C A R D I O V A S C U L A R D I S E A S EMSCT ANGIOGRAPHY, CONVENTIONAL ANGIOGRAPHY

C A R D I O V A S C U L A R D I S E A S EMSCT ANGIOGRAPHY, CONVENTIONAL ANGIOGRAPHY, SURGICAL TREATMENT

SPECIAL HOSPITALFILIP VTORI

2

• Multislice(64)CTcoronaryangiography

Noninvasive method, fast, precise and safe, without absolute contraindications.Compared to catheter angiography more patient-friendly procedure.

Advantages over conventional coronarography: • Noninvasive method with very high diagnostic

accuracy• Comfortable for the patient Informations for: • Wall, plaques and lumen of the blood vessels • Evaluation of surrounding structures

Clinical impact & indication Cardiac CT has a role in the management of patients especially with atypical angina. To provide an accu-rate diagnosis we need: high image quality, efficient post processing, clinical expertise

Indications:• Detection of coronary artery disease (CAD) for a

patient with atypical chest pain/angina• Screening in asymptomatic patients with high

risk for CAD • Evaluation of suspected coronary congenital

anomalies before/after cath lab• Coronary assessment before cardiac & vascular

surgery• Planning of interventions - stenting • Stent & coronary artery bypass-graft (CABG)

follow up • Evaluation of valvular, ventricular function, aor-

tic root• Triple rule out (aortic dissection,pulmonary em-

bolisam PE, CAD)• To provide examination we need MSCT, pre-

medication with oral/i.v β blockers, regular heart rate <70 hbm, contrast enhancement and breath hold 8-20 sec.

Anatomy of coronary arteries

3

Multislice CT coronary angiography – normal findings

right coronary artery

coronary arteries 3-D volumerendered

left circumflex artery left descending artery

Conventional coronary angiography – normal findings

Anatomy of coronary arteriesAnatomy of coronary arteries

4

Significantstenosisofleftanteriordescendingcoronaryartery(bluearrow),afterstenting(redarrow).

Multislice CT coronary angiography

Conventional coronary angiography

left coronary artery left coronary artery


Coronary artery disease

5



Nonsignificantnarrowingof leftanteriordescendingcoronaryartery(bluearrow),angioconfirmed(redarrow).


left coronary arteryleft coronary artery


6

Significantnarrowingofleftcircumflexcoronaryartery(bluearrow),afterstenting(redarrow).

left coronary circumflex artery left coronary circumflex artery




7

Significantnarrowingofleftanteriordescendingcoronaryartery(bluearrow),forCABG(redarrow).

left coronary artery





8

Significantnarrowingofrightcoronaryartery(bluearrow),afterstenting(redarrow).

right coronary artery right coronary artery

right coronary arteryright coronary artery




9

MultiplesignificantcoronarylesionsforCABG(bluearrow).




left circumflex coronary arteryleft descendence coronary artery



10

MultiplesignificantcoronarylesionsforCABG(bluearrow)(redarrow).







11

Agenesisofrightcoronaryartery(bluearrow).

Congenital anomaly of coronary arteries


12

AnomalusoriginofleftcoronaryarteryfrompulmonaryarteryALCAPAsyndrome.

Congenital anomaly of coronary arteries

13

Coronaryby-passgrafts

Arterial by-pass graft - left internal mammary artery (LIMA)

Venous aorto-coronary grafts

Coronary artery bypass


14

PostoperativemultisliceCTcoronaryangiography–occlusionofarterialby-passgraft(bluearrow)-leftinternalmammaryartery,afterreoperation(redarrow).

Multislice CT angiography of aorta and coronary arteries

Conventional angiography of aorta and coronary arteries

Coronary artery bypass

15

Multislice CT angiography of aorta and coronary arteries

StanfordAdissectionofaorta(whitearrow),aneurysmofascendingaorta(bluearrow),coronaryar-terieswithnormalfinding.Replacementofaortaascendensandarcuswithvasculargraft(redarrow).Replacementoftruncusbrachiocephalicus(yellowarrow)andreimplantationofrightcoronaryartery(greenarrow).

Preoperative image Postoperative image

left circumflex coronary arteryleft descendent coronary arteryright coronary artery

Dissection of aorta - Stanford A

16

Bicuspideaorticvalve.Aorticaneurismofascendingaorta60mm(bluearrow).Coarctationofaorta9mm(greenarrow)withintercostalcollaterals(yellowarrow)

Multislice CT angiography of aorta - congenital defect of aorta

Vascular anomalies - coarctation of aorta, bicuspide aortic valve

right coronary artery left circumflex coronary artery

left marginal coro-nary artery

left descendence coronary artery

17


Aorticstent(redarrow)becauseofcoarctation.Replacementofaortaascendens(root)(bluearrow)withgraftnativevalverepairandreimplantationofcoronayarteries(TironeDavid)becauseofaorticaneurism.

Conventional angiography of aorta - congenital defect of aorta

Vascular anomalies - coarctation of aorta, bicuspide aortic valve

18

Coarctationofaorta3mm

Narrowing at level of distal arch / descending aorta.

Vascular anomalies - coarctation of aorta


19

Coarctationofaorta1cm(bluearrow)afterstenting(redarrow).AberrantRightsubclavianartery.

Vascular anomalies - coarctation of aorta


20

Pulmonarysling(bluearrow)withtrachealnarrowing(redarrow)

In pulmonary sling the left PA originates from the right PA and courses between the esophagus and the trachea.

Vascular anomalies - Pulmonary sling


21

Ductusarteriosuspersistance

Vascular anomalies - Ductus arterious persistance

The ductus arteriosus is the communication between the pul-monary artery and the proximal descending aorta.


22

Theyare“transposed”fromtheirnormalpositionsothattheaorta(redarrow)arisesfromtherightventricleandthepulmonaryartery(bluearrow)fromtheleftventricle

Vascular anomalies - Transposition of great vessels of the heart

Multislice CT angiography of thoracic aorta with cardio protocol

In casesofTranspositionof theGreatArteries,thesevesselsarisefromthewrongventricle.

23

Rightaorticarch(bluearrow).(RV)outflowtractobstruction(RVOTO)infundibularstenosis(yellowarrow).ASD(AtrialSeptalDefect10mm),(greenarrow)VSD(VentricularSeptalDefect16mm)(redarrow)

Vascular anomalies - Pentalogia fallot

Multislice CT angiography of thoracic aorta with cardio protocol

bul. “Ilindenska”, 1000 Skopje, Republic of MacedoniaTel: +389 2 3091-500, +389 2 3091-484

www.cardiosurgery.com.mk

SPECIAL HOSPITALFILIP VTORI

C A R D I O V A S C U L A R D I S E A S EMSCT ANGIOGRAPHY, CONVENTIONAL ANGIOGRAPHY

Documents

conventional angiography

s emsct angiography

catheter angiography

r d i s e

r d i o v

high risk

evaluation of valvular

patient informations