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We report a case of 5-year-old girl with double outlet right ventricle with a rare combination of partial anomalous pulmonary venous drainage into a persistent left superior caval vein in the presence of an unroofed coronary sinus while highlighting its possible embryological origins and therapeutic implications.
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Seio Coronário , Comunicação Interatrial , Veias Pulmonares , Pré-Escolar , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Drenagem , Feminino , Humanos , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgiaAssuntos
Insuficiência da Valva Aórtica , Insuficiência da Valva Pulmonar , Valva Pulmonar , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Humanos , Valva Pulmonar/anormalidades , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Resultado do TratamentoRESUMO
Classically described in tortuous coronaries, the concertina effect is a type of pseudostenosis induced by guidewire and is extremely rare in the left main coronary artery because of its short length. However, concertina effect in the left main coronary artery after percutaneous intervention should be considered in the appropriate setting to avoid confounding management dilemmas and unwarranted interventions.
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Angioplastia Coronária com Balão , Vasos Coronários , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , HumanosRESUMO
The left ventricular outflow is an anatomically complex region situated between the anterior leaflet of the mitral valve and the left ventricular aspect of the muscular and membranous interventricular septum. It gives rise to the aorta, provides support to the aortic valvular cusps, and houses important components of the conduction system. The left ventricular outflow handles high pressures and pressure variations and is subsequently affected by a variety of aetio-pathological conditions. Diseases involving the left ventricular outflow can be intraluminal, mural, or extramural, and the consequent complications of the lesions can be local, loco-regional, or even systemic. Appropriate evaluation requires comprehensive multimodality imaging with each modality contributing to assessment of different aspects of diagnosis, lesion characterization, local extension, prognostication for systemic complications and mortality, and the decision for the approach and type of intervention and aggressive follow-up in case non-interventional management is decided. In this review, we briefly describe the relevant anatomy and the gamut of structural abnormalities pertaining to the left ventricular outflow on multidetector computed tomography angiography.
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Aortic involvement can be secondary to various pathologic disease processes. These may result in stenotic or aneurysmal aortic lesions with a varied spectrum of imaging findings including intra-luminal, mural, and periaortic changes along with associated loco-regional or distal changes, depending on the etiology. Multidetector computer tomography with its recent advances has become the frontline imaging modality for the evaluation of aortic pathologies. Comprehensive evaluation of the aortic pathology with simultaneous evaluation of lungs, bones, and visceral organs is possible with a single multidetector computer tomography acquisition. It allows accurate primary diagnosis, identifies important anatomic landmarks and relationships, and identifies associated cardiovascular anomalies. Moreover, it serves as an adjunct in diagnosis of various complications, helps in treatment planning and detection of disease progression during follow-up.
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Angiografia , Tomografia Computadorizada Multidetectores , Aorta , Angiografia por Tomografia Computadorizada , Constrição Patológica , Humanos , PulmãoRESUMO
AIM: To evaluate the imaging features and associations in patients with supravalvar aortic stenosis on multidetector computed tomography (CT) angiography. MATERIALS AND METHODS: We retrospectively reviewed all CT angiography studies performed for evaluation of congenital heart diseases at our institution through the period from January 2014 to June 2020. Cases with supravalvar aortic stenosis were identified and classified as syndromic and nonsyndromic based on history, physical examination, and relevant investigations. The type and extent of vascular involvement and associated cardiovascular abnormalities were characterized. RESULTS: Supravalvar aortic stenosis was identified in 26/3926 (0.66%) patients (22 males and 4 females; Age range: 2 months to 20 years). Discrete stenosis was seen in 14/26 (53.8%) patients, while diffuse involvement of the ascending aorta to varying degrees was seen in the remaining 12 (46.2%) patients. About 15/26 (57.7%) patients had pulmonary involvement at some level, namely, infundibular, valvar, supravalvar, or peripheral pulmonic stenosis while 15/26 (57.7%) patients had coronary arterial involvement either in the form of stenosis, occlusion, or ectasia. Aortic valvular abnormality including thickening, partial fusion, and adhesion of leaflet edges to the sinutubular junction causing reduced coronary inflow was seen in 15/26 (57.7%) patients. Associated ventricular septal defect, patent ductus arteriosus, and mitral valvular prolapse were seen in four (15.4%), five (19.2%), and two (7.7%) patients respectively. CONCLUSION: Supravalvar aortic stenosis is a rare abnormality showing associated pulmonary arterial involvement, coronary arterial involvement, aortic valvular abnormalities, and associated congenital cardiac defects in the majority of cases, which may influence surgical outcomes.
