¿Podría ser la arteria septal descendente otra variante de la doble arteria descendente anterior? / Could descending septal artery be another variant of the dual left anterior descending artery?

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Can left ventricular function be assessed on non-ECG-gated CT?

To evaluate whether non-gated computed tomography (CT) can assess left ventricular (LV) function, 101 patients with both CT and echocardiography were selected, with ejection fraction <50% on echocardiography used as a reference standard. CTs were blindly reevaluated, and qualitative assessment of LV dysfunction on CT correlated with echocardiographic dysfunction, odds ratio of 21.0 (95% confidence interval=6.55-71.0), specificity of 86% (56/65). Systolic and diastolic images were identified on CT, and the ratio of systolic to diastolic LV internal diameters and ratio of LV to RV internal diameter were determined, both showing correlation with LV dysfunction on echocardiography (P<.0001). Non-gated CT can be used to predict LV dysfunction.

Neonatal myocardial infarction: case report and review of the literature.

Myocardial infarction in a neonate is rare. We describe the case of a full-term male who presented with respiratory distress. A chest radiograph demonstrated cardiomegaly. An electrocardiogram revealed ST segment changes suggestive of ischemia. Cardiac enzymes were elevated and an echocardiogram revealed a regional wall motion abnormality. Cardiac catheterization was performed demonstrating occlusion of the ramus intermedius branch of the left main coronary artery. The patient decompensated, requiring extracorporeal membrane oxygenation (ECMO). The infant was able to be decannulated from ECMO support in 5 days and was ultimately discharged on hospital day 25. We review this case as well as the literature on neonatal myocardial infarction.

MRI and computed tomography of cardiac and pulmonary complications of tetralogy of fallot in adults.

Tetralogy of Fallot (TOF) represents the most common form of cyanotic congenital heart disease, accounting for 6.8% of all congenital heart disease. As surgical techniques and medical management of patients with TOF have improved, most affected patients are reaching adulthood. Though surgical outcomes are favorable (<2% early mortality rate), adults with TOF may experience complications from the long-term sequelae of congenital heart disease and complications related to treatment. We describe common and uncommon findings in adults with TOF, including pulmonary insufficiency, central and peripheral pulmonary artery stenosis and aneurysms, in addition to graft and shunt-related complications. Pulmonary function abnormalities and lung parenchymal imaging findings will be detailed. The diagnostic value of computed tomography and magnetic resonance imaging in adults with complications of TOF will be illustrated.

Anomalies of visceroatrial situs.

OBJECTIVE: Visceroatrial situs refers to the position and configuration of the cardiac atria, the tracheobronchial tree, and the thoracoabdominal viscera. Accurate determination of situs is essential because anomalies of situs are associated with an increased incidence of complex congenital heart disease. CONCLUSION: We propose a methodical diagnostic approach to determining the visceroatrial situs and cardiac configuration that predicts the probability and types of associated congenital heart disease.

CT angiography for evaluation of coronary artery disease in inner-city outpatients: an initial prospective comparison with stress myocardial perfusion imaging.

To evaluate the utility of CT coronary angiography (CTA) for demonstrating coronary artery disease in inner-city outpatients, we prospectively compared CTA with stress SPECT myocardial perfusion imaging in an ethnically diverse, gender balanced population. All patients gave written informed consent for this IRB approved, HIPAA compliant study. Sixty-one patients completed both CTA and SPECT. About 67% were ethnic minorities, 51% were women. A stenosis of >or=70% on CTA was considered positive. Results were compared with perfusion defects on SPECT and correlated with clinical endpoints (hospital admissions, cardiovascular events, coronary interventions and deaths). CTA and SPECT data were compared with results of coronary angiography, when performed. There was moderate global agreement of 79% (48/61) between CTA and SPECT, kappa = 0.483 (SE +/- 0.13, P = 0.0001). With SPECT as the reference standard, CTA had sensitivity of 73% (11/15), specificity of 80% (37/46), negative predictive value of 90% (37/41) and positive predictive value of 55% (11/20). Positive SPECT was associated with positive CTA, (P < 0.0001, OR = 22). Eleven (18%) underwent subsequent cardiac catheterization, which was positive in 91% (10/11). CTA and SPECT had positive predictive values of 90 and 83% compared with catheterization. This study lends preliminary evidence to support to the utility of CTA as an alternative modality for the evaluation of CAD in an ethnically diverse, gender balanced inner-city outpatient population. Similar to more homogenous groups, CTA had a high negative predictive value and demonstrated disease occult to SPECT. Further study is necessary to evaluate the impact of CTA on patient outcomes.

