Journal of Cardiovascular Computed Tomography - Articles in Press

Study of Hemodynamics of Abdominal Aortic Dissection with ECG-gated CT: Letter to the Editor - Accepted Manuscript

Farhood Saremi — 2010-02-08

Study of Hemodynamics of Abdominal Aortic Dissection with ECG-gated CT: Letter to the Editor, Author Response - Accepted Manuscript

Michael A. Bolen — 2010-02-08

Computed tomography of pulmonary venous variants and anomalies - Accepted Manuscript

Prabhakar Rajiah, Jeffrey P. Kanne — 2010-01-29

Abstract: Radiofrequency ablation of the pulmonary veins is a well established technique in the management of atrial fibrillation. Computed tomography (CT) plays an important role in the evaluation of these patients, especially delineating pulmonary venous anatomy, anatomic variations, and complications following radiofrequency ablation. CT scan is characterized by high spatial and temporal resolutions, multiplanar reconstruction capabilities, and wide field of view. Knowledge of the normal pulmonary venous anatomy, anatomic variants, and optimal scanning protocol is essential for preablation planning and for evaluation of postablation complications. In this pictorial review, the CT appearances of various pulmonary venous variants and anomalies are discussed and illustrated.

Adenosine-Stress Dynamic Myocardial Volume Perfusion Imaging with Second Generation Dual-Source CT: Concepts and First Experiences - Accepted Manuscript

2010-01-28

Abstract: Recent research suggests that multi detector-row CT may have potential as a standalone modality for integrative imaging of coronary heart disease, including the assessment of the myocardial perfusion. However, the technical prerequisites for volumetric, time-resolved imaging of the passage of a contrast medium bolus through the myocardium have only been met with latest generation wide-detector CT scanners. Second generation dual-source CT enables performing ECG-synchronized dynamic myocardial perfusion imaging by means of a dedicated “shuttle” mode. With this acquisition mode, image data can be acquired during contrast medium infusion at two alternating table positions with the table shuttling back and forth between the two positions covering a 73 mm anatomic volume. We applied this acquisition technique for detecting differences in perfusion patterns between healthy and diseased myocardium and for quantifying myocardial blood flow under adenosine stress in three patients with coronary heart disease. According to our initial experience, the addition of adenosine stress volumetric dynamic CT perfusion to a cardiac CT protocol comprising coronary artery calcium quantification, prospectively ECG-triggered coronary CT angiography, and delayed acquisition appears promising for the comprehensive assessment of coronary artery luminal integrity, cardiac function, perfusion, and viability with a single modality.

Journal introduction - Uncorrected Proof

Allen J. Taylor — 2010-01-25

It's the start of a new decade in cardiovascular computed tomography (CVCT) and with that comes the opportunity to look forward to another exciting year of growth and development in the field! What are your personal “New Year's resolutions” for your practice of CVCT? Haven't set any? Here are some suggestions! “In the coming year, I resolve to….”Submit a manuscript to JCCT!Read every issue of JCCT!Share my copy of JCCT with a friend!Cite JCCT in my own work!Mentor a colleague in CVCT!Reduce radiation exposure in my laboratory!Achieve certification by CBCCT!Measure the “appropriateness” of CT indications in my lab!Read the SCCT CT guidelines (published in JCCT)!Attend and submit an abstract to the annual scientific meeting of SCCT!Encourage a friend to join SCCT!

One of 600,000 - Uncorrected Proof

Jack A. Ziffer — 2010-01-25

Dear Colleagues,

Relation of coronary artery plaque location to extent of coronary artery disease studied by computed tomographic angiography - Uncorrected Proof

