Search Results (13)

Coronary arteries have a wide range of anatomical variability, and their spectrum ranges from asymptomatic cases to those predisposed to hemodynamic compromise or even sudden cardiac death. This paper aims to review the classification of coronary artery anomalies (CAAs) and illustrate their imaging characteristics by highlighting the important role of CT coronary angiography. Some of the coronary anomalies usually met in current practice are the high origin coronary artery, multiple ostia, aberrant origin from the opposite/non-coronary Valsalva sinus, single coronary artery, ALCAPA syndrome, duplications of the left anterior descending artery, coronary fistulas, and extracardiac terminations. CT coronary angiography is a non-invasive diagnostic modality for CAAs. The complex anatomy of these anomalies can be accurately described by employing 3D reconstructions and post-processing techniques. Knowledge of the imaging characteristics and potential functional impact of these anomalies is essential for accurate diagnosis and therapeutic planning of patients. Full article

A rare case of an anomalous location of the orifice of the coronary artery was found in a 99-year-old male cadaver undergoing routine dissection. The presence of the right coronary artery (RCA), left coronary artery (LCA), and conus artery (conus branch) originating from the right Valsalva sinus are the characteristic findings of this case. Then, the LCA passed through the aorta and the pulmonary artery. The LCA and RCA branches were normal. These findings are useful for future surgical procedures, including cardiac catheterization. Full article

In current clinical practice, commissural alignment of the transcatheter heart valve (THV) during transcatheter aortic valve implantation (TAVI) is seldom achieved. Orientation of the THV within the aortic root and the subsequent influence upon leaflet haemodynamic function, coronary blood flow, and ease of access to the coronary ostia are gaining significant interest. Herein, we review the incidence and clinical implications of commissural misalignment in TAVI and offer thorough descriptions of how optimal alignment can be achieved with several different contemporary THV devices. Full article

Due to technological advancements during the past 20 years, transcatheter aortic valve replacements (TAVRs) have significantly improved the treatment of symptomatic and severe aortic stenosis, significantly improving patient outcomes. The continuous evolution of transcatheter valve models, refined imaging planning for enhanced accuracy, and the growing expertise of technicians have collectively contributed to increased safety and procedural success over time. These notable advancements have expanded the scope of TAVR to include patients with lower risk profiles as it has consistently demonstrated more favorable outcomes than surgical aortic valve replacement (SAVR). As the field progresses, coronary angiography is anticipated to become increasingly prevalent among patients who have previously undergone TAVR, particularly in younger cohorts. It is worth noting that aortic stenosis is often associated with coronary artery disease. While the task of re-accessing coronary artery access following TAVR is challenging, it is generally feasible. In the context of valve-in-valve procedures, several crucial factors must be carefully considered to optimize coronary re-access. To obtain successful coronary re-access, it is essential to align the prosthesis with the native coronary ostia. As part of preventive measures, strategies have been developed to safeguard against coronary obstruction during TAVR. One such approach involves placing wires and non-deployed coronary balloons or scaffolds inside an at-risk coronary artery, a procedure known as chimney stenting. Additionally, the bioprosthetic or native aortic scallops intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure offers an effective and safer alternative to prevent coronary artery obstructions. The key objective of our study was to evaluate the techniques and procedures employed to achieve commissural alignment in TAVR, as well as to assess the efficacy and measure the impact on coronary re-access in valve-in-valve procedures. Full article

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve’s durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes. Full article

Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = −0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible. Full article

Aortopulmonary fistula secondary to a large pseudoaneurysm after a Bentall procedure is a rare but complex complication. Herein, we report a case of Cabrol shunt obliteration and pseudoaneurysm formation three months after a Bentall procedure. The patient also presented with congestive heart failure due to an aortopulmonary fistula six years later. Surgery was successfully performed to repair the dehiscence of the biliteral coronary ostia and the aortopulmonary fistula, and to replace the ascending aorta. Postoperatively, the patient recovered uneventfully. Full article

This study aims to demonstrate the use of surgical ostioplasty of the left main coronary artery as an alternative technique to the conventional use of coronary artery bypass grafting for the treatment of left main stem-isolated ostial stenosis. From 2002 to 2021, five patients—three women (60%) and two men (40%)—presented with a history of angina pectoris and were diagnosed with isolated stenosis of the coronary ostia associated with normal distal coronary arteries. Pre-operative cardiac catheterization and echocardiography were performed to aid in the diagnosis. The patients were submitted to surgical ostioplasty with a posterior approach using a saphenous patch. There were no hospital deaths or myocardial infarctions during the post-operative period. The mean cardiopulmonary bypass time was 82 min (range, 70–95 min), and the mean aortic-clamp time was 62 min (range, 55–75 min). The average time of hospitalization was 6.2 days (range, 4–18 days). Patients with isolated stenosis of the coronary ostia associated with normal distal coronary arteries may be submitted to left main coronary artery ostioplasty as an alternative to coronary artery bypass grafting, the traditional surgical technique for this pathology. Full article

