Abstract 18291: Computed Tomography Angiography Can Replace Cardiac Catheterization in the Surgical Planning of Select Neonates with Major Aortopulmonary Collaterals

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Holly Bauser-Heaton ◽  
Lynn Peng ◽  
Stanton B Perry ◽  
Jeffrey A Feinstein ◽  
Frank L Hanley ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Angiography ◽  
Cardiac Catheterization ◽  
Surgical Planning ◽  
Surgical Intervention ◽  
Neonatal Period ◽  
Aortopulmonary Collaterals ◽  
Initial Hospitalization ◽  
The Cost ◽  
Major Aortopulmonary Collaterals

Introduction: Neonates with Tetralogy of Fallot (TOF) and major aortopulmonary collaterals (MAPCAs) routinely undergo cardiac catheterization in the neonatal period. We have recently incorporated CT angiography into the neonatal evaluation with the hope of eliminating catheterization in those not needing neonatal intervention. We reviewed our experience with CT angiography and its accuracy in determining the need for neonatal intervention. Methods: Retrospective review of all patients from April 2005-October 2013 with MAPCAs who had both CTA and cardiac catheterization during the first 120 days of life and within 14 days of one another. The radiologist and interventionalist responsible for reading the studies were blinded to the results of the procedures and each other’s readings. The need for neonatal intervention as predicted by CTA was compared to the ultimate, cath-based decision. Results: 19 patients (mean age 3.73 days, range 1-9 days of age) were included in the study. In all patients CT was able to predict the need for surgical intervention correctly. CTA was found to be 87% sensitive, 93% specific and 91% sensitive with respect to number of MAPCAs, origin and distribution. Conclusion: CT angiography can accurately predict the need for neonatal intervention. In those not requiring neonatal intervention, neonatal cardiac catheterization is not required. CTA may also aid in guiding the subsequent, pre-operative catheterization but cannot replace it. This algorithm eliminates neonatal catheterization in the majority of TOF/MAPCAs patients, and with it the associated risks, and radiation, as well as substantially reducing the cost of the initial hospitalization.

scholarly journals An Unusual Cause of Hypoxia: Ventricular Septal Defect, Pulmonary Artery Atresia, and Major Aortopulmonary Collaterals Diagnosed in the Adult Cardiac Catheterization Lab

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Katia Bravo-Jaimes ◽  
Brian Walton ◽  
Poyee Tung ◽  
Richard W. Smalling
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Cardiac Catheterization ◽  
Mortality Risk ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
High Mortality Risk ◽  
Catheterization Laboratory ◽  
Aortopulmonary Collaterals ◽  
Major Aortopulmonary Collaterals

The association of pulmonary atresia, ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCA) is an extreme form of tetralogy of Fallot (TOF). It carries a high mortality risk if not intervened on during infancy with only 20% of unoperated patients surviving into adulthood. We present the case of a 40-year-old man who presented for evaluation prior to retinal surgery and was found to have hypoxia and a loud murmur. Cardiac catheterization was performed in the general catheterization laboratory, demonstrating a membranous VSD, pulmonary atresia, and MAPCA. We highlight the challenges and limitations that an adult interventional cardiologist may have when encountering these patients.

The Role of Doppler Ultrasound, CT Angiography, and Conventional Angiography in Detection of Peripheral Arterial Disease

2021 ◽  
pp. 154431672110303
Author(s):  
Sayan Sarkar ◽  
Shyam Mohan ◽  
Shakthi Parvathy
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Ct Angiography ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Color Doppler ◽  
Statistical Significance ◽  
Arterial Disease ◽  
P Value ◽  
Peripheral Arterial

The purpose of this study is to analyze how accurate duplex ultrasonography using color Doppler and computed tomography (CT) angiography are in detection of peripheral arterial disease (PAD) in comparison with the Gold Standard of digital subtraction angiography (DSA). This is a single-center prospective, analytical study done on patients with symptoms of PAD referred to the Department of Radiodiagnosis of Medical Trust Hospital (n = 53). All patients were imaged with color Doppler, CT angiography, and DSA. The peak systolic velocity (PSV) ratio was calculated by Doppler ultrasound, and the percentage stenosis for the same vascular segments was calculated using CT angiography and DSA. To test the statistical significance between the results, chi-square test was used. A P value <.05 indicates statistical significance. The PSV ratio for each grade—normal (<1.5), mild (1.5-2.8), moderate (2.9-4.9), and severe (≥5)—and the percentage of stenosis for each grade observed on CT angiography—normal (<20% stenosis), mild (20%-49% stenosis), moderate (50%-74% stenosis), severe (75%-99% stenosis), and total occlusion (100% stenosis)—were found to be highly sensitive and specific with good positive predictive value, negative predictive value, and accuracy level when compared with DSA with narrow confidence intervals for each range. The P value was <.001 for both color Doppler and CT angiography. Computed tomography angiography can be an effective tool as an alternative to DSA for gradation of stenosis if the artifacts resulting from vascular calcification can be avoided. Duplex ultrasonography can be utilized for gradation of stenosis by using the value of PSV ratio and spectral pattern together. However, it can only act as an adjunct to CT angiography because it is incapable of imaging the full length of the arterial segments in 1 frame.

