Mulitmedia Library
Computed tomography imaging for subclinical leaflet thrombosis following surgical and transcatheter aortic valve replacement
Subclinical leaflet thrombosis (LT) may occur following surgical and transcatheter aortic valve replacement. Computed tomography (CT) has become an established imaging modality to diagnose subclinical LT following bioprosthetic aortic valve replacement. Even so, there is a limited (but growing) experience in utilizing CT imaging for this indication. This review emphasizes a systematic approach to acquiring and analysing CT imaging for subclinical LT, highlighting evidence surrounding clinical sequelae of subclinical LT and anti-thrombotic implications following diagnosis.Follow-up assessment of myocardial calcification secondary to fulminant myocarditis with computed tomography
A 16-year-old man underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy due to hemodynamic collapse caused by viral fulminant myocarditis. Supplementary Figure 1 presents the time course of treatment. High-density areas wtihin the myocardium were initially detected by computed tomography (CT) 10 days after admission which was not observed on admission (Fig. 1A). The CT tissue attenuation value reached 106 Hounsfield Unit (HU) in these areas 40 days after admission (Fig. 1B), with changes in the left lateral wall being more evident than other areas.Systolic or diastolic CT image acquisition for transcatheter aortic valve replacement – An outcome analysis
Computed tomography (CT) imaging is the standard of care before transcatheter aortic valve replacement (TAVR). The aortic annulus undergoes conformational changes during the heart cycle. Therefore, the image acquisition time point can impact prosthesis sizing and fit. Clinical outcome data are lacking. The aim of this study was to compare systolic and diastolic cardiac CT data acquisition with regard to procedural and clinical outcomes in patients undergoing TAVR for severe aortic stenosis (AS).Impact of computed-tomography defined sarcopenia on outcomes of older adults undergoing transcatheter aortic valve implantation
The adoption of Computed tomography (CT)-defined sarcopenia to risk stratify transcatheter aortic valve implantation (TAVI) candidates remains limited by a lack of both standardized definition and evidence of independent value over currently adopted mortality prediction tools.Prognostic impact of identifying etiology of prosthetic valve dysfunction with CT
In 132 patients with suspected PVD, an etiology was diagnosed on CT in 60.6% and on echocardiography in 34.1% patients. On adjusted multivariable analyses, CT diagnosis of structural valve degeneration was significantly associated with the composite outcome of reoperation or death whereas echocardiography diagnosis was not. CT assessment of PVD had prognostic significance for hard outcomes and should be considered in the diagnostic evaluation of patients with suspected PVD.Clinical outcomes following transcatheter aortic valve implantation in patients with porcelain aorta
Current guidelines favor transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement in patients with porcelain aorta (PAo). The clinical relevance of PAo in patients undergoing TAVI is however incompletely understood. The purpose of this study is to evaluate clinical outcome of patients with PAo undergoing TAVI.Diagnostic performance of cardiac computed tomography versus transesophageal echocardiography in infective endocarditis: A contemporary comparative meta-analysis
Condensed abstract Data regarding the comparison of diagnostic accuracy of TEE and CCT for diagnosing IE are limited. The present meta-analysis compares the diagnostic performance of the two imaging modalities for a variety of complications of IE in the same patient populations. Our results show that both TEE and CCT have good diagnostic accuracy, with TEE showing superiority in detecting leaflet defects and CCT performing better in prosthetic valve endocarditis. CCT also showed a trend towards higher sensitivity than TEE for detection of periannular complications. These findings suggest that CCT is a useful adjunct to TEE for IE, whenever appropriate use of complementary imaging modalities is warranted.A pooled-analysis of age and sex based coronary artery calcium scores percentiles
Age and sex based coronary artery calcium score (CAC) percentiles have been used to improve coronary artery disease (CAD) risk prediction. However, the main limitation of the CACs percentiles currently in use is that they are often based on single studies. We performed a pooled analysis of all available studies that reported on CAC percentiles, in order to develop more generalizable age and sex nomograms.Low-kV coronary artery calcium scoring with tin filtration using a kV-independent reconstruction algorithm
To investigate the accuracy of Agatston scoring and potential for radiation dose reduction of a coronary artery calcium scoring (CACS) CT protocol at 100 kV with tin filtration (Sn100kV) and kV-independent iterative reconstruction, compared to standard 120 kV acquisitions.Reproducibility of aortic valve calcification scoring with computed tomography – An interplatform analysis
To investigate whether aortic valve calcification (AVC) scoring performed with different workstation platforms generates comparable and thus software-independent results.Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation
Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a “brick and mortar” hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization.3D fusion of coronary CT angiography and CT myocardial perfusion imaging: Intuitive assessment of morphology and function
The objective of this work was to support three-dimensional fusion of coronary CT angiography (coronary CTA) and CT myocardial perfusion (CT-Perf) data visualizing coronary artery stenoses and corresponding stress-induced myocardial perfusion deficits for diagnostics of coronary artery disease.The use of intraosseous needles for injection of contrast media for computed tomographic angiography of the thoracic aorta
The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using intraosseous needle intravenous access (ION-IVA) for contrast media injection (CMI).Automatic quantification of the myocardial extracellular volume by cardiac computed tomography: Synthetic ECV by CCT
