Simultaneous sizing and preoperative risk stratification for thoracic endovascular aneurysm repair: Role of gated computed tomography
Received 4 February 2008; accepted 24 April 2008. published online 01 July 2008.
Objectives
Risk factors are similar for the development of both thoracic aortic aneurysms (TAA) and other cardiovascular diseases. Coronary artery disease is highly prevalent in patients with TAA, with a reported prevalence of 30% to 70%. Knowledge of the underlying cardiac pathology can minimize perioperative risk and improve patient selection. This study investigated the feasibility of simultaneous assessment of thoracic aortic pathology and cardiac structures and function, including the coronary arteries, using electrocardiogram-gated 64-slice computed tomography (CT) angiography.
Methods
ECG-gated 64-detector row CT examinations of 11 patients (8 men, 3 women; mean age, 67 ± 16; range, 41-83 years) with thoracic aortic pathology, including aneurysms and dissections, were reviewed. Images were assessed for coronary artery disease, calcifications, cardiac function, and valve characteristics. Simultaneous assessment and measurements of thoracic aortic pathology were performed with the same scan.
Results
All images of the patients could be successfully assessed for calcium scores, coronary artery stenoses, coronary artery anomalies, interventricular septal wall thickness, myocardial scar, left ventricular ejection fraction, muscle mass, and aortic and mitral valve calcification, mobility, and valve anatomy. Diagnostic image quality was also achieved in all patients for the underlying thoracic aortic disease.
Conclusion
This study introduces the feasibility of dynamic imaging of the thoracic aorta and cardiac structures and function, including the coronary arteries, with just one CT scan. The images could be successfully assessed for thoracic aorta pathology, cardiac disease, and extracardiac pathology. With further developments of CT scanners—and more detailed insight in the prognosis of patients based on ECG-gated CTA findings—this new technique may become the initial imaging modality for preoperative cardiac risk stratification in patients with TAAs or dissections.
aSection of Vascular Surgery, Yale University, New Haven, Conn
bDepartment of Radiology, Yale University, New Haven, Conn
cDepartment of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
dDepartment of Vascular Surgery, Utrecht Medical Center, Utrecht, The Netherlands
Reprint requests: Bart E. Muhs, MD, PhD, Assistant Professor of Surgery, Co-Director of Endovascular Surgery, Yale University School of Medicine, Section of Vascular Surgery, 333 Cedar St, FMB-137, New Haven, CT 06510
ABSTRACT