Anne Sigal-Cinqualbre

MDCT of the coronary arteries : Feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose

OBJECTIVE The objective of our study was to show the feasibility of coronary CT using low kilovoltage (80 kV) combined with ECG-pulsed tube current modulation in selected patients. CONCLUSION This study showed the combined effect of lowering the kilovoltage setting (80 kV) and using an automatic modulation technique (ECG-pulsed tube current modulation) for coronary CT. Radiation dose exposure can be reduced by up to 88% for slim patients without impairing image quality.

Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography

AIMS We evaluated the accuracy of 64-slice computed tomography (CT) to identify ischaemic aetiology of heart failure (IHF). METHODS AND RESULTS Ninety-three consecutive patients in sinus rhythm with dilated cardiomyopathy but without suspicion of coronary artery disease (CAD) were enrolled when admitted for angiography. Accuracy of CT to detect significant stenosis (>50% lumen narrowing) was compared with quantitative coronary angiography. IHF was defined as a significant stenosis on left main or proximal left anterior descending artery or two or more vessels. Forty-three out of 1395 segments (3%) were heavily calcified and excluded. CT correctly assessed 103 of 142 (73%) significant stenosis and identified 46 of 50 (92%) patients without and 42 of 43 (98%) patients with CAD, 60 of 62 (97%) patients without and 28 of 31 (90%) patients with IHF. Overall, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT for identifying CAD by segment was 96, 73, 99, 92, and 97%, respectively; by patient was 95, 98, 92, 91, and 98%, respectively; and for identifying IHF was 95, 90, 97, 93, and 95%, respectively. CONCLUSION Non-invasive 64-slice CT assessment of the extent of CAD may offer a valid alternative to angiography for the diagnosis of IHF.

Diagnostic accuracy of dual-source multislice computed tomographic analysis for the preoperative detection of coronary artery anomalies in 100 patients with tetralogy of Fallot

OBJECTIVES A detailed preoperative evaluation of coronary anatomy is mandatory before surgical intervention for tetralogy of Fallot. In pediatric patients, the preoperative evaluation of coronary anatomy has relied classically on conventional angiographic analysis and, more recently, on echocardiographic analysis, which have well-known limitations and complications. Recent technological improvements allow the use of multislice computed tomographic analysis to evaluate coronary artery anatomy in very young children, even those with high heart rates. The purpose of this prospective study was to assess the accuracy of preoperative dual-source computed tomographic analysis in detecting coronary artery abnormalities by using surgical findings as the reference standard. METHODS We prospectively evaluated 100 patients with tetralogy of Fallot before surgical intervention between November 2006 and September 2009 by using dual-source computed tomographic analysis with either retrospective, electrocardiographically gated, helical computed tomographic analysis or prospective, electrocardiographically triggered, sequential computed tomographic acquisition. The patients had a median age of 6.8 months (range, 1.2 months-6.8 years) and a median weight of 7.9 kg (range, 3-30 kg). RESULTS Compared with surgical findings, dual-source computed tomographic analysis had 100% sensitivity and 100% specificity for detecting coronary artery abnormalities. Major coronary artery abnormalities were found in 7 (7%) patients. The radiation dose was low. CONCLUSIONS Dual-source computed tomographic analysis is an accurate and noninvasive tool for delineating coronary artery anatomy before surgical intervention in children with tetralogy of Fallot. Dual-source computed tomographic analysis might deserve to be used routinely instead of angiographic analysis and in combination with echocardiographic analysis for the preoperative assessment of patients with tetralogy of Fallot.

Comparison of delayed enhancement patterns on multislice computed tomography immediately after coronary angiography and cardiac magnetic resonance imaging in acute myocardial infarction

Objective: Recent experimental and limited clinical studies have demonstrated the usefulness of delayed enhancement multislice computed tomography (MSCT) for assessing myocardial infarct size (IS) and transmurality. The aim of this study is to compare MSCT enhancement patterns immediately after coronary angiography (CAG) in an acute myocardial infarction (AMI) setting with cardiac magnetic resonance (CMR) enhancement during the second week follow-up. Methods: 26 patients admitted for an AMI were evaluated by MSCT immediately after CAG without iodine re-injection. All but three were reperfused. The same patients had delayed enhancement CMR imaging at 10 (SD 4)-day follow-up. Myocardial enhancement was considered transmural (non-viable) when involving >75% of myocardial thickness, subendocardial (1 − ⩽75%) or normal (viable for the two latter). Two or more >75% enhanced segments were required to define transmurality on patient-level or culprit artery-level analysis. A semi-quantitative scale score was defined for the 17 left ventricular segments. IS was computed from these scores. Results: On segment analysis, sensitivity, specificity, accuracy, positive and negative predictive values of MSCT for transmurality assessment were 84%, 96%, 94%, 85% and 96%, respectively, compared to CMR. On patient analysis, these respective values were 90%, 80%, 88%, 95% and 67%. IS assessed by the two methods were highly correlated (r = 0.94, p<0.0001) and the regression line did not statistically differ from the identity line. Conclusion: MSCT enhancement immediately following CAG without iodine re-injection for an AMI is a reliable method for evaluating transmurality and IS. This very early evaluation could be an interesting alternative to CMR.

