Three-Dimensional Endo-Cardiovascular Volume-Rendered Cine Computed Tomography of Isolated Left Ventricular Apical Hypoplasia: A Case Report and Literature Review

We report multidetector computed tomography (MDCT) and cardiac magnetic resonance (CMR) findings of a 34-year-old female with isolated left ventricular apical hypoplasia. The MDCT and CMR scans displayed a spherical left ventricle (LV) with extensive fatty infiltration within the myocardium at the apex, interventricular septum and inferior wall, anteroapical origin of the papillary muscle, right ventricle wrapping around the deficient LV apex, and impaired systolic function. MDCT visualized morphologic and also functional findings of this unique cardiomyopathy.

An Adolescent Patient with Coarctation of Aorta Treated with Self-Expandable Nitinol Stent

Transcatheter treatment of aortic coarctation, with balloon angioplasty or stent implantation, is now an acceptable alternative to surgical repair. However these procedures may result in complications, such as vascular wall injury and re-stenosis of the lesion. A nitinol self-expandable stent, when deployed at the coarctation site, produces low constant radial force, which may result in a gradual widening of the stenotic lesion leaving less tissue injury ('stretching rather than tearing'). For an adolescent with a native aortic coarctation, a self-expandable stent of 20 mm diameter was inserted at the discrete stenotic lesion of 5 mm diameter without previous balloon dilatation procedure. No further balloon dilatation was done immediately after the stent insertion. With the self-expandable stent only, the stenosis of the lesion was partially relieved immediately after the stent deployment. Over several months after the stent insertion, gradual further widening of the stent waist to an acceptable dimension was observed.

Measurement of Shunt Amount Using Radionuclide Angiocardiography: Accuracy According to Level of Shunt and Associated Lesion / 핵의학분자영상

PURPOSE: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique. MATERIALS AND METHODS: We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions. RESULTS: The mean Qp/Qs was 1.83+/10.50 by radionuclide, and 1.74+/10.51 by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.52, 0.74, 0.96, 1.57, and 1.50, respectively. CONCLUSION: There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.

MRI for the Functional Evaluation of Systemic Right Ventricle in TGA

During the past few decades, rapid development has been achieved in cardiac MRI. Cardiac MRI has also proven to be a useful tool in congenital heart disease, especially for the evaluation of its function and physiology. MRI can measure the ventricular volume, ventricular mass, flow velocity and flow volume accurately. Cardiac MRI has basically three-dimensional natures, so it is well suited for the measurement of functional parameters of right ventricle without geometrical assumption unlike echocardiography. MRI is becoming the useful imaging modality for the evaluation of systemic right ventricle which is often failed in the patients with unoperated or surgically corrected transposition of the great arteries.

Transcatheter Closure of a Large Coronary Arteriovenous Fistula Using an Amplatzer Vascular Plug

We report the successful percutaneous closure of a large coronary fistula from the right coronary artery to the right ventricle in a 4-years-old boy using the Amplatzer vascular plug. The device was positioned and deployed via the arterial system.It allows a smaller delivery profile through small sheath or guide catheters and the technique appeared to be easy, safe, and effective.

Radilogic Diagnosis of Kawasaki Disease

No abstract available.

MR Imaging of Ischemic Heart Disease

MRI has achieved many technical advances in the spatial resolution, temporal resolution, contrast resolution, signal-to-noise ratio, and postprocessing technique. At one session of examination within a tolerable time, MRI can provide integrated information on coronary artery stenosis, systolic dysfunction, myocardial perfusion, and myocardial viability. Delayed enhancement study after contrast administration is highly reproducible and offers unique vision for myocardial viability in the patients with myocardial infarction. Cardiac MRI is very cost-effective and may be one-stop solution for the evaluation of ischemic heart disease.

Utility of CHROMagar Orientation Medium for Urine Cultures / 임상검사와정도관리

BACKGROUND: Urine cultures are among the most numerous of culture types for microbiology studies. In this study, we evaluated the utility of CHROMagar Orientation (CO; Becton Dickinson, Cockeysville, MD, USA), a new chromogenic medium, for the detection, enumeration, and presumptive identification of urinary tract pathogens. METHODS: The 438 clinical urine samples sent for routine culture were plated onto CO and Bi-plate (blood/MacConkey agar). We compared the detection and enumeration of potential pathogens, and the agreement between presumptive identification directly from CO and the confirmative identification, which was performed using conventional biochemical tests and Vitek system. RESULTS: The detection rate of urinary tract pathogens on all two media, CO and Bi-plate were nearly identical. The enumeration of colony counts was consistent on the two media for 102 of the 108 (94%) microorganisms. Colony color and morphology on CO accurately differentiated Escherichia coli and Enterococcus spp. The overall agreement of presumptive identification on CO was 91 of the 108 (84%). CONCLUSION: The CO enabled accurate detection, count determination, and presumptive identification of common urinary pathogens, both in pure and mixed cultures.

