Evaluation of cardiac morphology, function, and perfusion at low radiation dose before mitral valve surgery

A low-dose cardiac CT examination for preoperative assessment of coronary artery disease and mitral valve annulus dimensions in 79-year-old female with mitral valve regurgitation, consisting of a prospectively ECG-triggered high-pitch first-pass perfusion scan under adenosine stress and a sequential scan at rest enabled the diagnosis of occlusion of the right coronary artery and high-grade stenosis of the left circumflex artery, reversible perfusion defects of the inferoseptal and inferolateral walls and a persistent inferior wall perfusion defect associated with inferior wall thinning and akinesia. All findings were confirmed with catheter coronary angiography and cardiac magnetic resonance imaging. Because of the diagnosis of peri-infarct ischemia, the patient underwent aortocoronary bypass grafting in addition to mitral valve reconstruction. CT allowed for comprehensive preoperative assessment of cardiac morphology, function, and perfusion at a low cumulative radiation dose of 4.3 mSv.