ABSTRACT
PURPOSE: multislice CT has been shown as a promising tool for coronary artery imaging. Our goal was to investigate the value of the new sixteen-slice, CT technology for non-invasive visualization of coronary arteries and assessment of coronary stenosis. MATERIALS AND METHODS: we assessed coronary artery visualization in 30 consecutive patients using 16-slice CT and compared the findings with conventional coronary angiography. The whole heart was scanned using 0.75 millimeter slices after injection of contrast medium. Retrospective ECG-gated reconstructions were performed and images were analyzed using axial CT, maximum intensity projection and 3D images, blind to the conventional angiography findings. Seventeen main coronary segments of more than 1.5 mm were analyzed and stenosis was graded on a four-point scale. RESULTS: CT angiography attained diagnostic quality for the whole coronary artery tree in 90% (27/30) of patients. Sixteen of 493 segments (4%) were not interpreted because of substantial motion artifacts (n=12) or heavy calcifications or stenting (n=4). Thirty seven of the 43 cases of significant stenosis (>50%) identified on coronary angiograms were correctly identified with multislice CT. All 6 false negatives involved stenosis of the circumflex artery or branches. Five false positive stenoses were found in 432 non stenotic segments. The sensitivity was thus 86%, specificity 99% for stenosis of more than 50%. CONCLUSION: 16-slice CT provides an excellent visualization of the coronary tree in most patients, allowing accurate non-invasive detection of significant coronary stenosis. Stenoses of the left circumflex artery remain more difficult to detect.
Subject(s)
Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Coronary Vessels , Electrocardiography , Female , Humans , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
Results of aortic arch repair for interrupted aortic arch or aortic coarctation have considerably improved. However, re-stenosis or aneurysm formation is a common complication requiring complex re-interventions or even extra-anatomic bypass grafting. In two patients with recurrent coarctation, the use of cardiopulmonary bypass was mandatory, in one due to the concomitant repair of the intra-cardiac defect, in the other due to the small aortic arch, the long segment aortic coarctation and the small diameter of the supra-aortic vessels. In both patients a segment of the ascending aorta was interposed between the distal aortic arch and the proximal descending aorta with uneventful postoperative courses and freedom from pathological findings at 1 year and 6 months follow-up. In patients undergoing complex congenital heart surgery involving the ascending aorta, a segment of the autologous ascending aorta may be used to repair recurrent isthmic stenosis, avoiding the use of any foreign material.
Subject(s)
Aorta/transplantation , Aortic Coarctation/surgery , Heart Defects, Congenital/surgery , Anastomosis, Surgical , Aortic Coarctation/diagnosis , Female , Follow-Up Studies , Heart Defects, Congenital/diagnosis , Humans , Infant, Newborn , Male , Recurrence , Risk Assessment , Transplantation, Autologous , Treatment Outcome , Vascular Patency , Vascular Surgical Procedures/methodsABSTRACT
An increase in H+ ions concentration by infusion of hydrochloric acid produces a reduction in lactacidemia. This phenomenon is a result of the inhibitory effect of acidosis on phosphofructokinase producing a diminution of intracellular glycolysis.