ABSTRACT
En los últimos años hemos sido testigos del continuo desarrollo de las técnicas de imagen en cardiología. Entre ellas, la tomografía computarizada cardiaca, técnica emergente y en continua evolución. Con la posibilidad actual de realizar estudios con muy baja radiación se han ampliado sus indicaciones más allá de la coronariografía no invasiva. En el presente trabajo de revisión repasamos las novedades técnicas de la tomografía computarizada cardiaca así como sus nuevas aplicaciones.
During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications.
Subject(s)
Humans , Cardiac Imaging Techniques/methods , Tomography, X-Ray ComputedABSTRACT
During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications.
Subject(s)
Cardiac Imaging Techniques/methods , Tomography, X-Ray Computed , HumansSubject(s)
Aortic Diseases/congenital , Heart Defects, Congenital/diagnosis , Heart Ventricles/abnormalities , Sinus of Valsalva/abnormalities , Vascular Fistula/congenital , Vascular Fistula/pathology , Aortic Diseases/diagnosis , Heart Defects, Congenital/surgery , Humans , Male , Vascular Fistula/diagnosis , Young AdultSubject(s)
Calcinosis/diagnostic imaging , Calcinosis/epidemiology , Coronary Angiography/statistics & numerical data , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/epidemiology , Evidence-Based Medicine , Tomography, X-Ray Computed/statistics & numerical data , Causality , Comorbidity , Coronary Angiography/methods , Humans , Prevalence , Prognosis , Reproducibility of Results , Risk Assessment , Sensitivity and SpecificityABSTRACT
Single coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. We report the case of a 77- year- old man who was referred for invasive coronary angiography with a diagnosis of a non-ST-segment elevation acute coronary syndrome of inferior-lateral location. Significant lesion was detected in the proximal segment of the right coronary artery (RCA). During the procedure, it was impossible to catheterize the left coronary ostium, being the left anterior descending filled from the RCA. Given the suspicion of agenesis of the left main, 64-multidetector computed tomography was performed which confirmed the existence of a solitary coronary ostium with a single artery arising from the right sinus of Valsalva.
Subject(s)
Abnormalities, Multiple/diagnostic imaging , Coronary Angiography/methods , Coronary Vessel Anomalies/diagnostic imaging , Multidetector Computed Tomography , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Aged , Humans , MaleABSTRACT
La arteria coronaria única con origen en el seno de Valsalva derecho es una anomalía coronaria congénita poco frecuente. Presentamos el caso de un hombre de 77 años remitido para coronariografía invasiva con diagnóstico de síndrome coronario agudo sin elevación del segmento ST de localización ínfero-lateral. En el estudio se demostró enfermedad significativa en el tercio proximal de la coronaria derecha. Durante el procedimiento no se logró cateterizar el ostium de la coronaria izquierda que aparentemente se rellenaba desde la coronaria derecha. Ante la sospecha de un origen anómalo de la misma, se realizó coronariografía no invasiva mediante tomografía multicorte de 64 cortes que confirmó la existencia de una arteria coronaria única con origen en el seno de Valsalva derecho.
Single coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. We report the case of a 77- year- old man who was referred for invasive coronary angiography with a diagnosis of a non-ST-segment elevation acute coronary syndrome of inferior-lateral location. Significant lesion was detected in the proximal segment of the right coronary artery (RCA). During the procedure, it was impossible to catheterize the left coronary ostium, being the left anterior descending filled from the RCA. Given the suspicion of agenesis of the left main, 64-multidetector computed tomography was performed which confirmed the existence of a solitary coronary ostium with a single artery arising from the right sinus of Valsalva.
Subject(s)
Aged , Humans , Male , Abnormalities, Multiple , Coronary Angiography/methods , Coronary Vessel Anomalies , Multidetector Computed Tomography , Sinus of Valsalva/abnormalities , Sinus of ValsalvaSubject(s)
Coronary Aneurysm/pathology , Coronary Vessels/pathology , Incidental Findings , Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Coronary Vessels/diagnostic imaging , Echocardiography , Heart Murmurs , Humans , Male , Middle Aged , Tomography, Spiral Computed/instrumentationSubject(s)
Calcinosis/diagnostic imaging , Calcinosis/epidemiology , Coronary Angiography/statistics & numerical data , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/epidemiology , Tomography, X-Ray Computed/statistics & numerical data , Comorbidity , Female , Germany/epidemiology , Humans , Male , Middle Aged , Prevalence , Risk Assessment/methods , Risk FactorsSubject(s)
Accidents, Traffic , Contusions/diagnosis , Coronary Occlusion/diagnosis , Coronary Vessels/injuries , Heart Injuries/diagnosis , Myocardial Infarction/diagnosis , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Aged , Angioplasty, Balloon, Coronary/instrumentation , Contusions/etiology , Coronary Angiography , Coronary Occlusion/etiology , Coronary Occlusion/therapy , Coronary Vessels/diagnostic imaging , Echocardiography , Electrocardiography , Female , Heart Injuries/etiology , Humans , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Stents , Tomography, X-Ray ComputedABSTRACT
A 35-year-old man with a history of syncope and echocardiographic diagnosis of right ventricular outflow tract obstruction and ventricular septum defect was submitted to complete evaluation with an Aquilion Toshiba 64-multislice CT in order to confirm diagnosis and to complete information prior to surgery.