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Estenose Aórtica Supravalvular , Angiografia , Estenose Aórtica Supravalvular/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Lactente , Masculino , Tomografia Computadorizada Multidetectores , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate safety and efficacy of angiogenesis induced by intraarterial autologous bone marrow-derived stem cell (BMSC) injection in patients with severe peripheral arterial disease (PAD). MATERIALS AND METHODS: Eighty-one patients with severe PAD (77 men), including 56 with critical limb ischemia (CLI) and 25 with severe claudication, were randomized to receive sham injection (group A) or intraarterial BMSC injection at the site of occlusion (group B). Primary endpoints included improvement in ankle-brachial index (ABI) of > 0.1 and transcutaneous pressure of oxygen (TcPO2) of > 15% at mid- and lower foot at 6 mo. Secondary endpoints included relief from rest pain, > 30% reduction in ulcer size, and reduction in major amputation in patients with CLI and > 50% improvement in pain-free walking distance in patients with severe claudication. RESULTS: Technical success was achieved in all patients, without complications. At 6 mo, group B showed more improvements in ABI of > 0.1 (35 of 41 [85.37%] vs 13 of 40 [32.50%]; P < .0001) and TcPO2 of > 15% at the midfoot (35 of 41 [85.37%] vs 17 of 40 [42.50%]; P = .0001] and lower foot (37 of 41 [90.24%] vs 19 of 40 [47.50%]; P < .0001). No patients with CLI underwent major amputation in group B, compared with 4 in group A (P = .0390). No significant difference was observed in relief from rest pain or > 30% reduction in ulcer size among patients with CLI or in > 50% improvement in pain-free walking distance among patients with severe claudication. CONCLUSIONS: Intraarterial delivery of autologous BMSCs is safe and effective in the management of severe PAD.
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Transplante de Medula Óssea , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Neovascularização Fisiológica , Doença Arterial Periférica/cirurgia , Transplante de Células-Tronco , Adulto , Amputação Cirúrgica , Transplante de Medula Óssea/efeitos adversos , Estado Terminal , Método Duplo-Cego , Feminino , Humanos , Índia , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Transplante de Células-Tronco/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: To evaluate the imaging characteristics and associations in patients with isolation of arch vessels on multidetector computed tomography angiography (CTA). MATERIALS AND METHODS: We retrospectively reviewed all multidetector CTA studies performed for the evaluation of congenital heart diseases (CHDs) at our institution from January 2014 to June 2020. Cases with isolation of arch vessels were identified. The isolated arch artery and its relationship with patent arterial duct, pulmonary artery, and aortic arch were characterized in addition to other associated intra- and extracardiac anomalies. RESULTS: Isolation of arch vessels was seen in 14/3926 (0.36%) patients. Left subclavian artery (SCA) was the commonest isolated arch vessel, involved in 7/14 (50%) cases. Isolation of right SCA, left brachiocephalic artery, and left common carotid artery was seen in 4 (28.6%), 2 (14.3%), and 1 (7.1%) patient, respectively. The isolated arch vessel was seen associated with right aortic arch in 10/14 (71.4%) cases and was on the opposite side of aortic arch in all 14 (100%) patients. Right-sided nonrestrictive patent arterial duct was seen in 3/14 (21.4%) cases, left-sided nonrestrictive patent arterial duct was seen in 1/14 (7.1%) while a left-sided restrictive patent arterial duct was seen in 3/14 (21.4%) cases. Tetralogy of Fallot (ToF) was the commonest associated anomaly seen in 8/14 (57.1%) patients. CONCLUSION: Isolation of aortic arch branch vessels is rare, seen most commonly associated with ToF. Left SCA is the commonest involved vessel. CTA is useful not only in the diagnosis of isolation of arch vessels, but also in the presence or absence of associated anomalies which may impact the symptomatology, prognosis, and surgical management.
