Difference between revisions of "CT of the heart before surgery or intervention"
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==Planning== | ==Planning== | ||
{{Heart imaging before surgery or intervention - choice of modality}} | {{Heart imaging before surgery or intervention - choice of modality}} | ||
| + | ===Settings=== | ||
| + | *'''Prospective ECG triggering''' is used in most instances, which is associated with significant reduction in radiation dose.<ref name="RajiahSchoenhagen2013"/> | ||
| + | *'''Retrospective ECG-gated acquisition''' (with dose modulation) is mostly limited to situations when information from all the phases of cardiac cycle is required, particularly for 4D imaging. Another indication is a patient with high and irregular heart rate.<ref name="RajiahSchoenhagen2013"/> | ||
| + | *'''Non-ECG-gated''' scanning is used to reduce radiation dose if motion artefact is not a major concern, e.g. for left atrial assessment in patients with atrial fibrillation.<ref name="RajiahSchoenhagen2013"/> | ||
==Evaluation== | ==Evaluation== | ||
Depending on procedure:<ref name="RajiahSchoenhagen2013"/> | Depending on procedure:<ref name="RajiahSchoenhagen2013"/> | ||
| − | Re-operative cardiothoracic surgery | + | ;Re-operative cardiothoracic surgery |
*Relationship of cardiovascular structures to sternum. | *Relationship of cardiovascular structures to sternum. | ||
*Relationship of coronary bypass grafts to sternum | *Relationship of coronary bypass grafts to sternum | ||
*Atherosclerotic calcification of ascending aorta | *Atherosclerotic calcification of ascending aorta | ||
*Anatomy of subclavian & axillary arteries and aortic arch | *Anatomy of subclavian & axillary arteries and aortic arch | ||
| − | Percutaneous aortic valve | + | ;Percutaneous aortic valve |
*Aortic root dimensions | *Aortic root dimensions | ||
*LV outflow tract: size; septal thickness | *LV outflow tract: size; septal thickness | ||
| Line 24: | Line 28: | ||
*Relationship of aortic root to body axis | *Relationship of aortic root to body axis | ||
*Caliber and contour of access vessels | *Caliber and contour of access vessels | ||
| − | Pulmonary venous ablation | + | ;Pulmonary venous ablation |
*Pulmonary venous anatomy | *Pulmonary venous anatomy | ||
*Branching pattern | *Branching pattern | ||
| Line 32: | Line 36: | ||
*Thrombus | *Thrombus | ||
*Relationship to oesophagus | *Relationship to oesophagus | ||
| − | Robotic mitral valve repair | + | ;Robotic mitral valve repair |
*Annulus and leaflet morphology | *Annulus and leaflet morphology | ||
*Mitral annular calcification | *Mitral annular calcification | ||
| Line 39: | Line 43: | ||
*Atherosclerosis of access vessels | *Atherosclerosis of access vessels | ||
*Distance from sinotubular junction to arch | *Distance from sinotubular junction to arch | ||
| − | Cardiac resynchronisation therapy | + | ;Cardiac resynchronisation therapy |
*Coronary venous anatomy | *Coronary venous anatomy | ||
*Scar in lateral wall | *Scar in lateral wall | ||
| − | Percutaneous mitral annuloplasty | + | ;Percutaneous mitral annuloplasty |
*Distance between coronary sinus/GCV and annulus | *Distance between coronary sinus/GCV and annulus | ||
*LCX between CS-GCV and annulus | *LCX between CS-GCV and annulus | ||
*Calcification of mitral annulus | *Calcification of mitral annulus | ||
| − | Atrial septal defect closure | + | ;Atrial septal defect closure |
*Type of defect | *Type of defect | ||
*Size of defect | *Size of defect | ||
*Rim of defect | *Rim of defect | ||
| − | Associated cardiovascular anomalies | + | *Associated cardiovascular anomalies |
| − | Thrombus | + | *Thrombus |
| − | Ventricular septal defect closure | + | ;Ventricular septal defect closure |
*Type of defect | *Type of defect | ||
*Size of defect | *Size of defect | ||
