Correlation Between Cardiac Computed Tomography and Histopathology for Evaluating Patients with Aortic Valve Disease.

BACKGROUND: The use of cardiac computed tomography (cardiac CT) and the quantification of the Agatston score for the evaluation of calcium of the aortic valve (AVC) has increased in different clinical contexts for diagnostic and prognostic purposes. This study aims to evaluate the correlation between cardiac CT and histopathology for the quantification of AVC. METHODS: Ninety patients diagnosed with severe aortic valve dysfunction, of any etiology and regardless of the predominant type of injury, were included. Before the surgical event, a Cardiac CT were performed with Agatston Score measurement. The removed native valve was evaluated by a Pathologist, who provided a qualitative and quantitative evaluation of valve calcium. Calcium density was also analyzed by quantifying the area in pixel units obtained from photomicrographs. Follow-up was performed for four years after the aortic valve replacement. RESULTS: Ninety patients were analyzed. The degenerative etiology predominated 63.3% (57 patients). The calcium load was different for the gender (p = 0.01) and type of valve injury (p = 0.0013). There was a positive correlation between the Agatston score, and the percentage of calcium reported by the pathologist in a conventional qualitative way (rs = 0.75, p < 0.001) and between the AVC and the Cote et al. score (rs = 0.77, p < 0.001). There was no difference in survival after aortic valve replacement concerning valve calcium load. Left ventricular dysfunction showed a significant difference in survival (p = 0.003, Log-rank). CONCLUSION: There is a moderately high correlation between the Agatston score quantified by Cardiac CT and the histopathological evaluation. The severity of the calcification did not prove to be a predictor of death in the postsurgical follow-up.

Anomalous origin of pulmonary branches from the ascending aorta. A report of five cases and review of the literature.

The anomalous origin of pulmonary branches is a rare entity where, either the right or the left pulmonary arteries arise from the ascending aorta and where the aortic and pulmonary valves are separated. Clinical manifestations usually appear in the infant or, more rarely, in the newborn and include respiratory distress or congestive heart failure due to increased pulmonary resistance.The survival rate in an Indian series was 94% with the death of one patient from Fallot tetralogy. We have treated five patients with this congenital heart disease in 20 years; the survival rate was of 80% and in all survival cases, the systolic pressure was significantly decreased. The current treatment of choice, consisting of the anatomical correction with translocation of the right pulmonary artery to the pulmonary trunk, was first performed by Kirkpatrick in 1961.The aim of this paper is to show the Mexican experience in the diagnosis and treatment of the anomalous origin of pulmonary branches from the ascending aorta. CONCLUSION: Early surgery with timely correction of this congenital heart disease improves the prognosis and survival rate of patients, with a reduction in pulmonary hypertension..