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

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).

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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