Subject(s)
Heart Septal Defects, Ventricular/diagnostic imaging , Pulmonary Subvalvular Stenosis/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Diagnosis, Differential , Heart Septal Defects, Ventricular/complications , Humans , Male , Pulmonary Subvalvular Stenosis/complicationsABSTRACT
Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with a myocardial bridge in left anterior descending coronary artery in which surgical treatment was proposed. Previous to surgery a non invasive coronariography with cardiac CT was practised in order to define the anatomy.
Subject(s)
Coronary Vessels/pathology , Myocardial Bridging/diagnosis , Adult , Angina Pectoris/etiology , Angina Pectoris/pathology , Cardiac Surgical Procedures , Coronary Angiography , Humans , Male , Myocardial Bridging/complications , Myocardial Bridging/surgery , Organophosphorus Compounds , Organotechnetium Compounds , Radiopharmaceuticals , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Cardiomyopathies/diagnosis , Coronary Angiography , Heart Defects, Congenital/diagnosis , Adult , Cardiomyopathies/diagnostic imaging , Coronary Circulation/physiology , Coronary Vessels/pathology , Heart Defects, Congenital/diagnostic imaging , Humans , Male , Pulmonary Valve Stenosis/etiology , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To study the effects of two levels of positive end-expiratory pressure (PEEP), 2 cm H(2)O above the lower inflection point of the inspiratory limb and equal to the point of maximum curvature on the expiratory limb of the pressure-volume curve, in gas exchange, respiratory mechanics, and lung aeration. DESIGN AND SETTING: Prospective clinical study in the intensive care unit and computed tomography ward of a university hospital. PATIENTS: Eight patients with early acute lung injury. INTERVENTIONS: Both limbs of the static pressure-volume curve were traced and inflection points calculated using a sigmoid model. During ventilation with a tidal volume of 6 ml/kg we sequentially applied a PEEP 2 cm H(2)O above the inspiratory lower inflection point (15.5+/-3.1 cm H(2)O) and a PEEP equal to the expiratory point of maximum curvature (23.5+/-4.1 cmH(2)O). MEASUREMENTS AND RESULTS: Arterial blood gases, respiratory system compliance and resistance and changes in lung aeration (measured on three computed tomography slices during end-expiratory and end-inspiratory pauses) were measured at each PEEP level. PEEP according to the expiratory point of maximum curvature was related to an improvement in oxygenation, increase in normally aerated, decrease in nonaerated lung volumes, and greater alveolar stability. There was also an increase in PaCO(2), airway pressures, and hyperaerated lung volume. CONCLUSIONS: High PEEP levels according to the point of maximum curvature of the deflation limb of the pressure-volume curve have both benefits and drawbacks.
Subject(s)
Positive-Pressure Respiration/methods , Respiration , Respiratory Distress Syndrome/therapy , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pulmonary Gas Exchange , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/physiopathology , Tidal Volume , Tomography, X-Ray ComputedABSTRACT
The inflection points of the pressure-volume curve have been used for setting mechanical ventilation in patients with acute lung injury. However, the lung status at these points has never been specifically addressed. In 12 patients with early lung injury we traced both limbs of the pressure-volume curve by means of a stepwise change in airway pressure, and a computed tomography (CT) scan slice was obtained for every pressure level. Although aeration (increase in normally aerated lung) and recruitment (decrease in nonaerated lung) were parallel and continuous along the pressure axis during inflation, loss of aeration and derecruitment were only significant at pressures below the point of maximum curvature on the deflation limb of the pressure-volume curve. This point was related to a higher amount of normally aerated tissue and a lower amount of nonaerated tissue when compared with the lower inflection point on both limbs of the curve. Aeration at the inflection points was similar in lung injury from pulmonary or extrapulmonary origin. There were no significant changes in hyperinflated lung tissue. These results support the use of the deflation limb of the pressure-volume curve for positive end-expiratory pressure setting in patients with acute lung injury.
