ALCAPA AND TAKEUCHI PROCEDURE
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A 29-year-old female with a history of ALCAPA and Takeuchi procedure as a child presented with palpitations. Her recent echocardiogram showed worsening pulmonic stenosis and her holter monitor detected non-sustained ventricular tachycardia. She was ordered for a cardiac MRI to assess for left ventricular scar that could explain her arrhythmia and to evaluate her coronary anatomy before potential angiogram or hemodynamic study. CMR is useful for delineating coronary anatomy and detecting characteristic sub-endocardial late gadolinium enhancement in the basal anterolateral wall seen in ALCAPA patients. CMR may avoid the need for invasive procedures by clearly defining the postoperative anatomy in adults who
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CORONARY ANOMALY
1) Coronary artery anomalies (CAAs) are defined as morphological features found in less than 1% of the population. They can be classified based on origin, course, termination, or hemodynamic significance.
2) Some important CAAs include anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), anomalous origin of the coronary artery from the opposite sinus (ACAOS), and coronary artery fistulas.
3) ALCAPA causes retrograde flow of blood from the right coronary artery to the pulmonary artery. ACAOS, especially when the ectopic artery takes an interarterial course, can cause ischemia. Coronary artery fistulas can lead to complications like aneurysm formation
Echocardiography in intervention cardiology
Echocardiography can be used to guide various cardiac interventions and procedures. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are commonly used to guide percutaneous procedures like pericardiocentesis, balloon mitral valvuloplasty, and ablation procedures. Intracardiac echocardiography (ICE) provides high-quality images and is used for transseptal punctures and atrial fibrillation ablation. Echocardiography helps with catheter placement and rules out complications. It is also used to identify coronary artery disease by detecting retrograde flow in occluded vessels and "mosaic flow" patterns in stenotic vessels.
CUORE E TECNOLOGIE: EVOLUZIONE DELLA CARDIOLOGIA INTERVENTISTICA CHIUSURA DEL...
The document discusses surgical closure of the left atrial appendage (LAA). It notes that LAA ligation during mitral valve surgery is associated with a reduction in risk of embolism. However, surgical techniques for LAA closure are often incomplete, resulting in blood stasis and potential clot formation. Newer clipping devices allow for atraumatic, complete exclusion of the LAA via various access methods and may help prevent stroke in atrial fibrillation patients when performed during concomitant cardiac surgery or as a standalone procedure.
Role of ct angiography in diagnosis of coronary anomalies
CT angiography plays an important role in diagnosing coronary artery anomalies. It provides detailed 3D images of the coronary arteries with high spatial and temporal resolution in a noninvasive manner. Proper patient preparation including beta blockers to lower heart rate and nitroglycerin to dilate arteries is important for optimal imaging. CT angiography can detect various types of anomalies such as anomalous coronary artery origins, fistulas, myocardial bridging, and duplication of arteries. It serves as a roadmap for cardiologists in guiding patient management.
2. investigation of cardiovascular system )2(
This document discusses electrocardiography (ECG) and its use in evaluating cardiac disease. An ECG records the electrical activity of the heart and can detect abnormalities in rhythm, conduction, chamber size and ischemia. A standard ECG involves 10 electrodes that produce 12 leads displaying the heart's electrical signals from different angles. ECGs are used to diagnose conditions like myocardial infarction and assess heart muscle damage through changes in the ST segment and T waves.
2. investigation of cardiovascular system )2(
This document discusses electrocardiography (ECG) and its use in evaluating cardiac disease. An ECG records the electrical activity of the heart and can detect abnormalities in rhythm, conduction, chamber size and ischemia. A standard ECG involves 10 electrodes that produce 12 leads displaying the heart's electrical signals from different angles. ECGs are used to diagnose conditions like myocardial infarction and assess heart muscle damage through changes in the ST segment and T waves.