Current Role of Cardiac Radiology in Congenital Heart Disease

No Abstract available.

A Case of Isolated Left Main Coronary Ostial Stenosis Due to Acute Angle Take-off with Clockwise Rotation of Coronary Sinus confirmed by MRI Image

Isolated left main coronary ostial stenosis is a very rare condition. In the majority of cases there are coexisting diseases in multiple coronary vessels. Here, a case of isolated left main coronary ostial stenosis due to an acute angle take-off, with clockwise rotation of the coronary sinus, confirmed by cardiac MRI is presented. A 44-year old female patient presented with an exertional and stabbing anterior chest pain. The patient had no premedical history. A coronary angiogram showed an isolated left main coronary ostial stenosis due to an acute take-off of the left main coronary artery. A cardiac MRI showed an acute angle take-off of the left main coronary artery, with clockwise rotation of the coronary sinus. The patient underwent surgical angioplasty of the coronary ostia, with a patch of autologous pericardium. This acute angle take-off may be due to rotation of the coronary sinus.

One-stop Diagnosis of Ischemic Heart Disease Using Cardiac MRI

Recently, MRI has achieved many technical advances in the spatial resolution, temporal resolution, signaltonoise ratio, and postprocessing software. As a result, cardiac MRI has made a sudden rise from old obscurity in the diagnosis of coronary artery disease. Cardiac MRI may be a onestopshop solution for the assessment of systolic dysfunction, perfusion impairment and myocardial viability, and for the imaging of stenosed artery. The evaluation of myocardial ischemia and viability are very important in the decision of therapeutic strategy and the anticipation of the prognosis of the patients with ischemic heart disease. At one session of examination, MRI can provide combined information on myocardial contractile function and myocardial perfusion, and unique information on the transmural extent of delayed hyper-enhancement. Delayed hyperenhancement on contrastenhanced MRI is highly reproducible irrespective of the scanning procedure and the operator, which is used for the interpretation of myocardial viability in the patients with myocardial infarction. Cardiac MRI is a very accurate and costeffective modality for the evaluation of ischemic heart disease.

Diagnostic Accuracy of Spiral CT in Detecting Hepatic Tumors: Evaluation Using Portogenously Implanted Hepatic VX-2 Carcinoma in Rabbit

PURPOSE: To assess, by means of CT-pathologic correlation, the ability of CT to detect hepatic VX-2 carcinomas in rabbits, and to determine the factors influencing the sensitivity of tumor detection. MATERIALS AND METHODS: By means of direct portal inoculation, VX-2 carcinomas were implanted in the liver of eight rabbits after laparotomy. Two weeks later, dual-phase spiral CT scanning was performed using scan parameters of 3-mm collimation and reconstruction intervals of 1 mm and 3 mm. Radiologic-pathologic correlation involved the comparison of CT images and pathologic slices. The sensitivity and positive predictive value with which each technique detected the presence of tumors were calculated. RESULTS: Using pathologic slices, 2-40 (mean, 9.1) mm in size, 65 tumor nodules were detected. Overall sensitivity and the positive predictive value were 63% and 73%, respectively. Sensitivities for tumors of 2-5 mm and 6-10 mm were 28% and 79%, respectively. For images reconstructed with a 1-mm interval, sensitivity was significantly higher than that where a 3-mm interval was used (79% vs. 46%), but sensitivities for arterial and portal-phase imaging were not significantly different. Among small tumors (< or = 10 mm), 63% (12/19) showed strong enhancement at arterial-phase imaging. Regarding tumor detection, inter-observer concordance between the three radiologists was excellent for portal-phase images (k=0.86 and 0.83 for 1 mm and 3 mm reconstruction intervals, respectively), and good for arterial-phase images (k=0.77 and 0.73 for 1 mm and 3 mm reconstruction intervals, respectively. CONCLUSION: Even where dual-phase scanning with 3-mm collimation is used, spiral CT is limited in its ability to detect tumors 5 mm or less in diameter, though overlapping reconstruction improves the sensitivity with which those of 6-10 mm are detected. In the evaluation of arterial-phase images obtained at contrast-enhanced dual-phase imaging, special attention should be given to small hyper-attenuating nodules.