2010-01-21

Background: Distal coronary artery disease (CAD) is less amenable to surgery or stenting compared with proximal disease. However, little is known about the epidemiology of distal versus proximal CAD.Methods: We determined the prevalence and factors associated with proximal, mid, and distally located plaque in the left anterior descending, left circumflex, and right coronary arteries in 418 subjects without prior CAD history who underwent coronary computed tomographic angiography for symptoms or stress test results. Clinical characteristics and coronary artery calcium (CAC) scores were also determined.Results: Most subjects (88%) had plaque, but only 18% of plaques were associated with stenosis >50%. In subjects with single-vessel plaque, only 7% had distal plaque, whereas 75% had proximal plaque. With 3-vessel plaque, 70% had distal and 100% had proximal plaques. Of subjects with a single location of plaque along a vessel, most had proximal plaque (69%); isolated distal-vessel plaque was rare (2%). Distal plaque was dominantly found in association with both proximal and mid plaque (88%). After multivariable adjustment for demographics, traditional, and nontraditional risk factors, both increasing number of vessels with plaque and clinically significant CAC scores were independently associated with higher odds of distal plaque, whereas associations of traditional risk factors were weaker. Distal plaque was independently associated with stenosis > 50%.Conclusion: These data support the concept that early lesions are most often proximal and that CAC scoring may be a poor screening tool for detecting proximal disease. Furthermore, distal lesions are more associated with advanced disease than with traditional cardiovascular risk factors.

A bullet wandering through the heart - Uncorrected Proof

2010-01-21

Abstract: ▪▪▪

Cardiac computed tomography in the emergency department: A patient with acute epigastric pain - Uncorrected Proof

2010-01-21

Abstract: We report the application of coronary CT angiogram in urgent assessment of a patient presenting to the emergency department with acute and nonspecific cardiothoracic symptoms.

Influence of slice thickness and reconstruction kernel on the computed tomographic attenuation of coronary atherosclerotic plaque - Uncorrected Proof

2010-01-21

Background: The computed tomographic (CT) attenuation of coronary atherosclerotic plaque has been proposed as a marker for tissue characterization and may thus potentially contribute to the assessment of plaque instability.Objective: We analyzed the influence of reconstruction parameters on CT attenuation measured within noncalcified coronary atherosclerotic lesions.Methods: Seventy-two patients were studied by contrast-enhanced dual-source CT coronary angiography (330 millisecond rotation time, 2 × 64 × 0.6 mm collimation, 120 kV, 400 mAs, 80 mL contrast agent intravenously at 6 mL/s), and a total of 100 distinct noncalcified coronary atherosclerotic plaques were identified. Image data sets were reconstructed with a soft (B20f), medium soft (B26f), and sharp (B46f) reconstruction kernel. With the medium soft kernel, image data sets were reconstructed with a slice thickness/increment of 0.6/0.3 mm, 0.75/0.4 mm, and 1.0/0.5mm. Within each plaque, CT attenuation was measured.Results: Mean CT attenuation using the medium soft kernel was 109 ± 58 HU (range, −16 to 168 HU). Using the soft kernel, mean density was 113 ± 57 HU (range, −13 to 169 HU), and using a sharp kernel, mean density was 97 ± 49 HU (range, −23 to 131 HU). Similarly, reconstructed slice thickness had a significant influence on the measured CT attenuation (mean values for medium soft kernel: 102 ± 52 HU versus 109 ± 58 HU versus 113 ± 57 HU for 0.6-mm, 0.75-mm, and 1.0-mm slice thickness). The differences between 0.75-mm and 0.6-mm slice thickness (P = 0.05) and between medium sharp and sharp kernels (P = 0.02) were statistically significant.Conclusions: Image reconstruction significantly influences CT attenuation of noncalcified coronary atherosclerotic plaque. With decreasing spatial resolution (softer kernel or thicker slices), CT attenuation increases significantly. Using absolute CT attenuation values for plaque characterization may therefore be problematic.