scholarly journals Emphysematous pyelonephritis: A rare cause of sepsis in hepatocellular carcinoma

2021 ◽  
pp. 201010582199280
Author(s):  
Hany Haqimi Wan Hanafi ◽  
Nazri Mustaffa ◽  
Yeong Yeh Lee ◽  
Siti Nurbaya Mohd Nawi
Keyword(s):  
Diabetes Mellitus ◽  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Surgical Intervention ◽  
Computed Tomography Scan ◽  
Emphysematous Pyelonephritis ◽  
Urological Emergency ◽  
Tomography Scan

The association between emphysematous pyelonephritis (EPN) and diabetes mellitus is well known. EPN as the cause of sepsis in hepatocellular carcinoma (HCC) is rare and unreported. We report a case of EPN in a non-diabetic HCC patient, in which the clinical features of decompensated chronic liver disease masked the more sinister urological emergency to a certain degree. A computed tomography scan of the abdomen revealed a mixture of gas and fluid in the left retrorenal space, in keeping with left EPN. Nevertheless, the course of clinical deterioration was rather rapid that any surgical intervention was not feasible.

The Groote Schuur hospital classification of the orbital complications of sinusitis

1997 ◽  
Vol 111 (8) ◽  
pp. 719-723 ◽  
Author(s):  
S. Mortimore ◽  
P. J. Wormald
Keyword(s):  
Computed Tomography ◽  
Relative Frequency ◽  
Surgical Intervention ◽  
Acute Sinusitis ◽  
High Resolution Computed Tomography ◽  
Septal Group ◽  
Ready Availability ◽  
Clear Differentiation ◽  
Orbital Complications

AbstractThe complications of sinusitis have been well described. The most common classifications used for orbital complications have been that of Chandler et al. (1970) and Moloney et al. (1987). With the ready availability of high-resolution computed tomography (CT) scanners, limitations of these classifications have become apparent. The aims of this study were to determine the relative frequency of the various complications associated with acute sinusitis, to determine which groups of sinuses were most frequently involved and to correlate the orbital signs with a new proposed classification of orbital complications. Over a five-year period, 87 consecutive patients were admitted with acute sinusitis. Sixty-three patients (72.4 per cent) had one or more complications. When orbital complications were classified under the proposed classification, all patients with proptosis and/or decreased eye movement had post-septal infection. Visual impairment occurred only in the post-septal group. Most complications had a combination of sinus involvement with the maxillary/ethmoid/frontal combination being the most common. The authors propose a modification of Moloney's classification for orbital complications of acute sinusitis that allows a clear differentiation between pre- and post-septal infection and a radiological differentiation to be made between cellulitis/phlegmon and abscess formation. The latter is of importance when a decision is made on whether surgical intervention is appropriate or not.

The Cost-Effectiveness of Surgical Intervention for Spinal Metastases

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andrew J. Schoenfeld ◽  
Gordon P. Bensen ◽  
Justin A. Blucher ◽  
Marco L. Ferrone ◽  
Tracy A. Balboni ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Surgical Intervention ◽  
Spinal Metastases ◽  
The Cost

scholarly journals A Rare Stapes Abnormality

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hala Kanona ◽  
Jagdeep Singh Virk ◽  
Gaurav Kumar ◽  
Sanjiv Chawda ◽  
Sherif Khalil
Keyword(s):  
Computed Tomography ◽  
Hearing Loss ◽  
High Resolution ◽  
World Literature ◽  
Surgical Intervention ◽  
Conductive Hearing Loss ◽  
High Resolution Computed Tomography ◽  
Stapes Prosthesis ◽  
Diagnostic Difficulties ◽  
Conductive Hearing

The aim of this study is to increase awareness of rare presentations, diagnostic difficulties alongside management of conductive hearing loss and ossicular abnormalities. We report the case of a 13-year-old female reporting progressive left-sided hearing loss and high resolution computed tomography was initially reported as normal. Exploratory tympanotomy revealed an absent stapedius tendon and lack of connection between the stapes superstructure and footplate. The footplate was fixed. Stapedotomy and stapes prosthesis insertion resulted in closure of the air-bone gap by 50 dB. A review of world literature was performed using MedLine. Middle ear ossicular discontinuity can result in significant conductive hearing loss. This can be managed effectively with surgery to help restore hearing. However, some patients may not be suitable or decline surgical intervention and can be managed safely conservatively.

scholarly journals Physiological Evaluation of Anomalous Aortic Origin of a Coronary Artery Using Computed Tomography–Derived Fractional Flow Reserve

2021 ◽  
Author(s):  
Julien Adjedj ◽  
Fabien Hyafil ◽  
Xavier Halna du Fretay ◽  
Patrick Dupouy ◽  
Jean‐Michel Juliard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Fractional Flow Reserve ◽  
Coronary Ct Angiography ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Coronary Ct ◽  
Flow Reserve

Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.

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