Intracardiac shunt assessment using CT coronary angiography.

Background: Detection of intracardiac shunts using CT Coronary Angiography (CTCA) is currently based on anatomical demonstration of defects. We assessed a novel technique using a standard CTCA test bolus in detecting shunts independent of anatomical assessment and to provide an estimate of Qp/Qs.

Methods: We retrospectively reviewed 51 CTCAs: twenty-one from patients with known simple left to right intracardiac shunts with contemporaneous functional assessment (using CMR) within 6 months, 20 controls with structurally normal hearts, and 10 patients with shunt repairs.

Left circumflex coronary artery from the pulmonary artery in scimitar syndrome.

Background: Scimitar syndrome is a rare combination of cardiopulmonary abnormalities found in 1-3 per 1000 live births. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is only found in 1 in 250-400 congenital heart disease patients.

Objective: We aimed to investigate the incidence of left circumflex ALCAPA within our referral center's cohort of scimitar syndrome patients.

High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: a real-world appraisal.

Objective: High-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known.

Methods: We reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate.

Evaluation of High-Pitch Ungated Pediatric Cardiovascular Computed Tomography for the Assessment of Cardiac Structures in Neonates.

Purpose: We evaluated a high-pitch, non-electrocardiogram-gated cardiac computed tomographic protocol, designed to image both cardiac and extracardiac structures, including coronary arteries, in a neonatal population (less than 1 year old) that was referred for congenital heart disease assessment and compared it with an optimized standard-pitch protocol in an equivalent cohort.

Materials And Methods: Twenty-nine high-pitch scans were compared with 31 age-matched, sex-matched, and weight-matched standard-pitch, dosimetrically equivalent scans. The visualization and subjective quality of both cardiac and extracardiac structures were scored by consensus between 2 trained blinded observers.

Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images.

Objectives: We validate a novel CT coronary angiography (CCTA) coronary calcium scoring system.

Methods: Calcium was quantified on CCTA images using a new patient-specific attenuation threshold: mean + 2SD of intra-coronary contrast density (HU). Using 335 patient data sets a conversion factor (CF) for predicting CACS from CCTA scores (CCTAS) was derived and validated in a separate cohort (n = 168).

Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial.

Background: Lung volume reduction surgery improves survival in selected patients with emphysema, and has generated interest in bronchoscopic approaches that might achieve the same effect with less morbidity and mortality. Previous trials with endobronchial valves have yielded modest group benefits because when collateral ventilation is present it prevents lobar atelectasis.

Methods: We did a single-centre, double-blind sham-controlled trial in patients with both heterogeneous emphysema and a target lobe with intact interlobar fissures on CT of the thorax.

Clinical and economic consequences of non-cardiac incidental findings detected on cardiovascular computed tomography performed prior to transcatheter aortic valve implantation (TAVI).

Transcatheter aortic valve implantation (TAVI) is an effective treatment option for patients with severe degenerative aortic valve stenosis who are high risk for conventional surgery. Computed tomography (CT) performed prior to TAVI can detect pathologies that could influence outcomes following the procedure, however the incidence, cost, and clinical impact of incidental findings has not previously been investigated. 279 patients underwent CT; 188 subsequently had TAVI and 91 were declined.

Pulmonary atresia with double ductus arteriosus.

We present the case of a neonate with pulmonary atresia and persistent bilateral patent ductus arteriosus imaged by gated multidetector CT. Traditionally, these patients have been assessed preoperatively with invasive angiocardiography or with cardiovascular magnetic resonance under sedation. Our case illustrates that contemporary cardiovascular CT techniques can now be used for preoperative evaluation with minimal radiation penalty, obviating the risks of sedation or cardiac catheterization.

CT imaging for left atrial appendage closure: a review and pictorial essay.

Cardioembolic stroke is an important complication of atrial fibrillation. The thrombus responsible for this arises from the left atrial appendage (LAA) in >90% of cases, providing the rationale for device-based LAA closure as a means of thromboprophylaxis. Although oral anticoagulant therapy remains the mainstay for reducing the risk of stroke in patients with atrial fibrillation, an increasing number of patients, particularly those ineligible for conventional pharmacotherapy, are being offered percutaneous left atrial appendage closure.

Deriving coronary artery calcium scores from CT coronary angiography: a proposed algorithm for evaluating stable chest pain.

We validate a method of calcium scoring on CT coronary angiography (CTCA) and propose an algorithm for the assessment of patients with stable chest pain. 503 consecutive patients undergoing coronary artery calcium score (CACS) and CTCA were included. A 0.

Multidetector computed tomography of congenital aortic abnormalities.