Society News - Uncorrected Proof

2010-01-15

Coronary distensibility index measured by computed tomography is associated with the severity of coronary artery disease - Uncorrected Proof

2010-01-14

Background: Atherosclerotic changes within the coronary artery wall can affect vessel distensibility.Objective: This study evaluated the relationship between the coronary distensibility index (CDI) and the severity of coronary artery disease (CAD) measured by computed tomographic angiography (CTA).Methods: One hundred thirteen subjects, age 63 ± 10 years, 32% women, who underwent coronary artery calcium (CAC) scanning and CTA, were studied. Early diastolic and mid diastolic (MD) cross-section area (CSA) of the left anterior descending (LAD) artery were measured 5 mm distal to the left main bifurcation. CDI was defined as Δlumen CSA/[lumen CSA in MD × estimated central pulse pressure (eCPP)] × 103 {eCPP = 0.77 × peripheral pulse pressure}. LAD diameter measured by CTA and quantitative coronary angiography (QCA) was compared in 19 subjects without CAD. CAD was defined as normal (no stenosis and CAC 0), mild (stenosis ≤ 30%), moderate (stenosis 31%–69%), and severe (stenosis ≥ 70%) on CTA.Results: Excellent correlation was observed between CTA and QCA measured by CDI (r2 = 0.96, P = 0.0001). CDI decreased from normal coronaries (6.75 ± 1.43) to arteries with mild (5.78 ± 1.45), moderate (3.96 ± 1.06), and severe (3.31 ± 1.06) disease (P = 0.004). The risk factor adjusted odds ratio of lowest versus 2 upper tertiles of CDI was 1.28 for mild, 8.47 for moderate, and 10.59 for severe CAD compared with the normal cohort. The area under the ROC curve to predict obstructive CAD (stenosis ≥ 50%) increased significantly from 0.71 to 0.84 by addition of CDI to CAC (P < 0.05).Conclusion: CTA-measured CDI is inversely related to the severity of CAD independent of age, sex, cardiovascular risk factors, and CAC.

Intravenous leiomyoma extending into the right ventricle - Uncorrected Proof

2010-01-14

Abstract: We present a case of a retroperitoneal leiomyoma invading the inferior vena cava and extending to the right ventricle. The tumor was visualized with electrocardiographic-gated dual-source computed tomography, showing a low-density, lobulated mass invading the inferior vena cava and prolapsing through the tricuspid valve during diastole. Cardiac computed tomography is useful in assessing the extension and hemodynamic effect of intracardiac masses.

Novel variant of dual left anterior descending coronary artery - Uncorrected Proof

2010-01-14

Abstract: A 29-year-old African American man presented with atypical chest pain. Coronary computed tomographic angiography (64-slice) showed a previously not described variant of dual (duplicated) left anterior descending artery (LAD). Duplication of LAD is a rare anomaly and has been categorized into 4 angiographic subtypes based on the origin, course, and termination of the short and long LAD. Our case is unique in that, unlike previous subtypes, the short LAD originates independently from the left coronary sinus and that the long LAD arises from the right coronary sinus and has an intramyocardial course before reaching the distal interventricular groove. It can be, thus, considered a new variant of dual LAD (type V).

Distribution matters: Diagnostic value of coronary plaque in distal segments - Uncorrected Proof

Stefan Möhlenkamp — 2010-01-11

Cardiac computed tomography (CT) has become a valuable tool for quantification of coronary artery plaque, whether calcified or not, because its extent is strongly related to the severity of angiographic obstructive coronary artery disease (CAD) and identifies subjects at increased risk of future coronary events at preclinical stages of the disease. Early pathoanatomic, histomorphometric, and cardiac CT-based studies found consistent evidence that advanced atherosclerotic lesions are most frequently located at the proximal left anterior descending coronary artery followed by the left circumflex and right coronary arteries. The prevalence of atherosclerotic lesions is lower within distal segments, particularly the left coronary artery. Similarly, the rate of progression of coronary plaque was found to be highest in the proximal left coronary artery, whereas plaque progression was more uniform throughout the right coronary artery.