Heart Transplant Patient Outcomes: 5-Year Mean Follow-Up by Coronary Computed Tomography Angiography

Backgrounds. We evaluate the feasibility and safety of coronary computed tomography angiography (CCTA) as the first-line investigation in heart transplant patients and the rate of coronary allograft vasculopathy detected using CCTA. Methods. From September 2003 to June 2009, we prospectively included 65 heart transplant recipients, retaining 62 who underwent yearly CCTA for coronary allograft vasculopathy detection (261 CCTAs). We used 16-slice, 64-slice, and 2×64-slice CT machines. Patients with coronary artery stenosis by CCTA had a confirmation and a further follow-up exclusively by conventional coronary angiography (CCA). Results. No major coronary events occurred during the study. Of the 62 baseline CCTAs, 37 (60%) were normal, 18 (29%) showed wall thickening, and 7 (11%) known significant stenosis, confirmed by CCA. The mean follow-up duration was 5 years. At the last follow-up, 26 (70%) patients with normal baseline findings remained normal, 9 (24%) had wall thickening, and 2 (6%) significant stenoses. Time to stenosis was consistently greater than 3 years. Of the 18 patients with initially wall thickening, 14 (78%) had wall thickening and 4 (22%) significant stenosis at last follow-up. The mean interval without any coronary lesion was 9.46±3.98 years. The mean interval without de novo significant stenosis was 10.31±4 years. Conclusions. CCTA seems to be a safe noninvasive tool for monitoring heart transplant patients, and thus obviating the need for CCA. In patients with normal baseline CCTA, a 2-year interval between CCTAs may be safe.

Slide tracheoplasty in infant with congenital tracheal stenosis and tracheomalacia after esophageal atresia with tracheoesophageal fistula repair.

Slide tracheoplasty can be applied successfully to all types of long segment congenital tracheal stenosis. In case of short segment tracheal stenosis, direct resection and anastomosis is often preferred. We report a case illustrating a new side benefit of the slide tracheoplasty in a patient presenting a relatively short hypoplastic tracheal segment coexisting with tracheomalacia after EA with TEF repair.

Right aortic arch and isolated left innominate artery from a left sided patent ductus arteriosus: a very rare aortic arch anomaly.

Malformation of the aortic arch system has been described in details by Stewart et al. in 1964. Innominate artery originating via the ductus arteriosus from the pulmonary artery is a very rare type of congenital aortic arch anomaly that has been seldomly reported. We report the case of an aortic arch anomaly revealed by a pulmonary hypertension because of left to right shunt. Surgical procedure was performed through a median sternotomy, without cardiopulmonary bypass. After section. of the ductus arteriosus, the left innominate artery was extensively dissected and mobilized to be implanted on the left side of the ascending aorta under lateral clamping.

Findings on Submillimeter MDCT Are Predictive of Operability in Chronic Thromboembolic Pulmonary Hypertension

OBJECTIVE The purpose of this study was to investigate whether preoperative 16-MDCT at 0.7-mm collimation can be used to predict the presence of an endarterectomy plane by depicting abnormal thickening of the walls of central pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension. MDCT scans of 40 patients were reviewed retrospectively by two radiologists who were blinded to surgical findings. CONCLUSION The sensitivity, specificity, and accuracy of MDCT in prediction of the presence of an endarterectomy plane were 99%, 80%, and 96%. Bilateral absence of an endarterectomy plane correlated with postoperative mortality according to Fishers exact test results (p = 0.004). Submillimeter 16-MDCT therefore may be useful in predicting operability in chronic thromboembolic pulmonary hypertension.

Supracardiac Total Anomalous Pulmonary Venous Connection: The Transaortopulmonary Approach

We have been confronted with patients in whom classical techniques did not offer optimum exposure to correct supracardiac forms of total anomalous pulmonary venous connection, especially in neonates. Therefore, we present a surgical modification of the superior approach for enhanced exposure as a result of transection of the ascending aorta associated or not with the transection of the pulmonary trunk. The transaortopulmonary approach ensures a perfect exposition without any need to pull on the surrounding structures. Because of the better exposure, most patients do not require circulatory arrest.

Superior Sulcus Tumors: Do They Really Exist?

Superior sulcus tumors are a particular entity in thoracic oncology and surgery. These malignant tumors arise in the apical segment of the upper lobes, are locally aggressive, and tend to invade the main anatomical structures around the first rib. When associated with symptoms of neurological involvement they are called Pancoast–Tobias tumors after those physicians who, for the first time, drew attention to the association of shoulder and arm symptoms and tumors arising in the apex of the chest. 1,2 Pancoast introduced the term “superior sulcus” and he presumably referred to the groove of the subclavian artery in the pleural cuff that represents the limit between the thorax and subclavian vessels with surrounding structures. 1 He suggested that a remnant of the fifth pharyngeal pouch was at the origin of the tumor. The same year, however, Tobias described the true origin as being from the lung apex. 2 But what exactly is the superior sulcus of the lung from a purely anatomical or radio logical point of view? Two major textbooks of anatomy have no mention of a superior sulcus at the apex of the lung. 3,4 Anatomically, in the groove of the subclavian artery is the “fossette sus- et retropleurale de Sebileau,” named after the French anatomist who first described it, which contains the stellate or cervicothoracic ganglia (