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Zucker EJ. Cardiac Computed Tomography in Congenital Heart Disease. Radiol Clin North Am 2024; 62:435-452. [PMID: 38553179 DOI: 10.1016/j.rcl.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Computed tomography (CT) has emerged as a leading imaging modality in the evaluation of congenital heart disease (CHD). With ever-faster acquisition speed, decreasing radiation exposure, impeccable anatomic detail, optional functional data, and numerous post-processing tools, CT offers broad utility in CHD diagnosis, preoperative planning, and postoperative assessment. In this article, the far-reaching role of CT in CHD is reviewed, focusing on technical imaging considerations and key clinical applications.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Divisions of Pediatric and Cardiovascular Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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2
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Ito S. Challenging situation of coronary artery anomaly associated with ischemia and/or risk of sudden death. World J Cardiol 2024; 16:173-176. [PMID: 38690213 PMCID: PMC11056873 DOI: 10.4330/wjc.v16.i4.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 04/23/2024] Open
Abstract
Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked. The incidence of coronary artery anomalies is as low as 1%-2% of the general population, even when the various types are combined. Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter. If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention (PCI) is required, the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues. The level of PCI risk itself should also be considered on a case-by-case basis. In this case, emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye. Meticulous follow-up would be crucial, because sudden death may occur in single coronary arteries. To prevent atherosclerosis with full efforts is also important, as the authors indicated admirably.
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Affiliation(s)
- Shigenori Ito
- Division of Cardiology, Sankuro Hospital, Toyota 471-0035, Japan.
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3
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Cabello-Ganem A, Espejel-Guzman A, Aparicio-Ortiz AD, Guerra EC, Luna-Alcala S, Solorzano-Pinot E, Serrano-Roman J, Cano-Zarate R, Criales-Vera S, Espinola-Zavaleta N. Spectrum of the anomalous origin of the coronary arteries. Radiol Case Rep 2023; 18:2929-2934. [PMID: 37383175 PMCID: PMC10293585 DOI: 10.1016/j.radcr.2023.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
The anomalous origin of the coronary arteries (AOCA) has several patterns. Most are functional and asymptomatic. However, some are associated with persistent chest pain and sudden cardiac death. Multiple imaging techniques are available for the assessment of AOCA. We present a report of 4 cases with AOCA, including the anomalous aortic origin of a coronary artery (AAOCA) of the right coronary artery, AAOCA of the circumflex artery, AAOCA of the left anterior descending artery, and AAOCA of the circumflex artery with retroaortic trajectory, in which the clinical manifestations throughout the cases are discussed, highlighting the similarity among patients despite having different patterns. Multiple imaging techniques are indispensable for assessing AOCA, where transthoracic echocardiogram is the first-line study, and cardiac computed tomography provides detailed cardiac and coronary anatomy.
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Affiliation(s)
- Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14030, Mexico
| | | | - Alexis D. Aparicio-Ortiz
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14030, Mexico
| | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14030, Mexico
| | - Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14030, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14030, Mexico
| | | | - Roberto Cano-Zarate
- Department of Computer Tomography, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Magnetic Resonance, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Sergio Criales-Vera
- Department of Computer Tomography, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Magnetic Resonance, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14030, Mexico
- Department of Echocardiography, ABC Medical Center, IAP, Mexico City, Mexico
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Mizukami K, Higashiyama H, Arima Y, Ando K, Okada N, Kose K, Yamada S, Takeuchi JK, Koshiba-Takeuchi K, Fukuhara S, Miyagawa-Tomita S, Kurihara H. Coronary artery established through amniote evolution. eLife 2023; 12:e83005. [PMID: 37605519 PMCID: PMC10444023 DOI: 10.7554/elife.83005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/17/2023] [Indexed: 08/23/2023] Open
Abstract
Coronary arteries are a critical part of the vascular system and provide nourishment to the heart. In humans, even minor defects in coronary arteries can be lethal, emphasizing their importance for survival. However, some teleosts survive without coronary arteries, suggesting that there may have been some evolutionary changes in the morphology and function of coronary arteries in the tetrapod lineage. Here, we propose that the true ventricular coronary arteries were newly established during amniote evolution through remodeling of the ancestral coronary vasculature. In mouse (Mus musculus) and Japanese quail (Coturnix japonica) embryos, the coronary arteries unique to amniotes are established by the reconstitution of transient vascular plexuses: aortic subepicardial vessels (ASVs) in the outflow tract and the primitive coronary plexus on the ventricle. In contrast, amphibians (Hyla japonica, Lithobates catesbeianus, Xenopus laevis, and Cynops pyrrhogaster) retain the ASV-like vasculature as truncal coronary arteries throughout their lives and have no primitive coronary plexus. The anatomy and development of zebrafish (Danio rerio) and chondrichthyans suggest that their hypobranchial arteries are ASV-like structures serving as the root of the coronary vasculature throughout their lives. Thus, the ventricular coronary artery of adult amniotes is a novel structure that has acquired a new remodeling process, while the ASVs, which occur transiently during embryonic development, are remnants of the ancestral coronary vessels. This evolutionary change may be related to the modification of branchial arteries, indicating considerable morphological changes underlying the physiological transition during amniote evolution.
