Postcardiac injury syndrome following transvenous pacer or defibrillator insertion: CT imaging and review of the literature.

Postcardiac injury syndrome (PCIS) is a frequent clinical entity developing as a complication of cardiac procedures. Some of these may be only minor procedures, such as the insertion of permanent pacer or defibrillator devices. The purpose of this article is to review and illustrate its common imaging findings. PCIS is expected to occur in approximately 1%-2% of patients after pacer or defibrillator device placement. The mechanism of pericarditis following implantation is unclear, but it may involve a direct irritation of the pericardium by minimally protruding electrodes, low-grade bleeding with hemorrhagic pericarditis, and a late autoimmune or inflammatory response to those insults. Radiologists may detect findings that in the appropriate clinical setting should raise the possibility of PCIS. On chest x-ray, the findings include the presence of a pericardial or pleural effusion or both. Computed tomography, in addition to having better characterization capabilities of the pericardial or pleural effusion or both, may also accomplish the diagnosis of lead perforation. Although typically rather benign, PCIS may result in significant morbidity and potential mortality due to arrhythmias, noncardiac pulmonary edema, and cardiac tamponade. Therefore, its early detection is of clinical importance.

Congenital rock and a hard place: unicuspid aortic valve with sinus of valsalva aneurysm.

Cardiac CT angiography (CTA) is an ideal tool to investigate possible cardiac malformations. In this case, careful planning of the CTA acquisition and reconstruction provided high resolution images of cardiac anatomy revealing 2 extremely rare coexisting congenital defects; a unicuspid aortic valve (UAV) and sinus of Valsalva aneurysm (SVA). Detailed planning of CTA acquisition reconstruction protocols is essential in obtaining necessary information for clinical decision-making strategies and interventions in the patients with suspected cardiac anomalies.

Simultaneous assessment of coronary stenosis, myocardial perfusion, and ventricular function in a patient with acute myocardial infarction.

Cardiac CT angiography (CTA) is an ideal tool to investigate cardiac and noncardiac causes of acute chest pain. In this case, careful planning of the CTA acquisition and reconstruction limits permitted not only the exclusion of aortic dissection and provided high resolution images of coronary anatomy but also showed a concordant abnormality in myocardial perfusion and ventricular function in the setting of an acute coronary syndrome. Detailed planning of every CTA acquisition reconstruction protocol is essential to obtain the information necessary for clinical decision-making strategies and interventions in the patient with chest pain.

Reclassification of patients for aggressive cholesterol treatment: additive value of multislice coronary angiography to the National Cholesterol Education Program guidelines.

BACKGROUND: National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. OBJECTIVE: We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. METHODS: Multislice computed tomography was performed in 114 consecutive patients (mean age 57+/-14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). RESULTS: Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n=12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low- and intermediate-risk groups, MSCT found coronary plaque in 76% (n=77/102), with moderate or severe plaque in 38% (n=39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p=0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). CONCLUSION: Multislice computed tomography reclassifies a high percentage of patients considered to be low- to intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.