Diagnostic accuracy of Doppler echocardiography for determining left ventricular diastolic pressure elevation: prospective comparison to chest radiography, serum B-type natriuretic peptide, and chest auscultation.

BACKGROUND: Doppler echocardiography (DE), chest radiography (CXR), serum B-type natriuretic peptide (BNP) measurement and physical examination are all commonly employed to estimate left ventricular diastolic pressure (LVDP) in clinical care. There are no published studies directly comparing the diagnostic accuracy of these tests. METHODS AND RESULTS: DE, BNP, CXR, and physical examination were performed on 56 consecutive patients immediately following clinically indicated cardiac catheterization with measurement of LVDP. LVDP measured preceding atrial contraction at end-expiration was elevated (>16 mmHg) in 19 subjects. Diagnostic accuracies were 79%, 70%, 61% for DE, BNP, and CXR, respectively. None of the study subjects had evidence of raised LVDP by chest auscultation. CONCLUSIONS: The diagnostic accuracy of DE compares favorably to other noninvasive markers for prediction of invasively determined LVDP.

Coronary sinus compression: an early computed tomographic sign of cardiac tamponade.

OBJECTIVE: To determine retrospectively the distinguishing features of cardiac tamponade on conventional chest computed tomography (CT). MATERIALS AND METHODS: Blinded retrospective analysis of CT scans from 14 patients (6 women, 8 men; age range, 49-93 yrs; mean age, 71 yrs) with echocardiographic evidence of tamponade and 15 controls (11 women, 4 men; age range, 37-96 yrs; mean age, 66 yrs) without tamponade was performed by 3 cardiothoracic radiologists. Computed tomographic scans were analyzed for right ventricular flattening, contrast reflux into the azygos vein, and coronary sinus compression. Inferior vena cava (IVC) and superior vena cava short-axis diameter and pericardial fluid attenuation were recorded. If the pericardium or pericardial fluid was sampled, results were noted. Case and control group variables were compared using the Fisher exact test and the t test. Results were also subjected to logistic regression analysis. RESULTS: Coronary sinus compression was present in 46% (6/13) patients with tamponade and in no controls (P = 0.006). Trends toward IVC dilatation and elevation of pericardial fluid attenuation in cases of tamponade did not reach statistical significance. A specific pathological diagnosis was made in 88% (7/8) of tamponade cases and 29% (2/7) of controls (P = 0.04). CONCLUSIONS: The detection of coronary sinus compression on CT is an early specific indicator of cardiac tamponade. Dilatation of the IVC and the presence of elevated pericardial fluid attenuation are CT signs suggestive of the diagnosis.

Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT.

BACKGROUND: Pacemakers and implantable cardiac defibrillators (ICDs) are widely used for the management of cardiac arrhythmias and congestive heart failure (CHF). Acute implantation complication rates range from 3% to 7%. The aim of this study is to describe the incidence of lead perforation on computed tomography (CT), and correlate these findings with electrophysiologic data. METHODS: Images of 100 consecutive patients with permanent pacemakers (n = 72) or ICDs (n = 28) who underwent multidetector CTs of the chest were identified. Cases were reviewed by 2 cardiothoracic radiologists, and a third if there was disagreement. Each CT was reviewed for device and fixation type, tip position, and presence of pericardial effusion. Results were correlated with lead impedance and pacing threshold, when available [79% (79/100)]. A cardiac electrophysiologist interpreted device data. RESULTS: All 100 patients had right ventricular leads (58 passive, 42 active) and 61 had right atrial leads (12 passive, 49 active). 15% (15/100) of patients had a lead perforation. Perforation rates were 15% (9/61) for atrial and 6% (6/100) for ventricular leads (P < 0.05, chi square). Four of 28 (14%) right ventricular ICD leads and 2 of 72 (3%)right ventricular pacemaker leads were perforated (P < 0.05, chi square). 12% (6/49) of active right atrial leads, and 25% (3/12) of passive right atrial leads perforated (P = NS, chi square). 7% (3/42) of active right ventricular leads, and 5% (3/58) of passive ventricular leads perforated (P = NS, chi square). Electrophysiologic parameters did not differ significantly between perforated and nonperforated leads. CONCLUSION: Asymptomatic perforation is a common phenomenon and rarely resulting in electrophysiologic consequences. Atrial leads perforated more frequently than ventricular leads, and ventricular ICD leads perforated more frequently than ventricular pacemaker leads.

