Imaging of Coronary Artery Fistulas by Multidetector Computed TomographyIs Multidetector Computed Tomography Sensitive

×
Rating : Rate It:
 
Embed :   
Post a comment
    Post Comment on Twitter
Comments:  



  Notes
 
 
Slide 1 : Imaging of Coronary Artery Fistulas by Multidetector Computed Tomography:Is Multidetector Computed Tomography Sensitive? Fehmi Kacmaz,M.D.,Nilgun Isiksalan Ozbulbul,M.D.,Omer Alyan,M.D.,Orhan Maden,M.D.,Ahmet Duran Demir,Ramazan Atak, Kubilay Senen, Ali Riza Erbay, Yucel Balbay,Tulay Olcer,Erdogan Ilkay; Turkiye Yuksek Ihtisas Hospital, Department of Cardiology,Ozel Mesa Hospital, Ankara,TURKEY
Slide 2 : Coronary artery fistula (CAF) is a rare anomaly in which a communication is present between coronary artery and either cardiac chamber or another vascular structure. It is observed in 0.3% to 0.8% of patients who underwent coronary angiography. CAF arises from the right coronary artery(RCA) more often than left coronary artery(LCA) and arises from both RCA and LCA in approximately 5% of patients. More than 90% of fistulas drain into the systemic venous side of the circulation. Coronary Artery Fistula
Slide 3 : Multidetector computed tomography(MDCT) is a recently developed imaging technique to detect coronary artery stenosis, anomalous vessel of coronary artery and coronary artery fistula(CAF) Case reports of CAF detected by MDCT. The sensitivity of MDCT in patients having CAF has not been determined before. We discribed diagnostic sensitivity of MDCT in a series of 13 patients with 15 coronary artery fistulas. This is first study as well as we know in current literature. MDCT
Slide 4 : Nakamura et al. reported a case of giant congenital CAF to the left branchial vein clearly detected by MDCT. Soon et al. showed how well the non-invasive CT coronary angiography with a 16-slice CT scaner caracterized the anatomy of an anomalous coronary artery with coronary cameral fistula in one case Literature Circ J 2006;70(6:796-799) Int J Cardiol 2006;106(2):276-278
Slide 5 : Between June 2005 and June 2006 a total of 7854 consecutive patients underwent coronary angiography and 13 patients had coronary artery fistulas were incidentally found MATERIALS AND METHODS
Slide 6 : Patients had atrial fibrillation were excluded. Metoprolol (50-100 mg) was given orally 90-120 minutes prior to the MDCT scan to obtain adequate heart rate. MDCT was performed to all patients who had CAF detected by coronary angiography before.
Slide 7 : All patients were informed clearly about study orally and study was started after obtaining approval of patients whose gave written informed consent and the study protocol was approved by the institutional review board.
Slide 8 : To detection sensitivity of MDCT, the results of MDCT were evaluated by two experienced radiologist and one cardiologist who were unaware about study protocol. Finally, we determined diagnostic sensitivity of MDCT in patients had coronary artery fistula detected.
Slide 9 : Patients with angiographically documented coronary artery fistulas underwent 16-slice CT coronary angiography. First, noncontrast localization scan was performed that yielded an anteroposterior view of the chest In a second step, a bolus of 30 mL of contrast agent(Iohexol, Ultravist 350, Schering AG) was injected intravenously at 4 mL/s via an 18 gauge catheter placed in the antecubital vein In a third step, contrast agent (130 mL) was injected in to antecubital vein at 4mL/s and the CT scan was initiated with a delay according to the previously determined contrast agent transit time. MDCT Image and Data Analysis
Slide 10 : Axial, sagittal, coronary multiplanar reformations and three-dimensional images were created using standart software. MDCT images were analyzed by two experienced radiologist and one cardiologist.
Slide 11 : Thirteen patients (8 men, 5 women; age ranged 31-78) had CAFs detected by coronary angiography before were evaulated. Heart rate of patients were ranged between 48-69 bpm during MDCT scan. Six of 13 (46%) patients had atherosclerotic coronary artery disease. RESULTS
Slide 12 : When we evaulated coronary artery segments we found single vessel coronary artery disease in three patients, two vessels coronary artery disease in one patient and three vessels coronary artery disease in two patients.
Slide 13 : Table I. Coronary artery anatomy and fistulas course of each patients detected by coronary angiography and results of MDCT. LAD: left anterior descending coronary artery; LVC: left ventricle cavity; RCA: right coronary artery; PA: pulmonary artery; CX: circumflex coronary artery; RA: right atrium; RVOT: right ventricle outflow tract; PV: pulmonary vein
Slide 14 : In present study 12 of 15 (80%) CAFs were originated from left coronary artery system. CAFs were originated from right coronary artery(RCA) in remain. Left anterior descending coronary artery was the most common origin site of CAFs(46%).
Slide 15 : In this study 66% of CAFs were drained into sytemic venous circulation. Pulmonary artery(PA) was the most drainage site of CAFs(40%). CAFs were less commonly draining into left ventricle cavity(LVC), right ventricular outflow track(RVOT), right atrium(RA), pulmonary vein, bronchial artery.
Slide 16 : When we compared images of MDCT to coronary angiography we found that 4 of 15(27%) CAFs were not visulaized on MDCT The origins, courses and drainage sites of fistulas were visualized by MDCT in remain 11(73%) CAFs.
Slide 17 : Percutaneous coil embolization was performed to five patients but failed in one patient due to unsuitable anatomy of fistula.
Slide 18 :
Slide 19 :
Slide 20 :
Slide 21 :
Slide 22 :
Slide 23 :
Slide 24 :
Slide 25 :
Slide 26 : Although coronary angiography is gold standart diagnostic method for detection origin and course of CAFs, MDCT may be alternative imaging method especially in fistula coursing between coronary artery and another vascular structures to detect fistula origin and drainage site because of its excellent spatial resolution and ability to show relationship of anatomic structures. In this population sensitivity of MDCT is quite high(87%). Conclusion
Slide 27 : One of the most important result of this study is that the sensitivity of MDCT was low(58%) in patients who had CAF coursing between coronary arteries and cardiac chambers. When we re-evaluated this population, we observed that CAFs had small cameral vascular structure and originated from distalis segment of coronary artery and drained into cardiac chambers except one CAF that was coursing between LAD and PA.
Slide 28 : Having evaluated 13 patients with a total of 15 coronary artery fistulas, the current numbers are low to determined exact sensitivity of MDCT compared to coronary angiography. So, we need large series to obtain really sensitivity of MDCT. Suitable heart rates must obtain during MDCT procedure especially, in patients had small cameral and low flow to detect whole course of CAF. Study Limitations
Slide 29 :
Slide 30 : THANKS FOR YOUR ATTENTION
Slide 31 :
Slide 32 :
Slide 33 :
Slide 34 :
Slide 35 :
Slide 36 :
Slide 37 :
Slide 38 :
Slide 39 :
Slide 40 :
Slide 41 :
Slide 42 :
Slide 43 :
Slide 44 :
Slide 45 :

 


Related 

 
Free Powerpoint Templates
Add as Friend kacmazfehmi@superonline.com     4 Years ago.
1073 Views, 0 favourite
PowerPoint Presentation on Imaging of Coronary Artery Fistulas by Multidetector Computed Tomography    more
More By User

Flag as inappropriate





Browse | Powerpoint Templates | Tags | Contact | About Us | Privacy | FAQ | Blog

© Slideworld