Isolated congenital coronary anomalies: Evaluation by multislice-ct or MRI
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1 Isolated congenital coronary anomalies: Evaluation by multislice-ct or MRI B.K. Velthuis, Dept. of Radiology UMC Utrecht, the Netherlands ESC 2010
2 Coronary artery anomalies CAA Uncommon 0.3-5% normal population Can cause chest pain, sudden cardiac death Physical exercise Conventional angiography limited 2D projection, invasive Noninvasive alternatives Echocardiography CT angiography MR angiography
3 Coronary artery anomalies CAA Uncommon 0.3-5% normal population Can cause chest pain, sudden cardiac death Physical exercise Conventional angiography limited 2D projection, invasive Noninvasive alternatives Echocardiography CT angiography MR angiography
4 Coronary artery anomalies CTA Superior to conventional angiography in defining ostial origin and proximal course Dose Prospective ECG triggering
5 Coronary artery anomalies CTA Model shows retrospective ECG gating versus prospective ECG gating. Shuman W P et al. Radiology 2008;248: by Radiological Society of North America
6 Coronary artery anomalies CTA Superior to conventional angiography in defining ostial origin and proximal course Dose Prospective ECG triggering At least 64 detector CT Proximal or whole heart coverage* Shot 1 Shot 2 < 3 msv
7 Coronary artery anomalies CTA Superior to conventional angiography in defining ostial origin and proximal course Dose Prospective ECG triggering At least 64 detector CT Proximal or whole heart coverage Contrast contraindications Renal dysfunction Contrast allergy
8 Coronary artery anomalies CTA Kim SY, et al. Radiographics 2006;26:
9 CAA magnetic resonance imaging MRI in comparison to CT Longer imaging time Less robust image quality No radiation dose No contrast necessary Contraindications Pacemaker, ICD etc Claustrophobia
10 CAA magnetic resonance imaging Free-breathing, 3D, navigator gated MRA* No contrast Anatomical and functional imaging Cardiomyopathy Wall motion abnormality, ejection fraction Adenosine stress MRI Ischemia Delayed enhancement MRI Infarct, cardiomyopathy
11 Coronary artery anomalies MRI Free-breathing, 3D, navigator gated MR angiography
12 Coronary anomalies classification Kim SY, et al. RadioGraphics 2006;26: Source: Greenberg MA, et al. Radiol Clin North Am 1989;27:
13 Coronary anomalies classification Kim SY, et al. RadioGraphics 2006;26: Source: Greenberg MA, et al. Radiol Clin North Am 1989;27:
14 Anomalies of origin high take-off Asymptomatic 24 y o male LCx LAD LA PA Ao RCA CTA Volume rendering
15 Anomalies of origin high take-off Asymptomatic 24 y o male LCx LAD LA PA Ao RCA CTA Volume rendering
16 Anomalies of origin multiple ostia RCA PA Ao Ao PA LAD LCx LCx LAD Courtesy of Prof. Philippe Douek, Louis Pradel Hospital, Lyon, France
17 Anomalies of origin multiple ostia RCA conus branch Kim SY, et al. Radiographics 2006;26: by Radiological Society of North America
18 Anomalies Figure 8a. of Single origin coronary artery single an 80-year-old artery man. RCA Kim SY, et al. Radiographics 2006;26: by Radiological Society of North America
19 Anomalies of origin single artery LAD LCx Kang JW, et al. Semin Ultrasound CT MR 2008;29:
20 Anomalies Figure 9a. Bland-White-Garland of origin syndrome pulmonary in a 29-year-old woman. artery ALCAPA (Bland-White-Garland syndrome) 1: Kim SY, et al. Radiographics 2006;26: by Radiological Society of North America
21 Anomalies of origin and course (A) interarterial (B) retroaortic (C) prepulmonic (D) septal (subpulmonic = beneath RVOT) Kim SY, et al. Radiographics 2006;26: by Radiological Society of North America