The quantification of extracellular volume fraction (ECV) by Cardiac Computed Tomography (CCT) can identify changes in the myocardial interstitium due to fibrosis or infiltration. Current methodologies require laboratory blood hematocrit (Hct) measurement – which complicates the technique. The attenuation of blood (HUblood) is known to change with anemia. We hypothesized that the relationship between Hct and HUblood could be calibrated to rapidly generate a synthetic ECV without formally measuring Hct.Cardiac computed tomography for the detection of cardiac amyloidosis
In a 67-year-old Caucasian man who was admitted for atrial flutter ablation, echocardiography showed concentric left ventricular (LV) hypertrophy with severely impaired LV systolic function, particularly longitudinal (Fig. 1A, Video 1), and biatrial dilatation. Due to episodes of non-sustained ventricular tachycardia, he was fitted with an implantable cardioverter-defibrillator (ICD). The QRS complexes on peripheral leads were small compared to the structural wall thickening on echocardiography (Fig. 1B) raising the suspicion of cardiac amyloidosis.Persistence of levoatrial cardinal vein with an interatrial course
A 39-year-old woman presented with a history of chest pain, palpitations, and syncope. A coronary CT angiography revealed normal coronary arteries with a normal left atrial outflow. The only finding on the CT angiography was a persistent levoatrial cardinal vein with an interatrial course [Fig. 1]. The clinical and rest of other laboratory evaluations were unremarkable. The patient remained asymptomatic during an observation period and was discharged without treatment. During the follow-up visit, the patient remained asymptomatic.Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT
Right-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography.Circumferential type A aortic dissection with intimal intussusception
A 62-year-old man was admitted to our hospital with sudden chest pain. CT examination showed the presence of an intimal flap in the aortic root and in the descending aorta, with no intimal flap in the ascending aorta and curvilinear filling defects in the aortic arch, and extension into the left subclavian artery. Surgical treatment consisted of ascending aorta replacement. During the operation, the intimal tear was found to be circumferential with intussusception of the intimal layer. The patient died at surgery.Coronary CTA assessment of coronary anomalies
Coronary anomalies occur in <1% of the general population and can range from a benign incidental finding to the cause of sudden cardiac death. The coronary anomalies are classified here according to the traditional grouping into those of origin and course, intrinsic arterial anatomy, and termination. Classic coronary anomalies of origin and course include those in which a coronary artery originates from the contralateral aortic sinus or the pulmonary artery with anomalous course. Single coronary artery anomalies, in which single coronary artery branches to supply the entire coronary tree, are also included in this category.Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis
Development of an accurate test for noninvasive assessment of coronary arteries has been highly desirable.Computed tomography evaluation for transcatheter aortic valve implantation (TAVI): Imaging of the aortic root and iliac arteries
For patients with severe aortic stenosis, open-heart surgical valve replacement remains the current clinical standard with documented, excellent long-term outcome. Over the past few years, transcatheter aortic valve implantation (TAVI) has developed into a treatment alternative for high-risk patients with severe aortic stenosis. Because transcatheter valvular procedures are characterized by lack of exposure of the operative field, image guidance is critical. This Pictorial Essay describes the role of 3-dimensional imaging with multidetector row computed tomography for detailed reconstructions of the aortic valve, aortic root, and iliac arteries in the context of TAVI.A bullet wandering through the heart
We report a case of young male with a penetrating chest trauma due to a gunshot. The bullet was detected by conventional X-ray and localized within the lateral wall of the left ventricle by CT. During surgery the bullet was not found. Thereafter conventional X-ray showed migration of the bullet within the lung parenchyma.Computed tomography of a heterotopic heart transplant: Successful imaging despite two cardiac rhythms
A 61-year-old man with a history of heterotopic heart transplantation for end-stage dilated cardiomyopathy 16 years previously was referred for cardiac evaluation before undergoing chemotherapy for non-Hodgkins ileocecal lymphoma. An electrocardiogram showed 2 independent cardiac rhythms (Fig. 1), with the donor and native hearts being in sinus rhythm and atrial fibrillation, respectively. Transthoracic echocardiography provided limited views of the donor heart that were consistent with severely impaired ventricular function of the native heart.Cardiac multidetector computed tomography incidental finding of a membranous septal aneurysm
A 48-year-old woman was referred for the evaluation of an ongoing history of chest pain despite prior negative evaluations. An electrocardiographic-gated multidetector computed tomography (MDCT) study using a 64-slice scanner was performed. No coronary artery calcifications or obstructive lesions were observed. However, investigation of the chambers showed a membranous septal aneurysm with a patent lumen without intraluminal filling defects and which communicated with the left ventricular cavity through a widely patent neck.Anomalous left anterior descending coronary artery in a pediatric patient with Fallot tetralogy
Cardiac CT was performed in a 3-year-old patient (weight, 12.4 kg; heart rate, 100 beats/minute) with tetralogy of Fallot (pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy) to rule out coronary anomalies before surgical correction. A shunt graft from the brachiocephalic trunk to the pulmonary artery had been placed in the patient at the age of 8 months. Data were acquired in free breathing using dual-source CT (DSCT). Fifteen milliliters of contrast agent (2 mL/second) was injected, followed by 20 mL of saline chaser.