Left atrial size: When an imperfect measurement may be close enough - Uncorrected Proof

Daniel W. Entrikin — 2010-01-11

Few measurements in cardiovascular imaging have such wide-reaching clinical implications as left atrial (LA) size. Increasing LA size has been shown to be independently associated with increased risks of atrial fibrillation, systemic thromboembolism, congestive heart failure, and all-cause cardiovascular death. Over the years, techniques to measure LA size have ranged from M-mode echocardiography, 2-dimensional (2D) echocardiography, volumetric calculations from 2D echocardiography, 3-dimensional (3D) echocardiography, and cardiac magnetic resonance imaging (MRI). Cardiac-gated computer-assisted tomography (cardiac CT) has now emerged as an additional option for the measurement of LA size. Despite these many imaging options, the assessment of LA size has been recognized for years as being problematic. It is now widely accepted that volumetric measurements are the preferred techniques to assess LA size, because they avoid errors related to geometric assumptions, and they show a stronger relationship with cardiovascular disease states than do linear LA dimensions.

Challenge of coronary stent imaging - Uncorrected Proof

Koen Nieman — 2010-01-11

Although cardiac computed tomography (CT) has become an accepted diagnostic option for the management of patients with suspected coronary artery disease, its utility is less evident in patients with established coronary artery disease, for instance after percutaneous coronary intervention (PCI). Most of the currently available stent devices are made of metal for radial strength after expansion combined with longitudinal flexibility. Despite these mechanical advantages, the metal is also responsible for strong roentgen attenuation, which complicates noninvasive angiographic assessment by cardiac CT. Disproportional attenuation of low-energy photons by the stent shifts the roentgen spectrum of the remaining x-ray toward higher energy levels (beam hardening), which decreases roentgen attenuation and causes shadowing behind high-density material on CT images. In addition, the relatively limited spatial resolution of cardiac CT combined with convolution filters and residual coronary motion increases the apparent size of stent struts on CT (blooming artifacts). Although the extent of interference highly varies between different stent types (in terms of the type of metal and stent design), in vitro studies of stationary stents showed that on average nearly one-half of the in-stent lumen is affected by these blooming artifacts.

Computed tomography of the pericardium and pericardial disease - Uncorrected Proof

Prabhakar Rajiah, Jeffrey P. Kanne — 2010-01-11

Abstract: The spectrum of pericardial abnormalities includes congenital absence, pericardial cyst, pericarditis, effusion, construction, tamponade, retained foreign body, and neoplasms. Because of it high spatial and temporal resolutions, multiplanar reconstruction capability, and large field of view, computed tomography (CT) is a very useful tool in the comprehensive anatomical and functional evaluation of the pericardium. Knowledge of normal pericardial anatomy, anatomic variants, and imaging appearances of various pericardial abnormalities is essential for accurate diagnoses and characterization. In this pictorial review, the CT appearances of the normal pericardium and pericardial abnormalities are discussed and illustrated.

Suture-induced right coronary artery stenosis - Corrected Proof

Martin Seltmann, Stephan Achenbach, Gerd Muschiol, Richard Feyrer — 2010-01-11

Abstract: An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

A meandering mesenteric artery - Corrected Proof

2010-01-11

Abstract: An 83-year-old woman with a history of peripheral vascular disease presented for evaluation of lower left extremity discomfort. A peripheral multidetector CT angiography showed a dilated inferior mesenteric artery acting as an important source of retrograde collateral perfusion secondary to a celiac axis stenosis.

Erratum - Uncorrected Proof

2009-12-21

In the September/October 2009 issue of Journal of Cardiovascular Computed Tomography, in the article by Srichai and colleagues titled “Dual-source computed tomography angiography image quality in patients with fast heart rates” (2009;3:300-309; doi:10.1016/j.jcct.2009.05.014), the fifth author's name appears incorrectly. The correct spelling is Jessica Bod.

