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2.
J Thorac Imaging ; 37(3): 168-172, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595242

RESUMO

PURPOSE: The atrial septal pouch is an anatomic variant of the interatrial septum caused by incomplete fusion of the septum primum and secundum. It is debatable whether coexistence of septal pouch and atrial fibrillation (AF) increases the risk of stroke. Thus, the aim of the study was to evaluate the coexistence of left atrial septal pouch (LASP) and AF in patients with a history of stroke in comparison with those without an earlier history of stroke. MATERIALS AND METHODS: We analyzed 145 patients with AF (68 in the study group, 77 in the control group). The study group consisted of patients with previous stroke and AF; control group consisted of patients scheduled for AF ablation. All patients underwent computed tomography with the assessment of atrial septum morphology and presence of LASP. The study was a subanalysis of the ASSAM (AssesSment of the left atrial appendage morphoLogy in patients aAfter ischaeMic Stroke) study. RESULTS: The prevalence of LASP in the entire group was 38.6%. There were no significant differences in the prevalence of LASP between the study and control groups (33.8% vs. 42.9%, P=0.265). Mean longitudinal and transverse dimensions of LASP were 9.34±3.27 and 2.4±0.6 mm, respectively, and there was no significant difference between the study and controls. Patients from the stroke group were older (P<0.0001), had a higher CHA2DS2-VASc score (5.41±1.93 vs. 1.62±1.46, P<0.0001) compared with controls. CONCLUSIONS: Presence of LASP is not more prevalent in patients with a history of stroke. Additional information on the presence of LASP do not improve accuracy of risk stratification for stroke in patients with AF.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Isquemia Encefálica , Comunicação Interatrial , AVC Isquêmico , Acidente Vascular Cerebral , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Comunicação Interatrial/complicações , Comunicação Interatrial/epidemiologia , Humanos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia
3.
Eur J Radiol ; 138: 109637, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33740628

RESUMO

BACKGROUND: Infective endocarditis is one of the most severe complications after prosthetic valve implantation and an accurate diagnosis is a clinical challenge. The purpose was to assess the diagnostic usefulness of cardiac computed tomography (CT) in valvular and perivalvular complications in patients with prosthetic valve endocarditis (PVE) and to compare CT results with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and intraoperative findings. METHODS: The retrospective study included 44 consecutive patients with PVE who underwent cardiac surgery. The mean age was 59.6 ±â€¯12.9 years, 33 (75 %) were males. The presence of vegetations, abscess/pseudoaneurysm, paravalvular leakage (PVL) and inflammatory infiltration were evaluated by TTE, TEE and CT prior to surgery and the results were compared with intraoperative findings. RESULTS: Endocarditis affected 47 valves (26 mechanical, 21 biological) in 44 patients. PVE most often affected the aortic valve (n = 36), followed by the mitral valve (n = 9) and the pulmonary valve (n = 2). In the per-valve analysis, the sensitivity of TTE, TEE and CT in diagnosing vegetations was 65 %, 91 % and 96 %; abscess 44 %, 77 % and 89 %; paravalvular leakage 90 %, 100 % and 70 %; inflammatory infiltration 39 %, 56 % and 78 %, respectively. The combination of CT and echocardiography allowed the detection of abscesses/pseudoaneurysms and inflammatory infiltration in all cases except one. CONCLUSION: CT was superior to echocardiography in the diagnosis of paravalvular abscesses, vegetations and inflammatory infiltration. Echocardiography had a higher diagnostic value to CT in the evaluation of paravalvular leakage. Cardiac CT combined with echocardiography improves the diagnostic accuracy of PVE and both modalities should be performed.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Idoso , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Hypertension ; 75(4): 1102-1109, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32148126

