M. Hansen

MRI of Hypertrophic Cardiomyopathy: Part I, MRI Appearances

OBJECTIVE We present a two-part review about the use of MRI in patients with hypertrophic cardiomyopathy (HCM). This article, Part 1, focuses on the MRI appearances of HCM. CONCLUSION MRI has proven to be an important tool for the evaluation of patients suspected of having HCM because it can readily diagnose those with phenotypic expression of the disorder and can potentially identify the subset of patients at risk of sudden cardiac death.

MRI of Hypertrophic Cardiomyopathy: Part 2, Differential Diagnosis, Risk Stratification, and Posttreatment MRI Appearances

OBJECTIVE We present a two-part review about the use of MRI in patients with hypertrophic cardiomyopathy (HCM). This article, Part 2, covers the differential diagnosis, risk stratification, and posttreatment MRI follow-up appearances in these patients. CONCLUSION Cardiovascular MRI is a useful imaging tool for the diagnosis of HCM and follow-up of patients after either surgical myomectomy or septal ablation therapy. In addition, MRI can help to discriminate HCM from the differential diagnoses of other cardiomyopathies and cardiac disorders, and it can potentially identify the subset of patients at risk of sudden cardiac death.

The value of dual-source 64-slice CT coronary angiography in the assessment of patients presenting to an acute chest pain service.

BACKGROUND The absence of radiological evidence of plaque on computed tomographic coronary angiography (CTCA) reliably excludes obstructive coronary artery disease. METHODS We studied patients who presented to our emergency department with chest pain and were admitted to our chest pain assessment service. If they were free of pain and without high-risk features of myocardial ischaemia including elevation of serum biomarkers they underwent CTCA and performed a standard treadmill exercise test. RESULTS Eighty-nine patients aged 56.3+/-8.6 years were admitted. Eleven of them had selective angiography; CTCA identified all who had obstructive disease. More than half of the 85 patients who had normal values of cardiac troponin and of the 75 with a negative exercise test had radiological evidence of disease. During follow-up for 355+/-72 days none died, suffered myocardial infarction or required coronary artery surgery: two with obstructive disease underwent percutaneous coronary intervention 1 and 7 days after the index study. CONCLUSIONS The CTCA findings were significantly correlated with those of selective angiography and with troponin status and increased the ascertainment of coronary artery disease in a cohort of patients at low risk for clinically significant ischaemic heart disease.

Vieussens’ Ring Combining Computed Tomography Coronary Angiography and Magnetic Resonance Imaging in Assessing Collateral Pathways

58-year-old man with a history of bicuspid aortic valve and severe childhood bacterial endocarditis presented to the Radiology Department for further investigation into the complex perivalvular anatomy seen on echocardiography and for assessment of the ascending aorta. Magnetic resonance imaging demonstrated a normal-caliber ascending aorta and a large perivalvular cavity. In addition, however, it showed dilated tortuous coronary arteries and an unusual appearance of the right coronary artery (RCA) origin (Figures 1 through 3). Phase-contrast imaging demonstrated retrograde flow within the mid RCA, presumably caused by large collaterals from the left coronary circulation. An ECG-gated computed tomography (CT) scan was performed to help further delineate the anatomy. This showed that the large perivalvular space communicated with the left ventricular outflow tract and aortic root through numerous fenestrations. The RCA origin was severely stenotic. Distally, the RCA was supplied by numerous collaterals from the left coronary circulation, as implied by magnetic resonance imaging. One collateral pathway included a long, tortuous connection from the left circumflex coronary artery through an obtuse marginal branch traveling around the inferior aspect of the heart and communicating through an acute marginal branch with the RCA. The other major collateral pathway passed from the left anterior descending artery across the right ventricular outflow tract to the RCA through the right conus artery. This second collateral is also known by its eponymous name of Vieussens’ collateral pathway.1,2 Also identified in this study is a significant stenosis of the right conus branch near its origin from the RCA, which affected its capacity to act as a collateral pathway. It is postulated that the clinically documented episode of severe bacterial endocarditis in childhood probably resulted in a perivalvular abscess, leading to the formation of a perivalvular cavity and stenosis of the RCA origin. This in turn eventually led to the formation of these impressive collateral pathways. Disclosures

Chagas cardiomyopathy with left ventricular apical aneurysm: first case report in Australia

only to surgery having been refractory medically prior to that. In summary, cardiogenic pulmonary oedema remains a possible and sufficient explanation for asymmetric right upper lobe pulmonary abnormalities in a patient with significant mitral valve regurgitation. Transthoracic and/or transoesophageal echocardiography with particular attention to mitral regurgitation jet direction and demonstration of regurgitant systolic reversal of flow into right pulmonary vein(s) would corroborate this diagnosis. Clinical judgment may mandate the need to exclude other coexisting pulmonary pathology, but indeed the sole underlying pathology may be cardiac. Such pulmonary oedema may persist despite aggressive medical measures and resolve only after surgical correction of the valve dysfunction.

Coronary CT angiography for patients with stable chest pain in the Emergency Department; an appraisal of current and emerging evidence

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Letter by Hamilton-Craig et al Regarding Article, “Posttraumatic Cardiac Contrecoup: In Vivo Evidence by Cardiac Magnetic Resonance Imaging”

To the Editor: We propose an alternative explanation to the findings reported by Moccetti et al.1 First, numerous biomechanical explanations of contrecoup injury have been proposed, such as the positive pressure, negative pressure, rotational shear stress, and angular acceleration theories.2,3 These theories relate to transmission of the deceleration force to a soft organ from the surrounding hard structures (eg, brain–skull, lung–ribs). The injury described …