Response - Uncorrected Proof

Matthew Budoff, on behalf of all authors — 2009-12-21

Although we agree that much of the robustness of our model was based on the coronary artery calcification (CAC) scan, no imaging test other than CTA would have led to the same results. The ability to do CTA literally within minutes of the CAC scan, at the same setting and time, assisted the model in getting the firefighters back to active duty in a cost-effective and timely manner. The CAC scan is not sufficiently specific enough for obstructive disease to be a stand-alone test, and adding CT angiography at the same setting, when needed, added significantly to the study outcomes. Sequential CAC and stress echocardiography or CAC and stress nuclear testing certainly have appeal but would not be a logical substitute in this setting, when patients are already on the CT table, and adding a CTA requires less than 5 minutes of preparation and 10 minutes of testing (inserting an intravenous catheter and subsequent injection of contrast). Furthermore, the incremental information related to stenosis location and severity may provide better guidance to need for future revascularization in this high-risk cohort. A recent study by Berman et al demonstrated that only 59% of patients with significant left main stenosis showed ≥10% ischemic burden on nuclear testing, results that would question the utility of that test in a setting where ruling out critical disease is paramount and cardiac risk is so elevated.

Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions - Corrected Proof

2009-12-18

Background: Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.Objective: We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT.Methods: Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined.Results: Eighty-three patients (mean age, 61.5±12.5 years; n=67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53–0.77), 100% (95% CI, 0.76–1.00), 100% (95% CI, 0.90–1.00), and 41% (95% CI, 0.26–0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51–0.64), 100% (95% CI, 0.99–1.00), 99% (95% CI, 0.94–1.00), and 92% (95% CI, 0.90–0.93), respectively, to detect myocardial hypoenhancement.Conclusions: Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions.

Screening asymptomatic firefighters - Uncorrected Proof

Stephen Fleet — 2009-12-14

In the article by Budoff et al the authors demonstrated that an anatomic strategy of coronary calcium score (CCS) followed by CT angiography (CTA) is more cost-effective than a myocardial perfusion imaging (MPI) strategy in screening firefighters for significant coronary artery disease. The “take-home lesson,” however, may be that CCS itself is such a robust screening tool that it may be followed by any imaging method one wishes to use with both clinical and cost effectiveness. Accordingly, CCS followed by MPI, stress echocardiography, or CTA might all be reasonable strategies, depending on availability and cost. It is primarily the CCS that is acting as gatekeeper, not the CTA.

Aortic valve calcification and subclinical coronary atherosclerosis - Uncorrected Proof

Naser Ahmadi, Melvin Clouse — 2009-12-14

Aortic valve calcification (AVC) is the most frequent cause of aortic stenosis (AS) in Western countries and has long been considered a passive degenerative process. However, recent data have challenged this concept, showing that AVC is an active, highly regulated process with histologic similarities to atherosclerosis.

Relationship of aortic valve calcification with coronary artery calcium severity: The Multi-Ethnic Study of Atherosclerosis (MESA) - Uncorrected Proof

2009-12-14

Background: Aortic valve calcification (AVC) and atherosclerosis share causative and pathologic features.Objective: We evaluated the relationship between AVC and coronary artery calcium (CAC) severity in the Multi-Ethnic Study of Atherosclerosis (MESA).Methods: Men and women aged 45–84 years (n=6809; mean age, 62 years) were studied. The presence and burden of AVC and CAC were determined by noncontrast cardiac computed tomography. Relative risk regression was used to model the probability of AVC as a function of CAC>0 as well as CAC categories (0, 1–99, 100–399, and ≥400) with the reference group being CAC=0.Results: The prevalence of AVC and CAC was 13% and 50%, respectively. Among those without CAC, the prevalence of AVC was 5% and increased across levels of CAC severity such that 14%, 25%, and 38% had AVC with increasing CAC scores of 1–99, 100–399, and ≥400, respectively (P for trend<0.0001). After controlling for patient demographic factors and cardiovascular risk factors, the prevalence ratio of AVC among those with mild CAC (1–99) was 1.83 (95% CI, 1.45–2.31) and increased to 3.36 (95% CI, 2.56–4.42) for CAC≥400. Similar statistically significant increased risk of AVC was found when CAC was assessed as a continuous variable.Conclusion: Our study shows that AVC is independently associated with increasing severity of CAC.

