RESUMEN
Congenital coronary artery disease (CAD) is commonly asymptomatic and often benign. Investigation of potential myocardial ischemia is also necessary. We report an original observation of abnormal origin and course of the right coronary artery (RCA), abnormal left main artery, and agenesis of the left anterior descending (LAD) artery. This is the first report of an association of 3 types of congenital coronary artery anomaly according to the modified Angelini's classification. This high-risk condition was successfully treated surgically.
Asunto(s)
Dolor en el Pecho/diagnóstico , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Isquemia Miocárdica , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/congénito , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Anomalías de los Vasos Coronarios/fisiopatología , Anomalías de los Vasos Coronarios/cirugía , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Diagnóstico Diferencial , Ecocardiografía , Prueba de Esfuerzo/métodos , Femenino , Humanos , Imagen por Resonancia Cinemagnética/métodos , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiología , Isquemia Miocárdica/cirugía , Resultado del TratamientoRESUMEN
To compare image quality of coronary CT angiography in step-and-shoot mode at the diastolic phase at low heart rates (<70 bpm) and systolic phase at high heart rates (≥70 bpm). We prospectively included 96 consecutive patients then excluded 5 patients with arrhythmia. Coronary CT-angiography was performed using a dual-source 128-slice CT machine, at the diastolic phase in the 55 patients with heart rates <70 bpm (group D) and at the systolic phase in the 36 patients with heart rates ≥70 (group S). Image quality was scored on a 5 point-scale (1, not interpretable; 2, insufficient for diagnosis; 3, fair, sufficient for diagnosis; 4, good; 5, excellent). In addition, we compared the number of stair-step artifacts in the two groups. Mean image quality score was 4 (0.78) in group D and 4.1 (0.34) in group S (NS), with an unequal distribution (p = 0.01). Step artifacts were seen in 44 % of group D and 18 % of group S patients (p = 0.02). In 3 group D patients and no group S patients, the image score was <3 due to artifacts, requiring repeat CT-angiography. When performing dual-source 128-slice CT-angiography, step-and-shoot acquisition provides comparable mean image quality in systole, with less variability and fewer stair-step artifacts, compared to diastole. This method may be feasible at any heart rate in most patients in sinus rhythm, allowing low-dose prospective acquisition without beta-blocker premedication.