Intrathoracic lymphadenopathy in hospitalized patients with pneumococcal pneumonia.

PURPOSES: Pneumococcal pneumonia is the most common etiology for community-acquired pneumonia. The prevalence of lymphadenopathy seen on CT scans in these patients is uncertain. The purpose of this series was to assess the prevalence of intrathoracic lymphadenopathy in hospitalized patients with pneumococcal pneumonia. MATERIALS AND METHODS: We retrospectively identified 35 hospitalized patients with pneumococcal pneumonia who had been evaluated with CT scanning between January 1998 and April 2002. There were 18 men and 17 women with a mean age of 56 years. The study inclusion criteria were as follows: blood culture positive for Streptococcus pneumoniae, clinical diagnosis of pneumonia, and chest CT scan. The study exclusion criteria were known causes of lymphadenopathy. Charts were reviewed for HIV status, smoking history, and comorbidities. CT scans were reviewed for the presence and degree of lymphadenopathy, and the characteristics of pneumonia. The number of enlarged lymph nodes was graded as few (one to two), moderate (three to five), or many (six or more). Pneumonias were described by location, the number of involved lobes, the presence of cavitation, and the presence of pleural effusion. Patients with different comorbidities and different imaging characteristics of pneumonia were compared. RESULTS: Among the 35 patients with pneumococcal pneumonia, intrathoracic lymphadenopathy was present on CT scans in 54% of patients (19 of 35 patients). The lymphadenopathy was ipsilateral to the pneumonia in 100% of patients (19 of 19 patients). One patient also had contralateral lymphadenopathy. The lymphadenopathy was graded as few in 37% of patients (7 of 19 patients), moderate in 37% of patients (7 of 19 patients), and many in 26% of patients (5 of 19 patients). The pneumonia was right-sided in 26% of patients (9 of 35 patients), left-sided in 17% of patients (6 of 35 patients), and bilateral in 57% of patients (20 of 35 patients). Comorbidities included the following: HIV infection (n = 15); smoking (n = 21); emphysema (n = 5); hepatitis C (n = 5); and diabetes (n = 3). The characteristics of pneumonia included the following: multilobar (n = 25); pleural effusion (n = 25); and cavitation (n = 5). The prevalence of lymphadenopathy according to comorbidities and characteristics of pneumonia ranged from 40 to 100%. None of the differences in prevalence of lymphadenopathy among the subgroups was statistically significant. CONCLUSION: Lymphadenopathy is a common CT scan feature of pneumococcal pneumonia in hospitalized patients, in a variety of settings. Therefore, when a patient with pneumococcal pneumonia has lymphadenopathy seen on a CT scan, other etiologies for the lymphadenopathy need not be suspected.

CT detection of acute myocardial infarction.

OBJECTIVE: The aim of this study was to evaluate the ability of contrast-enhanced CT to detect acute myocardial infarction (MI), which has not been systematically assessed. On contrast-enhanced helical chest CT, we retrospectively identified 18 patients (10 women, eight men; mean age, 66 years) with an initial MI. Each patient underwent contrast-enhanced single-detector helical chest CT within 1 month after the MI between March 2001 and June 2002. CONCLUSION: Acute MI is detectable on contrast-enhanced chest CT as an area of decreased left ventricular myocardial enhancement in a specific coronary arterial distribution.