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Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
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Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

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Evaluation of ascending aortic atherosclerosis with 16-multidetector computed tomography is useful before total

Gudrun Maria Feuchtner1, Thomas Schachner, Nikolaos Bonaros

  • 1Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria. Gudrun.Feuchtner@uibk.ac.at

The Heart Surgery Forum
|July 1, 2006
PubMed

Insights

Pre-operative assessment of ascending aortic atherosclerosis using 16-MDCT angiography is crucial for total endoscopic coronary artery bypass (TECAB) surgery. Mild atherosclerosis can cause intraoperative difficulties with cardiopulmonary bypass perfusion devices.

Area of Science:

  • Cardiovascular Imaging
  • Thoracic Surgery
  • Medical Diagnostics

Background:

  • Ascending aortic atherosclerosis poses risks during cardiac surgery.
  • 16-multidetector computed tomography (16-MDCT) angiography is a key imaging modality.

Purpose of the Study:

  • To assess ascending aortic atherosclerosis using 16-MDCT angiography before total endoscopic coronary artery bypass (TECAB) surgery.
  • To correlate imaging findings with intraoperative complications.

Main Methods:

  • 45 patients underwent electrocardiogram-gated, 16-MDCT angiography.
  • Ascending aortic atherosclerosis was graded (mild/severe) and plaque composition analyzed using Hounsfield units (HU).
  • TECAB was performed on arrested (n=39) or beating (n=6) hearts.

Main Results:

  • Mild ascending aortic atherosclerosis (11/39) was linked to difficulties with intra-aortic cardiopulmonary bypass (CPB) devices during arrested-heart TECAB.
  • Noncalcifying plaque (mean 58 HU) was associated with balloon migration, while calcifying plaque (mean 526 HU) correlated with balloon rupture.
  • Balloon rupture occurred in 2 patients with calcifying plaque.

Conclusions:

  • 16-MDCT angiography is valuable for evaluating ascending aortic atherosclerosis pre-TECAB.
  • Even mild atherosclerosis can complicate arrested-heart TECAB due to issues with the remote-access perfusion system.
Abstract

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