RESUMO

Fibromuscular dysplasia (FMD), regarded as a generalized vascular disease, may affect all vascular beds and may result in arterial stenosis, occlusion, aneurysm, or dissection. It has been proposed to systematically evaluate all vascular beds in patients with FMD, regardless of initial FMD involvement. However, the impact of this approach on clinical decisions and on management is unknown. Within the prospective ARCADIA-POL study (Assessment of Renal and Cervical Artery Dysplasia-Poland), we evaluated 232 patients with FMD lesions confirmed in at least one vascular bed, out of 343 patients included in the registry. All patients underwent a detailed clinical evaluation including computed tomography angiography of intracranial and cervical arteries, as well as computed tomography angiography of the abdominal aorta, its branches, and upper and lower extremity arteries. In the study group, FMD lesions were most frequently found in renal arteries (87.5%). FMD was also found in cerebrovascular (24.6%), mesenteric (13.8%), and upper (3.0%) and lower extremity (9.9 %) arteries. Newly diagnosed FMD lesions were found in 34.1% of the patients, and previously undetected vascular complications were found in 25% of the patients. Among all FMD patients included in the study, one out of every 4 evaluated patients qualified for interventional treatment due to newly diagnosed FMD lesions or vascular complications. The ARCADIA-POL study shows for the first time that the systematic and multidisciplinary evaluation of patients with FMD based on a whole-body computed tomography angiography scan has an impact on their clinical management. This proved the necessity of the systematic evaluation of all vascular beds in patients with FMD, regardless of initial FMD involvement.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Displasia Fibromuscular/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Imagem Corporal Total , Adulto Jovem
7.
Kardiol Pol ; 77(11): 1062-1069, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31584036

RESUMO

BACKGROUND: The Fontan procedure is performed in patients with congenital heart diseases and abnormal anatomy of the heart, which preclude intracardiac repair involving a separation of the systemic and pulmonary circulations. The role of computed tomography (CT) in assessing patients' clinical status after the total cavopulmonary connection (TCPC) procedure is not well defined. AIMS: To determine a potential role and diagnostic capability of CT in the functional assessment of adults with the TCPC. METHODS: Data obtained from 18 patients (10 women; mean [SD] age, 27.9 [6.3] years) with the TCPC were analyzed retrospectively. All patients underwent biochemical evaluation, cardiopulmonary exercise test, transthoracic echocardiography, and CT. Upon CT examination, the dimensions of the left and right pulmonary arteries, superior and inferior venae cavae, all pulmonary veins, and extracardiac conduits were measured. The measurements acquired by CT were correlated with the results of transthoracic echocardiography, cardiopulmonary exercise test, and biochemical analysis. RESULTS: The mean (SD) time after the TCPC was 18.5 (6.5) years. The area and circumference of the inferior vena cava significantly correlated with age (r = 0.503, P <0.05). A significant positive correlation was found between the area and circumference of a conduit and the predicted maximal oxygen uptake (r = 0.664, P <0.01). The area (ß = 0.746, R2 = 0.556, P <0.01) and the circumference (ß = 0.757, R2 = 0.572, P <0.01) of a conduit were considered significant predictors in estimating the value of maximal oxygen uptake. CONCLUSIONS: Our study showed an association between the dimensions of an extracardiac conduit and patient functional status, time elapsed since the procedure, and age of adults who underwent the TCPC in childhood. These findings support a more extensive use of CT in patients with TCPC, complemented by the measurements of the superior and inferior venae cavae and the conduit.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Tomografia Computadorizada por Raios X , Adulto , Teste de Esforço , Feminino , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos , Veias Cavas/diagnóstico por imagem , Adulto Jovem
9.
Pol J Radiol ; 83: e621-e626, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30800201

RESUMO

PURPOSE: Caseous calcification is a relatively uncommon variant of calcification of the mitral annulus. The purpose of the study was to assess characteristic radiological features of caseous calcification of the mitral annulus (CCMA) using computed tomography (CT) and compare the usefulness of CT and transthoracic echocardiogram (TTE) in a diagnosis of CCMA. MATERIAL AND METHODS: Seventeen patients with CCMA, who underwent TTE and CT, were analysed. The following features of CCMA were evaluated: location, size, attenuation, enhancement after contrast administration, and margins. RESULTS: In all cases TTE visualised an echo-dense structure with an irregular appearance involving the mitral valve annulus. In five cases the acoustic shadowing artefact was visible, and in four cases the mass contained central areas of echolucency. Eleven patients had valve disease.On CT CCMA appeared as a round mass in one case, in 10 cases as an oval mass, and in six patients it had a semilunar shape.In all cases on unenhanced CT, CCMA appeared as a hyperdense mass. On enhanced CT, CCMA in 10 cases (58.8%) had a hypodense centre, and in 7seven (41.2%) it had a hyperdense centre without enhancement after contrast administration. A hyperdense rim was observed in all cases except one patient. CONCLUSIONS: In cases of the atypical appearance of CCMA on TTE, CT can lead to a definitive diagnosis. The combination of unenhanced CT and after IV contrast administration scans allows for recognition and distinction of CCMA from other pathologies, while TTE allows for assessment of additional valve dysfunction.