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AIM: To evaluate the imaging characteristics and associations in patients with twisted atrioventricular connections on multidetector computed tomography (CT) angiography. MATERIAL AND METHODS: We retrospectively reviewed 2605 CT angiography studies performed for suspected congenital heart diseases in our institution from January 2014 to December 2018. Twisted atrioventricular connections were diagnosed in 12 patients. Segmental sequential approach developed by Anderson et al was employed to characterize the complex congenital heart disease. Ventricular topology was also determined. CTA was also assessed to look for any associated intra- and extracardiac anomalies. RESULTS: Out of 12 patients with twisted atrioventricular connections, usual viscero-atrial arrangement was seen in nine patients, two patients had mirror-imaged viscero-atrial arrangement and one patient had mirror-imaged atrial arrangement. Right-sided heart was seen in four patients. Two patients had discordant atrioventricular connections, seven had concordant atrioventricular connections while three showed double-inlet right ventricle. Ventriculoarterial connections were concordant in two patients, discordant in one patient while nine patients had double-outlet right ventricle. Superior-inferior ventricular morphology with near-horizontal interventricular septum was seen in four patients. Left-sided aortic arch with normal branching pattern was observed in nine patients. No coronary anomaly was seen in any patient. Other associations included ventricular and atrial septal defects, pulmonic stenosis, hypoplasia/atresia of tricuspid valve, straddling of mitral valve, and duplicated superior caval veins. CONCLUSION: CT angiography is useful in diagnosis of twisted atrioventricular connections with accurate identification of viscero-atrial arrangement, atrioventricular and ventriculoarterial connections, and orientation and presence or absence of associated anomalies.
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Coração Entrecruzado/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Anormalidades Múltiplas , Adolescente , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Feminino , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Humanos , Lactente , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Atresia Tricúspide/diagnóstico por imagemRESUMO
We present a case of a 12-year-old boy with discordance between the atrial arrangement and the thoracoabdominal arrangement in the setting of twisted atrioventricular connections. This case highlights the importance of a separate description of all visceral organs and venous drainage for an accurate description of visceroatrial arrangement in cases of congenital heart defects.
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Anormalidades Múltiplas/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Levocardia/diagnóstico , Estenose da Valva Pulmonar/diagnóstico por imagem , Criança , Angiografia por Tomografia Computadorizada , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , MasculinoRESUMO
We present a case of a 4-year-old child operated previously for cyanotic congenital heart disease where the follow-up computed tomography (CT) angiography revealed anomalous origin of the left vertebral artery from the descending thoracic aorta. This case also highlights the potential implications of this variant and the value of CT angiography in diagnosing this anomaly.
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Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Artéria Vertebral/anormalidades , Artéria Vertebral/diagnóstico por imagem , Pré-Escolar , Humanos , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagemRESUMO
Isolation of the right subclavian artery (RSCA), defined as loss of continuity between the RSCA and aorta, is a rare anomaly and its association with dextrotransposition of great arteries (D-TGA) is exceedingly unusual. We present the case of a 5-day-old neonate with cyanosis from birth and a transthoracic echocardiographic diagnosis of D-TGA, where on computed tomography angiography, the RSCA was seen arising from the proximal part of the ipsilateral pulmonary artery via a patent right ductus arteriosus.