Axial area and anteroposterior diameter as estimates of left atrial size using computed tomography of the chest: Comparison with 3-dimensional volume - Uncorrected Proof

2009-11-30

Background: Left atrial (LA) size has incremental value in risk stratification.Objectives: We aimed to assess feasibility and reproducibility of 2 quick measures of LA size by chest CT (axial LA area and LA anteroposterior [AP] diameter) by using contrast-enhanced and CT scans.Methods: We measured LA size in 100 contrast-enhanced 64-slice multidetector CT (MDCT) scans (randomly selected from the ROMICAT collective) by (1) axial LA area at the level of the left ventricular outflow tract and the mitral valve leaflets, (2) AP diameter in 3-chamber view, and (3) 3-dimensional (3D) LA volume by Simpson's methods. We assessed interobserver and intraobserver intraclass correlation coefficient (ICC) for axial LA area and AP diameter as well as their correlation to 3D LA volume. For axial area, feasibility and reproducibility were also determined in 100 non–contrast MDCT scans, randomly selected from the Framingham Heart Offspring collective.Results: In contrast-enhanced CT, both LA axial area and AP diameter had excellent reproducibility (interobserver: axial area: ICC, 0.96, mean relative difference, 2.4% ± 7.4%; AP diameter: ICC, 0.91, 3.6% ± 7.2%; intraobserver: axial area: ICC, 0.99, 0.4% ± 5.2%; AP diameter: ICC, 0.94, 1.7% ± 5.5%). Correlations with 3D volume were better for axial area (r=0.88) than for AP diameter (r=0.67). In non–contrast images, axial area could be assessed with excellent reproducibility (interobserver: ICC, 0.96, 0.5% ± 8.3%; intraobserver: ICC, 0.99, 0.01% ± 4.4%).Conclusion: Both AP diameter and axial LA area permit quick and reproducible estimates of LA volume in contrast-enhanced and non–contrast electrocardiographic-gated chest CT. However, LA area should be used preferably over AP diameter because of its better agreement to 3D LA volume.

Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography - Uncorrected Proof

2009-11-30

Background: Many studies have used multidetector computed tomography (MDCT) angiography to evaluate coronary stents qualitatively but not quantitatively.Objectives: This study sought to validate a method of quantitatively evaluating stent patency by using 64-row compared with invasive coronary angiography (ICA) and to evaluate the stent size threshold of MDCT in detecting stent patency.Methods: Stented lesions (n=122) in 55 patients (age, 65±10 years; 90% men) who underwent both 64-row MDCT and ICA were studied. Density measurements in Hounsfield units (HUs) and stent diameters in millimeters were recorded in the stented segments, with the density of the ascending aorta (AO) taken as a reference. The ratio of the average of stent's proximal, middle, and distal densities to mean AO density was defined as the AS/AO HU. Threshold values for the detection of stent patency were examined by using receiver operator characteristic (ROC) curve analysis.Results: One hundred six of 122 stents were interpretable. By ICA, 24 stents were found to have in-stent restenosis (22 interpretable and 2 noninterpretable with MDCT). The ROC curve showed that the optimal cutoff value of AS/AO HU to predict stent patency on MDCT was 0.81 with sensitivity of 90.9%, specificity of 95.2%, and the optimal stent diameter cutoff value was ≥2.5mm with a sensitivity of 91.8% and a specificity of 93.8%.Conclusion: With 64-row MDCT, coronary stent patency can be evaluated quantitatively with high sensitivity and specificity and with adequate diagnostic accuracy in stents ≥2.5mm in diameter.

Consider charity with caution - Uncorrected Proof

Thomas W. Johnson, Christopher Occleshaw, Mark W. Webster — 2009-11-30

Abstract: Cardiac CT offers a non-invasive diagnostic alternative to coronary angiography in the diagnosis of spontaneous coronary dissection.

Images of persistent left superior vena cava draining directly into left atrium and secundum-type atrial septal defect - Uncorrected Proof

Burcu Demirkan, Omer Gungor, Aysel Turkvatan, Yesim Guray, Umit Guray — 2009-11-30

Abstract: The images of persistent left superior vena cava with the absence of the right superior vena cava are presented in a patient with the diagnosis of secundum-type atrial septal defect.