10.
Kardiochir Torakochirurgia Pol ; 13(3): 276-282, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27785149

RESUMO

INTRODUCTION: Paragangliomas (PGLs) related to hereditary syndromes are rare mediastinal tumors. Paragangliomas are caused by mutations in genes encoding subunits of succinate dehydrogenase enzyme (SDH). AIM: To evaluate clinical, anatomical and functional characteristics of mediastinal paragangliomas related to SDHx gene mutations. MATERIAL AND METHODS: Retrospective analysis of 75 patients with confirmed SDHx gene mutations (24 patients with SDHB, 5 SDHC, 46 with SDHD mutations) was performed. Patients underwent evaluation using computed tomography (CT), somatostatin receptor scintigraphy (SRS) (99mTc-[HYNIC,Tyr3]-octreotide), 123I mIBG scintigraphy and urinary excretion of total methoxycatecholamines. RESULTS: Out of 75 patients, 16 (21%) patients (1 SDHB, 15 SDHD mutations) had 17 PGLs localized in the mediastinum. Fourteen PGLs were localized in the middle mediastinum (intrapericardial) and 3 PGLs in the posterior mediastinum. The median diameter of paragangliomas measured on the axial slice was 24.3 mm (interquartile range (IQR): 14.7-36.6), and the median volume was 2.78 ml (IQR: 0.87-16.16). Twelve out of 16 patients (75%) underwent SRS, and 11 of them (92.3%) had pathological uptake of the radiotracer. Eleven (68.75%) out of 16 patients underwent 123 I mIBG, with only 3 positive results. Symptoms of catecholamine excretion were observed in 3 patients with PGLs localized in the posterior mediastinum. All PGLs were benign except in 1 patient with the SDHB mutation and PGL detected in the posterior mediastinum, who had a metastatic disease. CONCLUSIONS: Most mediastinal paragangliomas were related to SDHD gene mutations. They were asymptomatic, localized in the medial mediastinum, intrapericardially.

11.
J Thorac Imaging ; 31(3): 156-62, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27043423

RESUMO

PURPOSE: The aim of this study was to assess the prevalence of variants and anomalies of the coronary arteries in patients with bicuspid aortic valve (BAV) and compare it with patients with tricuspid aortic valve (TAV). MATERIALS AND METHODS: A total of 428 patients (193 with BAV, 235 with TAV) who underwent coronary computed tomography angiography were analyzed. RESULTS: The right coronary artery was dominant in 360 (84.1%) cases, including 157 (81.34%) with BAV and 203 (86.38%) with TAV. Left dominance was observed in 51 (11.9%) patients, including 30 (15.54%) with BAV 21 (8.93%) with TAV (P=0.08), and codominance in 17 (4%). The mean length of the left main coronary artery (LMCA) in patients with BAV was 10.45±6.93 versus 12.02±5.12 mm in those with TAV (P=0.008). The absence of the LMCA with separate origins of the left artery descending and the left circumflex artery was observed in 18 cases, 14/193 (7.3%) with BAV and 4/235 (1.7%) with TAV (P=0.004). The ramus intermedius was present in 50 (11.7%) patients, 29 with BAV (15%) and 21 with TAV (8.9%) (P=0.05). Coronary artery anomalies were observed in 2.1% of all patients (5/193 with BAV vs. 4/235 with TAV, P=0.5). CONCLUSIONS: The prevalence of anomalies of coronary arteries was similar in both groups. Patients with BAV had a higher incidence of the absence of the LMCA and the presence of the ramus intrermedius. The mean length of the LMCA in patients with BAV was shorter than in patients with TAV. There was a trend for a higher incidence of left dominance in patients with BAV compared to those with TAV, but did not reach statistical significance.