*Shape of defect | *Shape of defect | ||
*Proximity to valves and AV conduction bundle | *Proximity to valves and AV conduction bundle | ||
| − | Endovascular stent grafts | + | ;Endovascular stent grafts |
*Measurement of the primary pathology | *Measurement of the primary pathology | ||
*Maximal aortic diameter at the landing zone/neck | *Maximal aortic diameter at the landing zone/neck | ||
| Line 64: | Line 68: | ||
*Angulation at diaphragm | *Angulation at diaphragm | ||
*Calibre of femoral/iliac arteries | *Calibre of femoral/iliac arteries | ||
| − | Percutaneous pulmonary valve implantation | + | ;Percutaneous pulmonary valve implantation |
*Calibre of RV-PA conduit | *Calibre of RV-PA conduit | ||
*Length of the conduit available from pulmonary artery bifurcation | *Length of the conduit available from pulmonary artery bifurcation | ||
Latest revision as of 09:44, 19 July 2019
Authors:
Mikael Häggström; Authors of integrated Creative Commons article[1] [notes 1]
Planning
Choice of modality
- Echocardiography is generally the first imaging modality for valvular surgery or vascular intervention.[1]
- CT of the heart before surgery or intervention provides anatomic mapping, including extra-cardiac structures.[1]
Settings
- Prospective ECG triggering is used in most instances, which is associated with significant reduction in radiation dose.[1]
- Retrospective ECG-gated acquisition (with dose modulation) is mostly limited to situations when information from all the phases of cardiac cycle is required, particularly for 4D imaging. Another indication is a patient with high and irregular heart rate.[1]
- Non-ECG-gated scanning is used to reduce radiation dose if motion artefact is not a major concern, e.g. for left atrial assessment in patients with atrial fibrillation.[1]
Evaluation
Depending on procedure:[1]
- Re-operative cardiothoracic surgery
- Relationship of cardiovascular structures to sternum.
- Relationship of coronary bypass grafts to sternum
- Atherosclerotic calcification of ascending aorta
- Anatomy of subclavian & axillary arteries and aortic arch
- Percutaneous aortic valve
- Aortic root dimensions
- LV outflow tract: size; septal thickness
- Leaflet morphology/calcification
- Valve area
- Leaflet opening
- Distance between annulus and coronary ostia
- Leaflet length
- Relationship of aortic root to body axis
- Caliber and contour of access vessels
- Pulmonary venous ablation
- Pulmonary venous anatomy
- Branching pattern
- Orientation
- Ostial size and pulmonary venous stenosis
- Left atrial dimensions
- Thrombus
- Relationship to oesophagus
- Robotic mitral valve repair
- Annulus and leaflet morphology
- Mitral annular calcification
- Annulus dimensions
- Calibre of femoral vessels
- Atherosclerosis of access vessels
- Distance from sinotubular junction to arch
- Cardiac resynchronisation therapy
- Coronary venous anatomy
- Scar in lateral wall
- Percutaneous mitral annuloplasty
- Distance between coronary sinus/GCV and annulus
- LCX between CS-GCV and annulus
- Calcification of mitral annulus
- Atrial septal defect closure
- Type of defect
- Size of defect
- Rim of defect
- Associated cardiovascular anomalies
- Thrombus
- Ventricular septal defect closure
- Type of defect
- Size of defect
- Shape of defect
- Proximity to valves and AV conduction bundle
- Endovascular stent grafts
- Measurement of the primary pathology
- Maximal aortic diameter at the landing zone/neck
- Thrombus/atheroma in the landing zone
- Distance from major branch vessel
- Angulation at diaphragm
- Calibre of femoral/iliac arteries
- Percutaneous pulmonary valve implantation
- Calibre of RV-PA conduit
- Length of the conduit available from pulmonary artery bifurcation
- RVOT/pulmonary trunk morphology
- Position of proximal coronary arteries
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
