Assessment of aortic valve in regard to its anatomical variants morphology in 2053 patients using 64-slice CT retrospective coronary angiography.

BACKGROUND: Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly. Other aortic valve variants are rare but are associated with an increased incidence of various pathologies of the aortic valve (AV). The aim of this study was to assess the AV function in regard to its anatomical variants morphology in patients who underwent 64-slice coronary computed tomography angiography (CCTA) for suspected or known coronary artery disease. METHODS: The results of 64-detector retrospective ECG-gated CCTA of 2053 patients (mean age 58 years; 1265 males) were analyzed retrospectively by experienced cardiovascular radiologist. Coronary anatomy (with coronary artery dominance) and the extent of occlusion in the coronary arteries were assessed. Furthermore morphological and functional status of AV variants were analyzed. Among measured parameters were area at the level of AV annulus, orifice and tubular portion of the ascending aorta. RESULTS: The AV was visualized in all CCTA studies and the analysis of its morphology and function was done in all patients. BAV was found in 19 patients (0.9 %), from which type 0 was diagnosed in five patients (0.2 %) and type 1 in 14 patients (0.7 %) - there was no patient with BAV type 2. Unicuspid (UAV) and quadricuspid (QAV) variant were both observed each in one patient (0.05 %). In rest of the patients from the study group tricuspid AV variant was recognized. Function of AV variants was mostly affected in BAV0 and UAV. Among patients with BAV1 there were patients with normal and abnormal function of AV. QAV variant did not deteriorate AV function. There was no difference in coronary artery disease and dominancy between different anatomical variants of AV. CONCLUSIONS: During CCTA different valve variants can be detected and detailed analysis of valvular function can be proceeded. Larger values of annulus area, wider diameters of ascending aorta and more stenotic profile were observed in BAV 0, BAV 1 and UAV. Among AV variants morphology and function was mostly affected in patients with BAV 0 and UAV variants, while subjects with BAV1 had normal or abnormal function of the AV. Moreover, we noticed that QAV variant did not deteriorate AV function.

The Role of Computed Tomography in the Diagnostics of Diaphragmatic Injury After Blunt Thoraco-Abdominal Trauma.

BACKGROUND: Diaphragmatic injuries occur in 0.8-8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries. Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications. The aim of this study was to present radiological findings in patients with diaphragmatic injury. MATERIAL/METHODS: The analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture. The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign). RESULTS: In our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively. In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed. Other signs were less common. CONCLUSIONS: The knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal trauma patients.

Quadricuspid aortic valve with mild aortic regurgitation and persistent foramen ovale: a multimodality imaging of rare concomitant findings.

Quadricuspid aortic valve is a rare congenital heart disease that is mostly detected incidentally during echocardiography or angiography, or at autopsy. This pathology is frequently associated with other congenital anomalies of the heart such as abnormalities of coronary ostia, coronary stenosis, aortic root dilation and coarctation of the aorta, as well as significant aortic valve dysfunction. Herein is presented the first documented case of an asymptomatic middle-aged male patient with incidentally diagnosed quadricuspid aortic valve and a preserved valve function associated with a patent foramen ovale and reverse right-left leak identified during the Valsalva maneuver. No other associated cardiac abnormalities were identified.

Unusual post-traumatic aortic rupture in a paraglide pilot - A case report.

Post-traumatic aortic injuries are more common in victims of aircraft accidents than in motor vehicle accidents, and are a leading cause of on-site and delayed mortality, regardless of cause. In this case report, we present a history of a nearly isolated aortic post-traumatic injury in a victim of a paragliding accident. The rarity of this case lies in 2 factors, that is, the lack of the other life-threatening injuries usually present in high-energy accidents, and an unusual, exfoliative type of injury not matching more closely the typical classifications made use of currently in clinical practice.

[Interventional radiology techniques in the treatment of Budd-Chiari syndrome]. / Zastosowanie metod radiologii interwencyjnej w zespole Budd-Chiari.

Budd-Chiari syndrome (BCS) is rare clinical state characterized by the stenosis or complete obstruction of hepatic veins. Currently interventional radiology techniques are more frequently used as a single method of treatment or as a bridge to liver transplantation. This paper presents current interventional radiology techniques used in BCS treatment. Depending on etiology of BCS two major techniques are used: transjugular intrahepatic portocaval shunts (TIPS) or percutaneous angioplasties of stenosed hepatic veins. We also present selected cases of BCS diagnosed and treated in our Department in years 1999-2003.

A case report of amyotrophic lateral sclerosis in a patient with Klippel-Feil syndrome­a familial occurrence: a potential role of TGF-ß signaling pathway.

The rationale for this article is a description of a unique, familial case of a patient with amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disorder of unknown etiology coexisting with Klippel-Feil syndrome (KFS), a congenital malformation of cervical vertebrae, characterized by a fusion of minimum 2 cervical vertebrae. We report a 68-year-old man with moderate dysarthria, fasciculations, short neck, hearing deficit, and low posterior hairline. Definite ALS was diagnosed based on neurological abnormalities and electromyography results. Magnetic resonance imaging and computed tomography showed bony abnormalities of the craniocervical junction, fusion of 2 cervical vertebrae, and syringomyelia at the level of C6-C7. KFS phenotype was noted in 2 more family members, and patient's stepsister with KFS phenotype died due to ALS. The pedigree of our family suggests an autosomal-dominant inheritance of both syndromes. Cosegregation of ALS and KFS with an autosomal-dominant trait suggests an impairment of transforming growth factor ß signaling pathway, and its potential role is discussed. Further evaluation of patients with autosomal-dominant and sporadic KFS by genetic testing, biochemical measurements, such as plasma transforming growth factor ß1, and systematic follow-up electromyography seems warranted.