Assuntos
Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Doença da Válvula Aórtica Bicúspide , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Tomografia Computadorizada por Raios X , Valva Tricúspide
12.
J Thorac Imaging ; 29(2): 113-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24247085

RESUMO

PURPOSE: The aim of the study was to assess thoracic aorta pathologies coexisting with bicuspid aortic valve (BAV) using dual-source computed tomography. MATERIALS AND METHODS: A total of 102 patients with BAV diagnosed by electrocardiogram-gated computed tomography angiography of the thoracic aorta were analyzed retrospectively. The morphology of BAV was characterized on the basis of the presence and orientation of cusps and raphes as "pure BAV" (i.e., without raphe) or "BAV with raphe." The assessment included aortic diameters and pathologies such as dilatation, aneurysm, dissection, or coarctation (CoA). RESULTS: Of the 102 patients, 75 (73.5%) had BAV with raphe, and 27 patients (26.5%) had pure BAV. The analysis revealed significant differences in the diameter of the annulus, the sinuses of Valsalva, the tubular portion of the ascending aorta, and the part of the aorta proximal to the innominate artery between patients with pure BAV and BAV with raphe (respectively 27.18±4.33 vs. 29.88±4.18 mm, P=0.005; 38.11±7.2 vs. 41.77±6.9 mm, P=0.022; 39.07±8.3 vs. 46.31±7.8 mm, P=0.0001; 30.85±6.7 vs. 34.89±5.08 mm, P=0.02). There was a significant difference in prevalence of dilatation and aneurysm of the thoracic aorta between patients with pure BAV and BAV with raphe [58.06% vs. 84.5% (18/31 vs. 60/71), P=0.004]. The prevalence of aortic CoA was higher in patients with pure BAV than in patients with BAV with raphe [44.4% vs. 13.3% (12/27 vs. 10/75), P=0.001]. CONCLUSIONS: BAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Pure BAV is more commonly associated with CoA.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Aorta Torácica/patologia , Doenças da Aorta/complicações , Doenças da Aorta/patologia , Valva Aórtica/diagnóstico por imagem , Doença da Válvula Aórtica Bicúspide , Meios de Contraste , Feminino , Doenças das Valvas Cardíacas/complicações , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos
13.
Pol J Radiol ; 77(3): 58-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23049583

RESUMO

BACKGROUND: Intra-atrial course of the right coronary artery is a rare anomaly. The recognition of this entity is crucial to avoid potential hazards related to vessel injury during interventional procedures such as right heart catheterization, pacemaker implantation, invasive electrophysiology testing or atrial flutter ablation. CASE REPORT: We present a case of a 62-year old female with paroxysmal atrial flutter and atrial fibrillation, whose cardiac computed tomography revealed an anomalous course of the right coronary artery through the right atrium. CONCLUSIONS: Cardiac computed tomography examination enables an accurate assessment of morphology and location of the anomalous vessel course.

14.
Kardiol Pol ; 67(10): 1147-50, 2009 Oct.
Artigo em Polonês | MEDLINE | ID: mdl-20017085

RESUMO

We describe a 23-year-old man with drug refractory, left atrial arrhythmias (paroxysmal atrial tachycardia, runs, pairs and single extra beats) in the area of remnant of left upper pulmonary vein ostium (in fact, this vein). The superior drained into vena innominata/vena cava superior. The patient underwent three unsuccessful catheter ablations in another center. Computed tomography scan of left atrium and pulmonary veins revealed this rare congenital anomaly. This information was crucial to perform successful ablation in the area of remnant and distinguish left atrial appendage from the remnant area. During 6 month follow-up the patient remained free of arrhythmia.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Taquicardia Paroxística/diagnóstico por imagem , Fibrilação Atrial/etiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Seguimentos , Átrios do Coração/cirurgia , Humanos , Masculino , Taquicardia Paroxística/etiologia , Taquicardia Paroxística/cirurgia , Tomografia Computadorizada Espiral , Resultado do Tratamento , Adulto Jovem
15.
Europace ; 11(12): 1718-20, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19812049

RESUMO

We reported on two unsuccessful implantations of the left ventricular lead in two first-degree relatives due to inability to cannulate the coronary sinus (CS). The anatomy of the coronary venous system investigated by means of dual source computed tomography showed several similarities in both patients: narrowing of the proximal part of CS and a small number of CS tributaries.


Assuntos
Seio Coronário/anormalidades , Seio Coronário/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Ventrículos do Coração/cirurgia , Implantação de Prótese/métodos , Adulto , Estimulação Cardíaca Artificial/métodos , Feminino , Humanos , Masculino , Falha de Tratamento , Adulto Jovem
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