Background—Bicuspid aortic valve (BAV) disease is the most prevalent congenital heart disease in the world. Knowledge about its subtypes origin, development, and evolution is poor despite the frequency and the potential gravity of this condition. Its prognosis mostly depends on the risk of aortic aneurysm development with an increased risk of aortic dissection. Aims—This review aims to describe this complex pathology in way to improve the bicuspid patients’ management. Study design—We reviewed the literature with MEDLINE and EMBASE databases using MeSH terms such as “bicuspid aortic valve”, “ascending aorta”, and “bicuspid classification”. Results—There are various classifications. They depend on the criteria chosen by the authors to differentiate subtypes. Those criteria can be the number and position of the raphes, the cusps, the commissures, or their arrangements regarding coronary ostia. Sievers’ classification is the reference. The phenotypic description of embryology revealed that all subtypes of BAV are the results of different embryological pathogenesis, and therefore, should be considered as distinct conditions. Their common development towards aortic dilatation is explained by the aortic media’s pathological histology with cystic medial necrosis. At the opposite, BAV seems to display a profound genetic heterogeneity with both sporadic and familial forms. BAV can be even isolated or combined with other congenital malformations. Conclusions—All those characteristics make this pathology a highly complex condition that needs further genetic, embryological, and hemodynamic explorations to complete its well described anatomy. Full article

Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use. Full article

Transradial coronaro-angiography (TRA) can be performed with one catheter. We investigate the efficacy of four different DxTerity catheter curves dedicated to the single-catheter technique and compare this method to the standard two-catheter approach. For this prospective, single-blinded, randomized pilot study, we enrolled 100 patients. In groups 1, 2, 3, and 4, the DxTerity catheters Trapease, Ultra, Transformer and Tracker Curve, respectively, were used. In group 5 (control), standard Judkins catheters were used. The study endpoints were the percentage of optimal stability, proper ostial artery engagement and a good quality angiogram, the duration of each procedure stage, the amount of contrast, and the radiation dose. The highest rate of optimal stability was observed in groups 2 (90%) and 5 (95%). Suboptimal results with at least one episode of catheter fallout from the ostium were most frequent in group 1 (45%). The necessity of using another catheter was observed most frequently in group 4. The analysis of time frames directly depending on the catheter type revealed that the shortest time for catheter introduction and for searching coronary ostia was achieved in group 2 (Ultra). There were no differences in contrast volume and radiation dose between groups. DxTerity catheters are suitable tools to perform TRA coronary angiography. The Ultra Curve catheter demonstrated an advantage over other catheters in terms of its ostial stability rate and procedural time. Full article

Accurate identification of the coronary ostia from 3D coronary computed tomography angiography (CCTA) is a essential prerequisite step for automatically tracking and segmenting three main coronary arteries. In this paper, we propose a novel deep reinforcement learning (DRL) framework to localize the two coronary ostia from 3D CCTA. An optimal action policy is determined using a fully explicit spatial-sequential encoding policy network applying 2.5D Markovian states with three past histories. The proposed network is trained using a dueling DRL framework on the CAT08 dataset. The experiment results show that our method is more efficient and accurate than the other methods. blueFloating-point operations (FLOPs) are calculated to measure computational efficiency. The result shows that there are 2.5M FLOPs on the proposed method, which is about 10 times smaller value than 3D box-based methods. In terms of accuracy, the proposed method shows that 2.22 ± 1.12 mm and 1.94 ± 0.83 errors on the left and right coronary ostia, respectively. The proposed method can be applied to the tasks to identify other target objects by changing the target locations in the ground truth data. Further, the proposed method can be utilized as a pre-processing method for coronary artery tracking methods. Full article

Congenital anomalies of the coronary ostia can lead to sudden death. A screening solution would be useful to prevent adverse outcomes for the affected individuals. To be considered for integration into clinical routine, such a procedure must meet strict constraints in terms of invasiveness, time and user interaction. Imaging must be fast and seamlessly integrable into the clinical process. Non-contrast enhanced coronary magnetic resonance angiography (MRA) is well suited for this. Furthermore, planar reformations proved effective to reduce the acquired volumetric datasets to 2D images. These usually require time consuming user interaction, though. To fulfill the aforementioned challenges, we present a fully automated solution for imaging and reformatting of the proximal coronary arteries which enables rapid screening of these. The proposed pipeline consists of: (I) highly accelerated single breath-hold MRA data acquisition, (II) coronary ostia detection and vessel centerline extraction, and (III) curved planar reformation of the proximal coronary arteries, as well as multiplanar reformation of the coronary ostia. The procedure proved robust and effective in ten volunteer data sets. Imaging of the proximal coronary arteries took $24\pm 5$ s and was successful within one breath-hold for all patients. The extracted centerlines achieve an overlap of 0.76 ± 0.18 compared to the reference standard and the average distance of the centerline points from the spherical surface for reformation was 1.1 ± 0.51 mm. The promising results encourage further experiments on patient data, particularly in coronary ostia anomaly screening. Full article