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Interventional cardiovascular magnetic resonance (iCMR) makes new minimally invasive therapies possible and is an attractive alternative option with high soft-tissue contrast and the possibility of a three-dimensional MR angiography compared to conventional angiography-guided interventions. Interventional MR-navigated cardiovascular therapies represent a new discipline whose systematic development will foster minimally invasive interventional procedures without radiation exposure. MR-compatible endovascular catheters and guide wires are needed for delivery of devices and therapies. Catheter tracking is based on active and passive approaches. Currently performed MR-guided cardiovascular procedures have been used to monitor, navigate and track endovascular catheters and to deliver local therapies to the targets. Heating of endovascular MR catheters, guide wires and devices during imaging still presents high safety risks.Cardiovascular MR contrast media improve the capability of MRI by enhancing blood signal, pathologic targets (such as myocardial infarctions and atherosclerotic plaques) and tracking injected therapies (such as cells or genes). Labeling injected therapies or cells with MR contrast media leads interventionalists to trace the distribution, differentiation and survival. The requirements for this iCMR technique are (1) high spatial and temporal resolution imaging, (2) special catheters and devices, and (3) effective therapeutic drugs. This review summarizes current aspects of iCMR, provides examples of its use in the heart and beyond, discusses the infrastructure required for successful implementation of iCMR approaches, and outlines the challenges that must be overcome for iCMR to advance further.