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Affiliation(s)
- Kaoru Mizukami
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
| | - Hiroki Higashiyama
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
| | - Yuichiro Arima
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
- Developmental Cardiology Laboratory, International Research Center for Medical Science, Kumamoto UniversityKumamotoJapan
| | - Koji Ando
- Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical SchoolTokyoJapan
| | | | - Katsumi Kose
- Institute of Applied Physics, University of TsukubaTsukubaJapan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Kyoto University Graduate School of MedicineKyotoJapan
| | - Jun K Takeuchi
- Molecular Craniofacial Embryology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | | | - Shigetomo Fukuhara
- Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical SchoolTokyoJapan
| | - Sachiko Miyagawa-Tomita
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
- Heart Center, Department of Pediatric Cardiology, Tokyo Women’s Medical UniversityTokyoJapan
- Department of Animal Nursing Science, Yamazaki University of Animal Health TechnologyTokyoJapan
| | - Hiroki Kurihara
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
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Type II single coronary artery from right aortic sinus, retro-aortic left coronary artery and dual LAD: a rare association of coronary arterial variations. Surg Radiol Anat 2023; 45:283-287. [PMID: 36656339 DOI: 10.1007/s00276-022-03064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The coronary arterial tree has a wide range of possible benign anatomical variations. It is important to differentiate them from coronary arterial anomalies, which can remain asymptomatic or in some cases lead to sudden death if undiagnosed. METHODS A 42-year-old female patient with a transient ST depression in right precordial leads performed an ECG-gated computed tomography angiography with dual layer spectral CT (IQon Elite Spectral CT, Philips, Amsterdam, The Netherlands) at Circolo Hospital of Varese. RESULTS A rare variant was observed and studied: a single common trunk arising from the right sinus of Valsalva which branches into a right coronary artery, a left anterior descending artery with malignant course and a left main with a retroaortic course; the left main gives origin to a dual anterior interventricular artery ("Dual LAD") and a left circumflex artery. CONCLUSIONS This type of variation was never described in the English literature. Identifying this variant is crucial for potential ischemic complications during sports activities or with the onset of atherosclerotic disease.
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Challenging Diagnosis of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery. Diagnostics (Basel) 2022; 12:diagnostics12112671. [DOI: 10.3390/diagnostics12112671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Anomalous origin of the right coronary artery (RCA) from the pulmonary artery, ARCAPA, is an extremely rare congenital heart disease. Only 200 cases were reported from 1885 to the present. Patients diagnosed with ARCAPA can be either asymptomatic or can experience symptoms, such as heart murmur, dyspnea, or angina, shortly after birth or around 40–60 years of life. Usually, those with isolated ARCAPA are diagnosed later in life compared to those who associate other structural cardiac defects. We report two cases of anomalous origin of the right coronary artery at the level of the pulmonary artery trunk (ARCAPA) that were diagnosed by invasive coronary angiography. Although asymptomatic, general recommendations suggest an early corrective intervention to prevent complications such as myocardial ischemia and cardiac dysfunction, which can lead to sudden cardiac death.
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Asl Fallah S, Mahdavi M, Rezaei-Kalantari K, Qanadli SD, Mirsadraee S. Left main coronary artery atresia in a 2-year-old toddler with de novo heart failure: Case report and review of the literature. Front Cardiovasc Med 2022; 9:898467. [PMID: 36337865 PMCID: PMC9634233 DOI: 10.3389/fcvm.2022.898467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Congenital coronary anomalies are among the rare disorders of the otherwise normal heart. A 2-year-old toddler was evaluated for de novo heart failure after a flu-like event 2 months before being suspicious of post-Covid-19 dilated cardiomyopathy. The cardiac magnetic resonance (CMR) technique displayed the basal to mid subendocardial to transmural scar, suggestive of an ischemic etiology. Further assessment with CT and invasive angiography confirmed the very uncommon left main coronary artery atresia (LMCAA) as the main cause of the patient's heart failure. This is not only the first reported LMCAA case that had undergone a CMR study but was also initially suspected with characteristic CMR findings.