Fetal Pericallosal Lipoma: US and MR Findings

We report a case of fetal pericallosal lipoma occurring at the anterior interhemispheric fissure and associated with agenesis of the corpus callosum. During targeted prenatal ultrasonography at 26 weeks' gestation, the lesion was seen as a highly echogenic mass. MR imaging performed at 35 weeks' gestation and during the postnatal period revealed a pericallosal fatty mass and agenesis of the corpus callosum.

Influence of Anatomical, Scanning, and Reconstructing Parameters on Image Quality of CT Angiography: Vascular Phantom Study

PURPOSE: To investigate the image quality of CT angiograms obtained with various anatomical, scanning, and reconstruction parameters using a phantom with small vessels, and to determine the technique appropriate to a specific vascular anatomy. MATERIALS AND METHODS: The vascular phantom consisted of three pairs of parallel tubes with a luminal size of 1, 2, and 3 mm. Using the phantom, CT scans were obtained at three inter-tubal distances (1, 2, and 3 mm), three angles of inclination relative to the z-axis (0 degree, 45 degree, and 90 degree), three collimation widths (1, 3, and 5 mm) and two pitch factors (1 and 2). Using axial images obtained at 1-, 2-, and 3-mm reconstruction intervals, two types of three-dimensional images were rendered, and the quality of 972 such images was subjectively graded in terms of edge definition and artifact by three radiologists. RESULTS: All vessels parallel to the z-axis showed good image quality irrespective of other factors. A pair of vessels separated by 1 mm appeared to be stuck to each other. As collimation width and reconstruction interval increased, image quality decreased significantly and artifact increased. The quality of images obtained at 3 mm collimation and with a 6 mm increment was significantly better where collimation and increment were both 5 mm (p=0.001). Vessels 1 mm in size suffered artifactual degradation, especially in the case of SSD images. Most obliquely oriented vessels showed stair-step artifact, which tended to be severe when the reconstruction interval was large. CONCLUSION: In small vessels perpendicular to or inclined relative to the z-axis, a smaller collimation width and reconstruction interval lessens image degradation. When wider scan coverage is intended, a larger pitch rather than a larger collimation width is recommended. To lessen the artifacts occurring where vessels are obliquely oriented, the reconstruction interval should be reduced.

Angiography and Magnetic Resonance Image in Patients with Double Outlet Right Ventricle

No Abstract available.

Modified Norwood Procedure without Circulatory Arrest and Myocardial Ischemia: Report of 2 cases / 대한흉부외과학회지

The effects of deep hypothermia and circulatory arrest during aortic arch reconstruction are associated with potential neurologic and myocardial injury. We describe a surgical technique that two patients underwent a modified Norwood procedure without circulatory arrest and myocardial ischemia. One was 13-day-old female patient, weighing 3.1kg, having a variant of hypoplastic left heart syndrome and another was 38-day-old male patient, weighing 3.4 kg, diagnosed Taussig-Bing anomaly with severe aortic arch hypoplasia, coarctation of the aorta, and subaortic stenosis. The arterial cannula was inserted in innominate artery directly. During Norwood reconstruction, regional high-flow perfusion into the inominate artery and coronary perfusion were maintained and there were no neurologic, cardiac, and renal complications in two patients. This technique may help protect the brain and myocardium from ischemic injury in patients with hypoplastic left heart syndrome or other arch anomalies including coarctation or interruption.

Congenital Anomalies of Aortic Arch: CT Angiography

Aortic arch anomalies result from the failure of an embryonic vascular structure to persist and regress in the usual manner during formation of the aortic arch. The anomalous aortic arch may encircle and compress the trachea and esophagus as a form of a vascular ring. The diagnosis of aortic arch anomaly and the recognition of airway compression are important because they are conditions which complicate the natural and surgical course of related diseases. CT can demonstrate the nature of anatomic structures such as the trachea and esophagus not revealed by angiography, simultaneously disclosing the relationship of stenotic airways and offending mediastinal vessels. Volumetric data acquisition by means of spiral CT enables three dimensional reconstruction,which can provide easy global understanding of the complex anatomy and spatial relationship of airway and cardiovascular structures. Three dimensional imaging is very useful for the physician and surgeon who are not accustomed to mentally reconstructing axial images, and can facilitate surgical planning.