For many years invasive angiographic techniques have been considered as the gold standard for the assessment of large arterial abnormalities. However, the complexities and complications inherent to invasive imaging have meant that more recently non-invasive techniques such as echocardiography, Magnetic Resonance Imaging (MRI) and multidetector CT (MDCT) have been increasingly used in congenital cardiovascular disorders. In particular, MDCT has emerged as a fundamental tool for the diagnosis and pre-surgical work-up of aortic abnormalities due to its high spatial resolution, large area of coverage, and short scan time, and therefore is now one of the most widely used modalities for the detection of congenital abnormalities of the aorta.

Great vessel and coronary artery anatomy in transposition and other coronary anomalies: a universal descriptive and alphanumerical sequential classification.

In patients with transposition of the great arteries, the identification of coronary anatomy is fundamental to optimal surgical outcome. A number of classifications describing the coronary vessels' origin and course in transposition of the great arteries have been published. However, all are limited to operative or pathological case series.

Paraoxonase-1 is not associated with coronary artery calcification in type 2 diabetes: results from the PREDICT study.

Objectives: To determine any association between serum paraoxonase-1 (PON1) activity, protein and coding region genetic polymorphisms and coronary artery calcification (CACS) and to determine factors which modulate serum PON1 in type 2 diabetes (T2DM).

Methods And Results: 589 patients (419 Caucasian, 120 South Asian, 50 other) from the PREDICT Study were investigated. All patients were asymptomatic for coronary disease and had established T2DM.

Cardiothoracic ratio from postero-anterior chest radiographs: a simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease.

Objective: The wide spectrum of intracardiac anatomy and reparative surgery available for adults with congenital heart disease (ACHD) makes uniform measurement of cardiac size and disease severity challenging. The aim of this study was to assess the prognostic potential of cardiothoracic ratio, a simple marker of cardiomegaly, in a large cohort of ACHD.

Patients And Setting: Chest radiographs from 3033 ACHD patients attending our institution between 1998 and 2007 and 113 normal controls of similar age were analyzed blindly.

Implications for single phase prospective CT coronary angiography for the diagnosis of significant coronary stenoses in clinical practice.

Background: CT coronary angiography (CTA) with 64 slice multi-detector CT (64-MDCT) has assumed an increasing role in clinical practice; however the high radiation dose associated with retrospective ECG-gated CTA has led to suggestions that a low dose prospectively gated strategy may be more appropriate. This study aims to assess the feasibility of this proposed strategy amongst standard referral for CTA in our centre.

Methods: We retrospectively analyzed 200 consecutive clinical CTA studies assessing the number of cardiac phases required to allow full diagnostic visualisation of the coronary tree.

Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease.

Aims: To demonstrate that exposure to chronic inflammation results in coronary microvascular dysfunction (CMD).

Methods And Results: Using positron emission tomography, resting and hyperaemic (adenosine, 140 microg/kg/min) myocardial blood flow (MBF) was measured in 25 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). Coronary flow reserve (CFR) was calculated as adenosine/resting MBF.

64-Channel cardiac computed tomography: intraobserver and interobserver variability, part 2: global and regional ventricular function, mass, and first pass perfusion.

Objectives: To assess intraobserver and interobserver variability in cardiac computed tomographic measurements of global biventricular function, left ventricular (LV) regional wall motion, systolic wall thickening, and first pass perfusion in 3 patient cohorts at very low, low to intermediate, and intermediate to high cardiac risk.

Methods: One hundred thirty-three patients underwent 64-channel cardiac computed tomography. Images were analyzed by 2 experienced, blinded observers.

64-Channel cardiac computed tomography: intraobserver and interobserver variability (part 1): coronary angiography.

Objectives: To assess intraobserver and interobserver variation in computed tomography coronary angiography (CTA) in 3 patient cohorts at very low, low-to-intermediate, and intermediate-to-high likelihood of coronary artery disease (CAD).

Methods: One hundred thirty-three patients underwent 64-channel CTA. Coronary arteries were analyzed by 2 experienced blinded observers and reported as having 0%, 1% to 29%, 30% to 49%, 50% to 69%, 70% to 99%, or 100% stenosis.

Defining the appropriate CTA stenosis threshold for gatekeeping to invasive angiography: 50% or 70%?

There is currently much debate around the limited positive predictive value (PPV) of CT coronary angiography (CTA). There remain no published studies comparing different thresholds to define significant visual stenoses on CTA compared to the gold standard quantitative coronary angiography (QCA). The spatial resolution for ICA is (0.

Clinical management and short-term cost - 64-slice MDCT vs. myocardial perfusion scintigraphy.

There are currently no published studies of the impact of CT coronary angiography (CTA) on patient management or cost when compared with other established imaging techniques. We assessed the short term investigation and treatment costs of CTA compared with myocardial perfusion scintigraphy (MPS) using real clinical scenarios. Clinical information with either their CTA or MPS results were presented to 20 cardiologists in a random order.