22 Anomalies of origin and course (A) interarterial - RCA (B) retroaortic (C) prepulmonic (D) septal PA LAD RCA LA Ao RV LCx LV Kim S Y et al. Radiographics 2006;26: CTA 2006 by Radiological Society of North America
23 Anomalies of origin and course (A) interarterial - RCA (B) retroaortic (C) prepulmonic (D) septal PA LAD RCA Ao LCx LA Kim S Y et al. Radiographics 2006;26: MRA 2006 by Radiological Society of North America
24 Anomalies of origin and course (A) interarterial - LAD (B) retroaortic (C) prepulmonic (D) septal RCA PA Ao LAD LA LV Courtesy of Dr. H. van de Bosch, Catharina Hospital, Eindhoven, the Netherlands 2006 by Radiological Society of North America
25 Anomalies of origin and course (A) interarterial (B) retroaortic - LCx (C) prepulmonic (D) septal RCA PA Ao LAD LCX LA Courtesy of Prof. Philippe Douek, Louis Pradel Hospital, Lyon, France 2006 by Radiological Society of North America
26 Anomalies of origin and course (A) interarterial (B) retroaortic - RCA (C) prepulmonic (D) septal PA LAD RCA Ao LA RV LV LCX Kim S Y et al. Radiographics 2006;26: Courtesy of Prof. Philippe Douek, Louis Pradel Hospital, Lyon, France 2006 by Radiological Society of North America
27 Anomalies of origin and course (A) interarterial (B) retroaortic (C) prepulmonic (D) septal LCA RCA LA LV 2006 by Radiological Society of North America Kim S Y et al. Radiographics 2006;26: Kang JW, et al. Semin Ultrasound CT MR 2008;29:
28 Anomalies of origin and course (A) interarterial (B) retroaortic (C) prepulmonic (D) septal (subpulmonic) Ao PA PA Proximal LAD LAD LV RCA Distal LAD 2006 by Radiological Society of North America Kim S Y et al. Radiographics 2006;26: Kang JW, et al. Semin Ultrasound CT MR 2008;29:
29 Anomalies course myocardial bridging Partial encasement 19% - dynamic compression in <2% Full encasement 39% - dynamic compression in 33% Kim, P. J. et al. Circulation 2009;119:
30 Anomalies course myocardial bridging Kim, P. J. et al. Circulation 2009;119:
31 Anomalies course duplication PA RV LV 2006 by Radiological Society of North America Kim S Y et al. Radiographics 2006;26: Kim SY, et al. Radiographics 2006;26:
32 Anomalies of termination fistula Kang JW, et al. Semin Ultrasound CT MR 2008;29:
33 Sudden cardiac death in athletes Maron, B. J. et al. Circulation 2006;114: Copyright 2006 American Heart Association
34 Coronary anomalies athletes
35 Coronary anomalies athletes Int J Cardiovasc Imaging (2010) 26:
36 Coronary anomalies athletes Int J Cardiovasc Imaging (2010) 26:
37 Coronary anomalies athletes
38 Coronary anomalies athlete case MRA CTA 1 msv Prakken N, et al. Int J Cardiovasc Imaging 2010;26:
39 Coronary anomalies case 1 17 yo M OHCA MRA CTA
40 Coronary anomalies case 2 33 yo M OHCA aberrant RCA with malignant course CTA
41 Coronary anomalies case 2 33 yo M OHCA aberrant RCA with malignant course
42 Coronary anomalies case 2 33 yo M OHCA aberrant RCA with malignant course CTA
43 Coronary anomalies case 2 33 yo M OHCA aberrant RCA with malignant course HCM Short axis diastolic phase Short axis systolic phase
44 Coronary anomalies case 2 Short axis diastolic phase Short axis systolic phase
45 Coronary anomalies case 3 20 yo M acute coronary syndrome CT Dag 0
46 Coronary anomalies case 2
47 Coronary anomalies conclusions Asymptomatic screening in young patients MRA Symptomatic / older patients CTA OHCA CTA and MRI
48
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screening; including image post processing CT, heart; without contrast material; with Requires authorization
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