Digital x-ray: methodological foundations and clinical significance.

The authors discuss the principles and specifies of digital c-ray. They underline the clinical and economic significance, regarding the high system instalation costs.

Direct transcatheter aortic valve implantation - one-year outcome of a case control study.

INTRODUCTION: Transaortic valve implantation (TAVI) has a well-established position in the treatment of high-risk and inoperable patients with severe aortic stenosis (AS). The TAVI protocol requires a pre-dilatation for native valve preparation. AIM: To assess the safety and feasibility of TAVI without pre-dilatation and to compare it with the procedure with pre-dilatation. MATERIAL AND METHODS: Out of 101 TAVI patients, in 10 the procedure was performed without balloon predilatation, and 8 patients were included in the analysis. The procedural, echocardiographic, and clinical outcomes were compared with a case control matched cohort (1: 2 ratio). A 12-month follow-up was done in all cases. RESULTS: The procedure was successfully completed in all patients in the study group (SG), but there was one procedural failure in the control group (CG). All patients received a CoreValve (Medtronic) bioprosthesis. There was a significant immediate decrease in transvalvular gradients (TG) in both study arms after the procedure (SG: mean TG: from 46.0 ±14.0 mm Hg to 10.0 ±4.8 mm Hg, p < 0.001; CG: mean TG: from 55.9 ±12.0 mm Hg to 9.9 ±2.9 mm Hg, p < 0.001). A marked increase in the effective orifice areas was observed in both cohorts (SG: 1.63 ±0.13 cm(2) and CG: 1.67 ±0.25 cm(2), p = 0.75). The periprocedural complication rate was equally distributed in both arms. The 12-month all-cause mortality was 12.5% in both groups. CONCLUSIONS: The direct TAVI approach seams to be safe and feasible. The clinical and echocardiographic results are not different from those achieved in patients treated with standard TAVI protocol with pre-dilatation.

Pancreatic lipoma: An incydentaloma which can resemble cancer - analysis of 13 cases studied with CT and MRI.

BACKGROUND: The purpose of this article is to present computed tomography (CT) and magnetic resonance imaging (MRI) findings of rare pancreatic lipomas. MATERIAL/METHODS: The analysis covered 13 patients (7 men and 6 women, aged 47-88, average: 65.6 years), with 13 pancreatic lipomas, whose cases constituted the basis for 10 contrast-enhanced CT and 5 MRI studies. RESULTS: Lipomas measured from 6 mm to 32 mm (average 12.8 mm) and were located in the pancreatic head (n=7), body (n=2), tail (n=3) and uncinate process (n=1). Most lesions (n=11) were homogenous, well-circumscribed. On contrast-enhanced CT scans, macroscopic fat (<-30 HU) was present in 9 lipomas. In one case (10 mm lesion) the density was -20 HU and the lesion was poorly circumscribed with septations, which altogether made it difficult to precisely characterize its contents. On MR scans fat was demonstrated in all studied cases (n=5). CONCLUSIONS: Lipomas are rare, small, homogenous and well-circumscribed pancreatic tumours. The most important feature, decisive for the diagnosis and distinguishing them from pancreatic carcinoma, is detection of fatty tissue on CT and MR scans. In these cases differential diagnosis includes other rare fatty tumours of the pancreas (focal fatty infiltration, teratoma, liposarcoma).

Transcatheter aortic valve implantation using direct aortic access: first procedures in Poland.

Transcatheter aortic valve implantation (TAVI) is an alternative option for the treatment of severe aortic stenosis in patients carrying an elevated operative risk of conventional surgical aortic valve replacement (AVR). Recently, data from randomised clinical trials confirmed superiority of TAVI when compared with the conservative treatment in inoperable patients, and its non-inferiority when compared with AVR in a high-risk population. Transfemoral vascular access remains the preferred route for delivering the bioprosthesis. However, in a significant proportion of patients, the presence of severe iliac-femoral arteriopathy or small vessel diameter render the transfemoral approach unusable. In this article, we report the first Polish experience of two successful TAVI procedures with bioprostheses (both balloon- and self-expandable) delivered using direct aortic access.

Previously undiagnosed congenitally corrected transposition of the great arteries in a 51-year-old woman with chronic heart failure symptoms.

We describe the case of a 51-year-old female with previously undiagnosed congenitally corrected transposition of the great arteries (ccTGA) who was admitted to the hospital due to the exacerbated symptoms of heart failure for planned coronary angiography. Patient cardiac functional status appeared to have gradually regressed to New York Heart Association class III at the time of the admission. The chart reviews were performed. Coronary angiography did not reveal the occlusion of the coronary artery. Radiography, echocardiography, and multislice computed tomography confirmed newly diagnosed ccTGA.

Budd-Chiari syndrome: current options in interventional radiology treatment exemplified by three selected cases.

BACKGROUND: Budd-Chiari syndrome (BCS) is rare clinical state characterized by stenosis or complete obstruction of hepatic veins. Currently, interventional radiology techniques are more frequently used as a single method of treatment or as a bridge to liver transplantation. CASE REPORT: This study presents current interventional radiology techniques used in BCS treatment. Depending on the etiology of BCS, two main techniques are used: the transjugular intrahepatic portocaval shunt (TIPS) or percutaneous angioplasty (PTA) of the stenosed hepatic veins. Our first case was treated by PTA of the stenosed ostium of the hepatic vein. In the second, BCS was complicated by portal vein thrombosis and a TIPS was placed along with portal vein fibrynolysis. In the third case the TIPS was used as a single interventional radiological treatment. CONCLUSIONS: TIPS placement or angioplasty of hepatic vein ostium stenosis allow the successful treatment of BCS or an extension of the period of waiting for a liver transplantation.