ABSTRACT
OBJECTIVES: Radiofrequency ablation of the pulmonary veins is an accepted treatment for atrial fibrillation. An accurate knowledge of pulmonary venous anatomy and dimensions is desirable prior to such a procedure. The objective of this study was to use 64-detector row cardiac CT to investigate the changes in pulmonary venous dimensions during the cardiac cycle. METHODS: Data from 44 consecutive patients with no significant cardiovascular pathology who underwent electrocardiogram (ECG)-gated 64-detector row coronary angiography were retrospectively analysed. Average diameter and cross-sectional area were measured at 5 mm intervals from each pulmonary vein ostium, in ventricular end-diastole and ventricular end-systole, using curved multiplanar reformats. RESULTS: 4 (9.1%) patients had pulmonary vein anomalies and were excluded. In the remaining 40 patients, pulmonary vein diameter and area at the ostium were significantly larger in end-systole in all four veins, with the largest differences in the superior pulmonary veins. Dimensional changes for diameter (millimetres) and area (square millimetres) were as follows: left superior pulmonary vein, 2.5 (p<0.001), 65.48 (p<0.001); right superior pulmonary vein, 1.63 (p<0.001), 56.27 (p<0.001); left inferior pulmonary vein, 1.1 (p<0.001), 30.41 (p<0.001); and right inferior pulmonary vein, 0.68 (p=0.005), 30.14 (p=0.005). Less marked changes were seen at measurement sites further from the atrium. Interobserver correlation was high (all but one measurement >0.9). CONCLUSION: Pulmonary vein dimensions change significantly between end-systole and end-diastole, and the ostia of the superior pulmonary veins are potentially the most vulnerable to dimensional inaccuracies. ECG-gated cardiac CT may provide a more precise method of pulmonary venous dimensional measurement than non-gated techniques. Knowledge of change in pulmonary vein diameter offers interesting potential research into the effect of pulmonary vein function.
Subject(s)
Atrial Fibrillation/surgery , Cardiac-Gated Imaging Techniques/methods , Coronary Angiography/methods , Pulmonary Veins/diagnostic imaging , Radiographic Image Interpretation, Computer-Assisted , Tomography, X-Ray Computed/methods , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Catheter Ablation/methods , Cohort Studies , Female , Humans , Imaging, Three-Dimensional , Male , Observer Variation , Preoperative Care/methods , Pulmonary Veins/abnormalities , Pulmonary Veins/surgery , Retrospective Studies , Sensitivity and Specificity , Statistics, NonparametricABSTRACT
AIM: To assess the accuracy of clinical coronary computed tomography angiography (CTA) data compared to invasive coronary angiography, and to determine the prognostic value of a negative coronary CTA examination in symptomatic, intermediate-risk patients. METHODS: Thirty-seven months of coronary CTA data were audited. Seventy-eight patients were identified who had undergone coronary CTA followed by invasive coronary angiography (ICA) to determine the accuracy of CTA versus ICA. One hundred and seventy-eight patients were identified who had a "negative" coronary CTA to enable evaluation of the prognostic value of a negative CTA examination. RESULTS: Of the 78 patients in the accuracy analysis group there were 43 true-negative, two false-negative, 26 true-positive, and seven false-positive results producing a sensitivity of 92.9%, specificity of 86%, negative predictive value of 95.6%, and positive predictive value of 78.8%. The 178 patients who had a negative coronary CTA examination were followed up for a mean of 366 days and were all alive (0% mortality) with no episodes of myocardial infarction or unstable angina; two patients underwent elective revascularization procedures (1.1%). CONCLUSION: According to medium-term analysis, the accuracy of the clinical coronary CTA programme is in line with published trial data, producing excellent sensitivity and negative predictive values. The finding of a negative coronary CTA in symptomatic, intermediate-risk patients appears to confer a good prognosis, at mean follow-up of 1 year, with no deaths or episodes of myocardial infarction or unstable angina. This suggests that the prognostic value of a negative coronary CTA may be similar to that conferred by negative myocardial perfusion scintigraphy or stress echocardiography.
Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Medical Audit , Middle Aged , Predictive Value of Tests , Prognosis , Risk Assessment , Sensitivity and SpecificitySubject(s)
Arterio-Arterial Fistula/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Coronary Disease/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Tomography, X-Ray Computed/methods , Arterio-Arterial Fistula/complications , Coronary Aneurysm/etiology , Coronary Angiography/methods , Coronary Disease/complications , Female , Humans , Middle AgedABSTRACT
Incarcerated umbilical hernias commonly present as emergencies. Often they are diagnosed clinically and repaired surgically. In the case reported here, surgery could have been complicated by a major haemorrhage. An accurate history, high index of suspicion and attention to detail are paramount.
