SPECIAL HOSPITAL
FILIP VTORI
CARDIOVASCULAR DISEASE MSCT ANGIOGRAPHY, CONVENTIONAL ANGIOGRAPHY, SURGICAL TREATMENT
Anatomy of coronary arteries
• Multislice (64) CT coronary angiography Noninvasive method, fast, precise and safe, without absolute contraindications. Compared to catheter angiography more patientfriendly 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 accurate 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, aortic root • Triple rule out (aortic dissection,pulmonary embolisam PE, CAD) • To provide examination we need MSCT, premedication with oral/i.v β blockers, regular heart rate <70 hbm, contrast enhancement and breath hold 8-20 sec.
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Anatomy of coronary arteries Multislice CT coronary angiography â&#x20AC;&#x201C; normal findings
coronary arteries 3-D volumerendered
right coronary artery
left circumflex artery
left descending artery
Conventional coronary angiography â&#x20AC;&#x201C; normal findings
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Coronary artery disease Multislice CT coronary angiography
left coronary artery
left coronary artery
Conventional coronary angiography
left coronary artery
left coronary artery
Significant stenosis of left anterior descending coronary artery (blue arrow), after stenting (red arrow).
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Coronary artery disease Multislice CT coronary angiography
left coronary artery
left coronary artery
Conventional coronary angiography
left coronary artery
left coronary artery
Nonsignificant narrowing of left anterior descending coronary artery (blue arrow), angio confirmed (red arrow).
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Coronary artery disease Multislice CT coronary angiography
Conventional coronary angiography
left coronary circumflex artery
left coronary circumflex artery
Significant narrowing of left circumflex coronary artery (blue arrow), after stenting (red arrow).
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Coronary artery disease Multislice CT coronary angiography
left coronary artery
Conventional coronary angiography
left coronary artery
Significant narrowing of left anterior descending coronary artery (blue arrow), for CABG (red arrow).
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Coronary artery disease Multislice CT coronary angiography
right coronary artery
right coronary artery
Conventional coronary angiography
right coronary artery
right coronary artery
Significant narrowing of right coronary artery (blue arrow), after stenting (red arrow).
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Coronary artery disease Multislice CT coronary angiography
left coronary artery
right coronary artery
right coronary artery
left descendence coronary artery
left circumflex coronary artery
Multiple significant coronary lesions for CABG (blue arrow).
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Coronary artery disease Multislice CT coronary angiography
left coronary artery
Conventional coronary angiography
left coronary artery
right coronary artery
Multiple significant coronary lesions for CABG (blue arrow) (red arrow).
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Congenital anomaly of coronary arteries Multislice CT coronary angiography
Agenesis of right coronary artery (blue arrow).
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Congenital anomaly of coronary arteries
Anomalus origin of left coronary artery from pulmonary artery ALCAPA syndrome.
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Coronary artery bypass Multislice CT coronary angiography
Arterial by-pass graft - left internal mammary artery (LIMA)
Venous aorto-coronary grafts
Coronary by-pass grafts
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Coronary artery bypass Multislice CT angiography of aorta and coronary arteries
Conventional angiography of aorta and coronary arteries
Postoperative multislice CT coronary angiography â&#x20AC;&#x201C; occlusion of arterial by-pass graft (blue arrow) left internal mammary artery, after reoperation (red arrow).
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Dissection of aorta - Stanford A Multislice CT angiography of aorta and coronary arteries
Preoperative image
right coronary artery
Postoperative image
left descendent coronary artery
left circumflex coronary artery
Stanford A dissection of aorta (white arrow), aneurysm of ascending aorta (blue arrow), coronary arteries with normal finding. Replacement of aorta ascendens and arcus with vascular graft (red arrow). Replacement of truncus brachiocephalicus (yellow arrow) and reimplantation of right coronary artery (green arrow). 15
Vascular anomalies - coarctation of aorta, bicuspide aortic valve Multislice CT angiography of aorta - congenital defect of aorta
right coronary artery
left marginal coronary artery
left circumflex coronary artery
left descendence coronary artery
Bicuspide aortic valve. Aortic aneurism of ascending aorta 60mm (blue arrow). Coarctation of aorta 9mm (green arrow) with intercostal collaterals (yellow arrow)
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Vascular anomalies - coarctation of aorta, bicuspide aortic valve Conventional angiography of aorta - congenital defect of aorta
Multislice CT angiography of aorta - congenital defect of aorta
Aortic stent (red arrow) because of coarctation. Replacement of aorta ascendens (root) (blue arrow) with graft native valve repair and reimplantation of coronay arteries (Tirone David) because of aortic aneurism.
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Vascular anomalies - coarctation of aorta
Narrowing at level of distal arch / descending aorta.
Multislice CT angiography of aorta - congenital defect of aorta
Coarctation of aorta 3mm
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Vascular anomalies - coarctation of aorta Multislice CT angiography of aorta - congenital defect of aorta
Coarctation of aorta 1cm (blue arrow) after stenting (red arrow). Aberrant Right subclavian artery.
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Vascular anomalies - Pulmonary sling Multislice CT angiography of aorta - congenital defect of aorta
In pulmonary sling the left PA originates from the right PA and courses between the esophagus and the trachea.
Pulmonary sling (blue arrow) with tracheal narrowing (red arrow)
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Vascular anomalies - Ductus arterious persistance Multislice CT angiography of aorta - congenital defect of aorta
The ductus arteriosus is the communication between the pulmonary artery and the proximal descending aorta.
Ductus arteriosus persistance
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Vascular anomalies - Transposition of great vessels of the heart
In cases of Transposition of the Great Arteries, these vessels arise from the wrong ventricle.
Multislice CT angiography of thoracic aorta with cardio protocol
They are â&#x20AC;&#x153;transposedâ&#x20AC;? from their normal position so that the aorta (red arrow) arises from the right ventricle and the pulmonary artery (blue arrow) from the left ventricle
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Vascular anomalies - Pentalogia fallot Multislice CT angiography of thoracic aorta with cardio protocol
Right aortic arch (blue arrow). (RV) outflow tract obstruction (RVOTO) infundibular stenosis (yellow arrow). ASD (Atrial Septal Defect 10mm), (green arrow) VSD (Ventricular Septal Defect 16mm) (red arrow)
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SPECIAL HOSPITAL
FILIP VTORI
bul. “Ilindenska”, 1000 Skopje, Republic of Macedonia Tel: +389 2 3091-500, +389 2 3091-484 www.cardiosurgery.com.mk