Coronary Angiographic Findings of Left Atrial Thrombi in Mitral Stenosis

PURPOSE: To investigate the coronary angiographic findings of left atrial thrombi associated with mitral stenosis. MATERIALS AND METHODS: In 98 patients who had undergone coronary angiography and in whom the presence of left atrial thrombi was confirmed by surgery or repeated transesophageal echocardiography, evaluated the pattern, origin and location of abnormal vasculature suggestive of left atrial thrombi such; abnormalities included neovascularity, staining, dye collection and fistula. RESULTS: Abnormal vasculature was observed in 70 patients (71.4%). It arose from the left circumflex artery in 66 patients (including the sinus nodal branch in four), the right coronary artery in 14 (including the sinus nodal branch in 7 and conal branch in 2), the left anterior descending artery in one, and the left main coronary artery in one. The patterns of abnormal vasculature arising from the left coronary artery were fistula in 50, dye collection in 32, staining in 29 and neovascularity in 24; those arising from the right coronary artery were fistula in four, dye collection in two, staining in four and neovascularity in nine. Abnormal vasculature located at the anterior third of the left atrium in 50 cases, the middle in 20, and the posterior region in 12. CONCLUSION: The abnormal vasculature suggested by left atrial thrombi most commonly arose from the left circumflex artery and was located at the anterior one-third of the left atrial cavity. Fistula was the most common finding of left atrial thrombi, and for that these detection of the abnormal vasculature thrombi give rise to, selective coronary angiography was the useful modality.

Angiographic Evaluation of Coronary Arterial Abnormalities in Kawasaki Disease

PURPOSE: To evaluate the coronary angiographic findings of patients with Kawasaki disease and to investigatethe natural course of aneurysms of the coronary artery. MATERIALS AND METHODS: Between June 1989 and January1996, we evaluated the coronary angiographic findings of 12 consecutive children with Kawasaki disease whosecoronary artery was abnormal. On initial study, we retrospectively analysed the size, configuration, and locationof 35 coronary aneurysms, and in five children, follow-up coronary angiography was performed at intervals of 17 to28 (mean, 23) months. Seventeen aneurysms detected on initial study were evaluated for subsequent change. RESULTS: Initial coronary angiography showed the aneurysms to be diffuse in 7 cases(20%), saccular in 7(20%), fusiform in17(49%), and tubular in 4(11%). They were large in 10 cases (29%), medium in 22(63%), and small in 3(9%) ; theirlocation in the coronary artery was proximal(71%), middle in 6(17%), and distal in 4(11%). The right coronaryartery was involved in 18 case(51%), and the left coronary artery in 17(49%). Follow-up study showed that theaneurysm had regressed in 11 cases (65%), persisted in 2(12%), and progressed to stenosis in 1(6%) and occlusionin 3(18%). Two(50%) of the four large aneurysms showed complete occlusion. On the other hand, medium and smallaneurysms showed regression in 9(82%) and in all cases, respectively. Diffuse-type aneurysms were complicated byocclusion in 2 cases (50%) and stenosis in 1(25%). On the other hand, six fusiform aneurysms (75%) and allsaccular and tubular aneurysms had regressed. CONCLUSION: In patients with kawasaki disease, informationregarding the size and configuration of coronary aneurysms may be useful for predicting the natural course andprognosis of coronary artery disease.

Congenital Anomalies of the Coronary Arteries Detected in Adulthood

BACKGROUND: Although congenital anomalies of the coronary arteries are rare, which may cause serious clinical problems in diagnostic or surgical procedures, the accurate knowlegde and understanding of these are essential. We are to assess the clinical and angiographic characteristics of congenital anomalies of the coronary arteries detected in adulthhood. METHODS: We retrospectively analyzed a total of 67 cases of primary congenital anomalies of the coronary arteries with particular emphasis in angiographic findings in corelation with the clinical and surgical findings, reviewing 16,099 coronary angiography performed during last 6 years in three institutes. RESULTS: The incidence of congenital anomalies of the coronary arteries detected in coronary angiography was 0.4% and all were primary anomalies, among which major anomalies were 53 cases(79%) and minor anomalies were 14 cases(21%). Twenty-nine cases had associated cardiac defects. Among them congenital heart disease were 10 cases(34%), valvular heart disease were 10 cases(34%), coronary atherosclerotic disease were 8 cases(28%) and hypertrophic obstructive cardiomyopathy was 1 cases(4%). The coronary artery fistula were 40 cases, which was the most common anomaly among major group and the communication between coronary artery and bronchial artery were 6 cases, which was the most common one among minor group. Myocardial ischemia was observed in 49% of major and in 29% of minor anomalies. CONCLUSION: We are reporting 67 cases of the congenital anomalies of the coronary arteries detected in adulthood with the clinical and the angiographic characteristics. We suggest that new modified classification of the congenital coronary anomalies is necessary, because symptoms and signs of myocardial ischemia were observed in a significant number of patients among minoranomaly group.