Manuel Pedro Magalhães

Sixteen‐Slice Multidetector Computed Tomography for Graft Patency Evaluation After Coronary Artery Bypass Surgery

Abstract  Objective: To investigate the ability of 16‐slice multidetector computed tomography (MDCT) to assess coronary artery bypass graft patency and to detect bypass stenosis by comparison with coronary angiography. Methods: Thirty patients underwent both conventional coronary bypass angiography and retrospective ECG gated 16‐slice multidetector computed tomography after surgery using 0.4 seconds rotation time and 1.25 mm slice thickness. Results: Among a total of 107 bypass grafts, 101 grafts (94.4%) were evaluable by MDCT. Thirteen patients were taking oral beta blockers. Mean heart rate was 73.6 (52‐105). Of the 40 internal mammary arteries and two radial arteries examined, only one was occluded by coronary bypass angiography and MDCT, resulting in a sensitivity of 100% and a specificity of 100%. MDCT correctly diagnosed all patent venous grafts and missed two of the 14 venous grafts shown occluded by conventional angiography resulting in a sensitivity of 85.7% and specificity of 100%. When occluded grafts were excluded, MDCT did not detect two out of two anastomotic arterial graft stenosis >50% and resulted in one false positive result for a sensitivity and specificity of 0% and 97.4%, respectively. MDCT correctly diagnosed one out of three venous stenosis >50% and falsely diagnosed one venous graft stenosis >50% yielding a 33.3% and 97.6% sensitivity and specificity, respectively. Conclusion: Sixteen‐slice MDCT allows for noninvasive evaluation of coronary bypass grafts patency with high diagnostic accuracy. Assessment of distal anastomotic stenosis was deficient, particularly for arterial grafts, still limited by low resolution or artifacts. Improved accuracy may be obtained by more aggressive heart rate reduction.

Rationale, design and methodology for a Prospective Randomized Study of graft patency in Off-pump and On-pump MultI-Vessel coronary artery bypasS Surgery (PROMISS) using multidetector computed tomography

BackgroundOff-pump coronary artery bypass grafting has been accused of possibly compromising graft patency. Sixteen slice computed tomography has shown good diagnostic accuracy in the assessment of coronary bypass graft patency when compared with conventional coronary artery angiography and is less invasive. The study hypothesis is that coronary artery bypass grafting (CABG) performed without cardiopulmonary bypass (Off-Pump) has equivalent early graft patency as if performed with cardiopulmonary bypass (On-Pump) and may have reduced complication rate.Methods/DesignThe P rospective R andomized Comparison of O ff-Pump and On-Pump MultI-vessel Coronary Artery BypasSS urgery (PROMISS) is a controlled, single blinded, single centre clinical trial, comparing early graft patency using 16-slice computed tomography in patients with multi-vessel coronary artery disease operated either without or with extracorporeal circulation. Inclusion criteria are multivessel disease with an indication for first time, isolated, non emergent coronary artery bypass grafting with a minimum of three distal anastomoses. Secondary end points are peri-operative mortality, combined morbidity, length of stay, neuro-cognitive testing at 6 weeks and adverse events, stress test and quality of life at 6 months and one year. The sample size of one hundred and fifty patients was calculated in order to enable the detection of a 5% difference in graft patency, with 80% power, considering a minimum of 3 distal anastomoses per patient. Enrolment started in April 2005 and ended July 2007 with study closure in July 2008.ConclusionThe PROMISS trial aims to shed new light on the effect of Off-Pump as compared to On-Pump coronary artery bypass surgery on graft patency, assessed by multidetector computed tomography, in unselected patients with multivessel coronary artery disease.Trial RegistrationCurrent Controlled Trials ISRCTN58800729

Ebstein's anomaly in children: A single-center study in Angola

INTRODUCTION AND OBJECTIVE Ebsteins anomaly is a rare complex congenital heart defect of the tricuspid valve. We aimed to describe the frequency, clinical profile, and early and short-term post-operative results in patients under the age of 18 years operated for this anomaly in a tertiary center in Angola. METHODS A retrospective cross-sectional study was conducted over a period of 37 months. We analyzed all patients diagnosed with congenital heart defects. RESULTS Of the 1362 patients studied, eight (0.6%) had Ebsteins anomaly; six patients (75%) were female. Mean age was 69±59 months. Five patients were in NYHA functional class III or IV. Mean cardiothoracic index was 0.72. Seven patients (87.5%) had severe tricuspid regurgitation and five (62.5%) had another associated congenital heart defect. All patients were operated: two had complications and one (12.5%) died in the early post-operative period. The mean follow-up time was 1.22±0.6 years, and mortality during follow-up was 12.5% (n=1). At the end of the study, of the five patients in whom cone reconstruction was performed, four (80%) were in functional class I. Mean cardiothoracic index decreased to 0.64. Three patients had mild and two had moderate tricuspid regurgitation. The patient who underwent cone reconstruction and a Glenn procedure was in functional class I. CONCLUSION The frequency of Ebsteins anomaly was similar to that in other centers. Cone reconstruction was viable in the majority of patients, with good early and short-term results.

EbsteinâÂÂs Anomaly: An Impressive Cardiothoracic Ratio

Cardiothoracic ratio upper to 0.60 is a fact of poor prognostic in patients with Ebstein’s anomaly and the prognostic is worse if is associated with others congenital heart disease. We present 4-months black boy with Ebstein’s anomaly associated with atrial septal defect, pulmonary valve atresia and patent ductus arteriosus wherein the cardiothoracic ratio nearly 1.0. The patient died five hours after modified Blalock-Tausig shunt. Delay diagnosis of congenital heart disease is a big problem in developing countries and contributes for poor prognosis.