using Intramyocardial Guidewire Navigation

(A) Short-axis T1-weighted late gadolinium-enhanced cardiac magnetic resonance showing a 3-mm thick region of hyperenhancement in the lateral wall consistent with myocardial fibrosis (red arrowhead). (B) Intraprocedure short-axis intracardiac echocardiogram. The MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) guidewire traverses (black asterisk) the lateral left ventricular wall entering (blue arrowhead) and then exiting (green arrowhead) an area of myocardial fibrosis (red arrow). (C to E) The explanted heart shows guidewire (arrowhead) traversal through dense scar (black asterisk). (F and G) Tissue from the area of guidewire traversal in E and the corresponding hematoxylin-eosin (H&E)-stained section. Magnified area within the red box stained with (H) Masson’s trichrome and (I) hematoxylin-eosin showing dense replacement fibrosis and no healthy myocardium at the site of guidewire traversal (black asterisk). ICE = intracardiac echocardiography; LV = left ventricular; MRI = magnetic resonance imaging; PM = anterolateral papillary muscle.