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OBJECTIVES: The present study sought to estimate the incidence and evaluate the patterns and associations of systemic venous anomalies in patients with tetralogy of Fallot on multidetector computed tomography (CT) angiography. METHODS: We retrospectively reviewed CT angiographies of 973 pediatric age group patients diagnosed with tetralogy of Fallot, performed at our institution between 1st January 2015 and 31st December 2019, for systemic venous drainage patterns. We also proposed a structured classification and reporting system on CT angiography which would simplify the characterization, classification, and communication of these anomalies. RESULTS: Variations in systemic venous drainage patterns were observed in 146 (15.01%) patients. The most commonly observed anomaly was persistence of left superior caval vein, which was seen in 112 (11.51%) patients, with the most prevalent pattern being the presence of bilateral superior caval veins with no intercommunicating vein (n = 85). The second most common anomaly observed was presence of anomalous brachiocephalic vein (39/973 [4.01%]). Patients with an anomalous course of brachiocephalic vein had significantly higher prevalence of a right aortic arch than those without (23/39 [58.97%] vs 188/934 [20.13%]; P < .0001). Similarly, a higher prevalence of pulmonary atresia was noted in patients with an anomalous course of brachiocephalic vein compared to those without (8/39 [20.51%] vs 80/934 [8.57%]; P = .0109). CONCLUSION: There is a high incidence of anomalies of superior caval veins and brachiocephalic vein in the presence of tetralogy of Fallot. With advancements in corrective cardiac surgery and use of intraoperative cardiopulmonary bypass, the presence of systemic venous anomalies assumes greater significance making preoperative identification of these anomalies imperative.
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Tetralogia de Fallot , Angiografia , Veias Braquiocefálicas/diagnóstico por imagem , Criança , Angiografia por Tomografia Computadorizada , Humanos , Incidência , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/cirurgia , Veia Cava SuperiorRESUMO
In the original article, the section "Fact Sheet" was not published. This section should give the reader an overview on the most important take-home messages on aortitis. Please see below the missing section.
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We present a case of cyanotic congenital heart disease with left common carotid artery agenesis in the setting of the right aortic arch highlighting the potential implications in management.
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Anormalidades Múltiplas/diagnóstico por imagem , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Tronco Braquiocefálico/anormalidades , Artérias Carótidas/anormalidades , Artérias Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Cardiopatias Congênitas/diagnóstico por imagem , Cianose/etiologia , Insuficiência de Crescimento/etiologia , Cardiopatias Congênitas/complicações , Humanos , Lactente , MasculinoRESUMO
Aortitis includes conditions with infectious or non-infectious etiology, characterized by inflammatory changes in one or more layers in aortic wall. Age at onset, geographic predilections, distribution and pattern of involvement in aorta, its branches and pulmonary arteries, and systemic associations provide a clue to etiology. Clinical presentations are often non-specific. An integrated approach including clinical, laboratory and imaging assessment is essential to confirm diagnosis and plan treatment. Assessment of disease activity is the key as it influences timing and outcome of treatment. Markers of activity include clinical, laboratory and imaging. Medical management remains the first-line therapy. Revascularization is indicated in the presence of hemodynamically significant stenosis and inactive disease. In the presence of flash pulmonary edema, left ventricular dysfunction or hypertensive encephalopathy, revascularization is performed irrespective of disease activity. Endovascular management is favored over surgery due to its high success and low restenosis rates. Symptomatic aneurysmal disease is usually managed by surgery.
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Aortite , Procedimentos Cirúrgicos Vasculares , Fatores Etários , Aorta/diagnóstico por imagem , Aortite/diagnóstico , Aortite/etiologia , Aortite/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/cirurgia , Humanos , Masculino , Arterite de Takayasu/diagnóstico , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
We present a case of type B aortic dissection with a rare aortic arch branching variation whereby two separate brachiocephalic trunks arise from the arch. This case also highlights the potential implications of this variant in the management of thoracic aortic dissections and aneurysms.