Sternal erosion detected by computed tomographic angiography before repeat sternotomy in an adolescent with congenital heart disease - Uncorrected Proof

Kevin O. Herman, U. Joseph Schoepf, Scott M. Bradley, Anthony M. Hlavacek — 2009-11-30

Abstract: The case of a 17-year-old male with congenital heart disease who was found to have erosion of a pseudoaneurysm into his posterior sternum is presented. The pseudoaneurysm originated from a right ventricle–to–pulmonary artery homograft, which had been placed 11 years before. It had not been appreciated by echocardiography. The pseudoaneurysm and erosion were visualized with computed tomographic angiography before scheduled surgical replacement of the homograft. This unexpected finding was critical for operative planning and was confirmed on direct visualization in the operating room.

Training in cardiovascular computer tomography: The Fellows-In-Training perspective - Corrected Proof

Ritesh Dhar, Sanjay Bhojraj, Mouaz H. Al-Mallah — 2009-11-30

Background: Cardiovascular computed tomography angiography (CCTA) is an emerging diagnostic technique in the evaluation of patients with suspected coronary artery disease. The recent CoCATS guidelines recommend that all cardiovascular fellows be exposed to CCTA in their training programs; however, not all programs have the ability to provide such training.Objective: This study aims to describe the present opinions of Fellows-in-Training (FIT) toward CCTA training.Methods: Cardiovascular FITs in the state of Michigan were contacted through the American College of Cardiology, Michigan chapter, e-mail list and were asked to complete a 12-question anonymous survey examining attitudes toward CCTA.Results: Sixty (54%) of 112 FITs completed the survey. Ninety-one percent of respondents had a CCTA program at their hospital and 52 (87%) considered CCTA important toward increasing their professional competitiveness. In addition, 93% had interest in obtaining at least level 2 training irrespective of their future career plans. The most important factors influencing their choice of third-party courses were cost, number of live cases, and student-to-faculty ratio. Finally, 47% supported creating an additional fourth year of training in advanced imaging, and 40% would pursue such training.Conclusion: Most cardiovascular FITs are interested in seeking advanced training in CCTA. Cardiovascular training programs should incorporate CCTA in their core curriculum to meet the increasing interest in CCTA among trainees.

Role of cardiac computed tomography in planning and evaluating percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy - Corrected Proof

Satoshi Okayama, Shiro Uemura, Tsunenari Soeda, Manabu Horii, Yoshihiko Saito — 2009-10-22

Abstract: A 72-year-old woman with hypertrophic obstructive cardiomyopathy underwent coronary computed tomography (CT) angiography that showed perfusion of the hypertrophied interventricular septum by the first septal artery. One month after percutaneous transluminal septal myocardial ablation, repeat CT perfusion imaging identified a transmural myocardial infarction in the basal hypertrophic interventricular septum which clinically correlated with a reduction in left ventricular outflow tract obstruction.

Uncorrected pink tetralogy of Fallot in an adult patient: Incidental CT findings - Corrected Proof

Thanongchai Siriapisith, Jitladda Wasinrat, Damras Tresukosol — 2009-08-10

Abstract: Tetralogy of Fallot (TOF), one of the most common congenital heart diseases, has four major components: right ventricular hypertrophy, overriding aorta, membranous ventricular septal defect, and right ventricular outflow tract obstruction. If not already present at birth, cyanosis develops in the first year of life. Survival of the patient depends on the degree of pulmonary obstruction and the pulmonary blood supply. Patients rarely survive after the fourth decade of life. Limitation of blood to the lungs combined with ventricular septal defect results in supply of oxygen-poor blood to the body, causing cyanosis (blue coloration) in the patient. If the pulmonary stenosis is mild and ventricular septal defect is in balance, however, the noncyanotic patient is referred as having “pink tetralogy of Fallot.”