Pierre-Julien Bruyere

Late gadolinium enhancement CMR in primary mitral regurgitation.

The appropriate timing for surgery in severe asymptomatic primary mitral regurgitation (MR) remains controversial. It has been shown that late gadolinium enhancement on cardiovascular magnetic resonance (LGE CMR), which may identify myocardial fibrosis, is associated with a worse outcome in various cardiomyopathies. We sought to investigate the prevalence and significance of delayed enhancement in primary MR.

Diagnostic accuracy of computed tomography coronary angiography in routine practice.

Objectives — The recent newer advances in computed tomography have dramatically changed our approach to imaging cardiac disease. This study sought to compare the diagnostic value of 16-multi-detector spiral computed tomography (MSCT) for detecting coronary artery stenosis. Methods — A total of 88 consecutive patients (52 men, mean age 68 ± 8 years) with atypical chest pain, stable angina or suspicion of ischaemia at stress test were studied by MSCT and invasive coronary angiography (ICA).The MSCT images and multiplanar reconstructions were analysed regarding the presence of > 50% coronary artery lesion. Results — All 88 scans obtained at a mean heart rate of 68 ± 8 beats/min were interpretable. Sixteen coronary segments were evaluated in each patient. Of the 1320 segments examined, 148 (11%) showed poor image quality.A total of 150 significant lesions were detected using ICA, and 80 of 150 (53%) were detected by MSCT. Sensitivity, specificity, positive and negative predictive values were as follows: 53%, 97%, 68%, and 94%. Fifty-four patients had > 50% coronary stenosis.The diagnosis was confirmed by MSCT in 42 patients and correctly ruled out in 30. By patient-based analysis, positive and negative predictive values were 91% and 71%. Conclusion — Although its specificity is high, the sensitivity of 16-slice MSCT for detecting > 50% coronary stenosis in non-selected patients submitted to ICA is rather low suggesting that for daily practice the diagnostic value of this technique should be improved.

Supraclavicular nerve entrapment syndrome.

Supraclavicular nerve entrapment syndrome, although rare, should be considered among the causes of anterior shoulder girdle pain. This syndrome is usually related to anatomic variants (involving the bone structures, fibrous bands, or muscles and tendons). Computed tomography is the most useful investigation. Medications used to treat neuropathic pain may provide relief. Otherwise, a local glucocorticoid injection or even surgical decompression should be considered.

Clinical vistas briefs: Emphysematous cystitis

Whats your call? Figure. Computed tomography scan of the abdomen of a 77-year-old woman without diabetes who was admitted to hospital because of hyperthermia, abdominal pain and confusion.

Ventricular aneurysm versus pseudoaneurysm: role of muti-imaging modality

A 54-year-old patient without previous cardiac disease presented at emergency room with dispnoea, left leg pain and clinical signs of peripheral artery occlusion. The thoracic computed tomography excluded pulmonary embolism but bilateral pleural effusion was visualized. An urgent Fogarty intervention with fasciatomy was performed. The transthoracic echocardiography obtained after surgery showed an enlarged and severely impaired left ventricle (ejection fraction < 40%) secondary to the presence of an extensive akinesia in the inferior and posterior walls. Surprisingly, the echo also revealed a voluminous cavity beneath the inferior wall which tethered the mitral leaflets at both ends and restricted their ability to close efficiently (Panel A, apical long axis view, no clear cavity border delineation). A severe mitral regurgitation was thus described (figure 1). This crater could be related to either ventricular aneurysm or pseudoaneurysm. The distinction between both is of clinical importance from a technical surgical point of view. As 2D echo was unable to carry out a clear diagnosis, a contrast-enhanced echo was performed. The left ventricular opacification perfectly identified the crater but a pseudoaneurysm could not be ruled out (figure 1 Panel B, possible neck (white arrow), doubt on the presence of pericardial effusion (yellow arrow)). Conversely, a multidetector row cardiac computed tomography accurately identified the presence of a ventricular aneurysm (figure 1 Panel C-D, absence of neck (black arrows), no pericardial effusion) and a partial disruption of the posterior papillary muscle which were confirmed at the time of surgery.

La tomodensitométrie cardiaque dans la mise au point préopératoire d’une anomalie congénitale d’une artère coronaire

We report the case of a 81-year-old man presenting with stable exercise angina pectoris. The stress test is positive and the coronaro-angiographic evaluation demonstrates a coronary fistula between the left anterior descending (LAD) artery and the pulmonary artery trunk. The mid LAD presents a significant lesion after the origin of the fistula. A cardiac computed tomography is used before surgical treatment. Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunt into a cardiac chamber, great vessel or other structure. Low-pressure structure is the most common site of drainage of the coronary fistula. The clinical presentation of coronary fistulas is mainly dependent on the severity of the left-to-right shunt. Various cardiac imaging modalities are used for diagnosis and anatomical exploration before surgical or percutaneous intervention if the closure of the fistula is indicated.