CT of the heart before surgery or intervention

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Authors: Mikael Häggström; Authors of integrated Creative Commons article[1] [notes 1]

Planning

Choice of modality

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

  1. 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.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Rajiah, Prabhakar; Schoenhagen, Paul (2013). "The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention ". Insights into Imaging 4 (5): 671–689. doi:10.1007/s13244-013-0270-8. ISSN 1869-4101.