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Affiliation(s)
- Sahar Asl Fallah
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kiara Rezaei-Kalantari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- *Correspondence: Kiara Rezaei-Kalantari
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Saeed Mirsadraee
- Department of Radiology, Royal Bromton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Malone LJ, Morin CE, Browne LP. Coronary computed tomography angiography in children. Pediatr Radiol 2022; 52:2498-2509. [PMID: 34734316 PMCID: PMC8566193 DOI: 10.1007/s00247-021-05209-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022]
Abstract
Imaging the coronary arteries of children, with their faster heart rates, small vessel size and common inability to lie still or breath-hold, has been a major challenge. With numerous advances in technology, CT examinations can now be performed quickly, often with children free-breathing and with much lower radiation doses than previously. This has led to increased use in children. Care must be taken with technique and choice of electrocardiogram (ECG)-gating technique to obtain adequate imaging for a diagnosis while keeping radiation dose as low as reasonably achievable (ALARA). In this paper, we discuss techniques and tips for CT imaging of the coronary arteries in children, including use of dual-source- and ultrawide-detector CT scanners.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, University of Colorado, Aurora, CO, USA.
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA.
| | - Cara E Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado, Aurora, CO, USA
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA
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Goo HW. Anomalous Origin of the Coronary Artery from the Pulmonary Artery in Children and Adults: A Pictorial Review of Cardiac Imaging Findings. Korean J Radiol 2021; 22:1441-1450. [PMID: 34047508 PMCID: PMC8390824 DOI: 10.3348/kjr.2021.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/17/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
Anomalous origin of the coronary artery from the pulmonary artery is a rare and potentially fatal congenital heart defect. Up to 90% of infants with an anomaly involving the left coronary artery die within the first year of life if left untreated. Patients who survive beyond infancy are at risk of sudden cardiac death. Cardiac CT and MRI are increasingly being used for the accurate diagnosis of this anomaly for prompt surgical restoration of the dual coronary artery system. Moreover, life-long imaging surveillance after surgery is necessary for these patients. In this pictorial review, multimodal cardiac imaging findings of this rare and potentially fatal coronary artery anomaly are comprehensively discussed, and representative images are provided to facilitate the understanding of this anomaly.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Goo HW, Siripornpitak S, Chen SJ, Lilyasari O, Zhong YM, Latiff HA, Maeda E, Kim YJ, Tsai IC, Seo DM. Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications. Korean J Radiol 2021; 22:1397-1415. [PMID: 33987995 PMCID: PMC8316776 DOI: 10.3348/kjr.2020.1332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shyh Jye Chen
- Department of Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taichung, Taiwan
| | - Dong Man Seo
- Department of Cardiothoracic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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Russo V, Sportoletti C, Scalas G, Attinà D, Buia F, Niro F, Modolon C, De Luca C, Monteduro F, Lovato L. The triple rule out CT in acute chest pain: a challenge for emergency radiologists? Emerg Radiol 2021; 28:735-742. [PMID: 33604768 PMCID: PMC8280047 DOI: 10.1007/s10140-021-01911-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. METHODS Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist-CR, an emergency senior radiologist-SER, and an emergency junior radiologist-JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. RESULTS Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. CONCLUSIONS Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The "undedicated" radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.
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Affiliation(s)
- Vincenzo Russo
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy.
| | - Camilla Sportoletti
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Giulia Scalas
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Domenico Attinà
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Buia
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Fabio Niro
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Cecilia Modolon
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Carlo De Luca
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Monteduro
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
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12
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Mancinelli A, Golino M, Miglierina E, My I, Crippa M, De Ponti R. Three Echocardiographic Signs to Identify Anomalous Origin of the Circumflex Coronary Artery from the Right Sinus of Valsalva: A Case Report. CASE 2020; 4:324-327. [PMID: 33117920 PMCID: PMC7581641 DOI: 10.1016/j.case.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The origins and courses of the coronary arteries can be detected on TTE. Three “echo-signs” can detect an anomalous origin of the circumflex coronary artery. A significant stenosis in the anomalous left circumflex artery can be detected on TTE.
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