Indications for coronary and cardiac computed tomographic angiography.

Cardiovascular disease remains the leading cause of death and disability in the developed world. Over the last several years, many noninvasive imaging techniques have been used to enhance the diagnosis of cardiac disease. One of these advances, multidetector computed tomographic angiography (CTA), has transformed computed tomography from a single-slice transaxial imaging modality to a true 3-dimensional imaging technique with the ability to acquire submillimeter volumetric data. These benefits enable novel applications of CTA for the assessment of cardiac and coronary anatomy that were not previously possible. In this report, we discuss evolving indications for coronary CTA, noncoronary cardiac CTA, and several potential future indications for cardiac CTA.

Simultaneous epicardial and endocardial mapping of a left-sided posteroseptal accessory pathway associated with a large coronary sinus diverticulum: successful ablation by transection of the diverticulum's neck.

Transcutaneous pericardial instrumentation in a patient with a left-sided posteroseptal accessory pathway associated with a large coronary sinus diverticulum was performed after three previous unsuccessful ablations. The earliest ventricular activation site was recorded epicardially using a catheterin the pericardial space, but energy delivery at this site was not possible due to high impedances. Intravascular linear lesions transecting the neck of the large coronary sinus diverticulum using the pericardial catheter as a target allowed successful radiofrequency catheter ablation of the accessory pathway. This case outlines potential problems with ablations in the pericardial space and provides an alternative solution that can spare patients from open surgical procedures.