ECG in young
A 33-year-old man presented to the emergency department after collapsing. His ECG showed Brugada pattern, which is characterized by ST-segment elevation in leads V1-V3 and increased risk of ventricular arrhythmias and sudden cardiac death. Brugada syndrome is a genetic condition caused by sodium channel mutations and commonly presents with syncope or cardiac arrest in young males. The diagnosis can be confirmed with ajmaline/flecainide provocation test showing transient Brugada pattern. Treatment involves lifestyle modifications and implantable cardioverter-defibrillator for high-risk patients.
Cardiology board mc qs.ppt2
The document discusses several different cardiac conditions and test results including atrial fibrillation with complete heart block, second degree 2:1 heart block, complete heart block, atrial flutter with 2:1 block, amyloidosis indicated by an echocardiogram showing severe LVH, speckled appearance and low voltage limb leads on ECG, inferolateral reversible ischemia of moderate degree found on a graft study for a post-CABG patient which also showed an occluded superior OM and diseased OM2 and OM3 that were stented.
2007 terni, workshop interattivo, caso clinico 3
- A 53-year-old man presented with 4.5 hours of chest pain radiating to both arms. His EKG showed downsloping ST depression in leads V1-V4 and tall R waves in V3. Posterior leads V7-V9 demonstrated ST elevation.
- He underwent immediate cardiac catheterization, which revealed a total occlusion of the LCA. He received stenting of the LCA.
Topic of the month...Neuroimaging of embolic cerebral infarctions
This document discusses radiological findings of cerebral infarction on CT scans. It describes how early CT signs such as a hyperdense middle cerebral artery can help identify acute ischemic stroke within the first few hours. It also explains the pathophysiology of cytotoxic and vasogenic edema that develops in the brain during the first days following a stroke, and how this edema appears on CT scans. Identifying these early signs accurately on CT is important for determining if patients may benefit from thrombolytic therapy.
EHJ-CR-Slide-Set (1).pptx
This case series presents 7 cases of congenital aortic diseases assessed using cardiac computed tomography angiography (CCTA). CCTA provided detailed visualization of vascular structures and spatial relationships that were important for diagnosis and surgical planning. The cases included vascular rings, interrupted arches, coarctation and hypoplasia. CCTA allowed early diagnosis and treatment. Multi-imaging is important for assessing these complex anomalies and guiding management, like surgical or endovascular interventions. Three-dimensional CCTA images provided valuable information for optimal diagnosis and surgical planning.
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Hepatic hydrothorax (HH) is a rare cause of unilateral pleural effusion generally seen in patients withcirrhosis who do not have other reasons to explain their effusion.1 Most commonly HH presents in patients with ascites andtypically results in right sided pleural effusion; however, we detail a unique case below of left sided HH seen in the absence of ascites.
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This document discusses aortic arch anomalies. It begins by describing normal aortic arch development. It then defines vascular rings as vessels that encircle the trachea and esophagus, causing symptoms. It classifies the main types of vascular rings as complete rings (double aortic arch with right/left/balanced dominance, right aortic arch with left ductus arteriosus) and incomplete rings (innominate artery compression, pulmonary artery sling, left aortic arch with aberrant right subclavian). Each type of ring is described in detail with examples and images provided.
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A 43-year-old male presented with chest trauma after a fall. A trans-thoracic echocardiogram revealed a 1 cm mass protruding into the left ventricular outflow tract. Cardiac MRI was obtained for better tissue characterization. The MRI showed the mass had a non-enhancing morphology. Based on the echocardiogram and MRI findings, the mass was determined to be a sub-aortic membrane. The patient was discharged with regular follow up since he did not have a significant gradient across the membrane or aortic regurgitation.
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ALCAPA AND TAKEUCHI PROCEDURE
- 2. A 29 year-old female who had an anomalous left main coronary artery from the pulmonary artery (ALCAPA) and subsequently underwent the Takeuchi procedure early in life presented for evaluation of palpitations. She had worsening of her pulmonic stenosis on a recent echocardiogram with her right and left ventricular function being preserved. Her holter monitor showed non-sustained ventricular tachycardia (NSVT) that correlated with her palpations. Cardiac MRI was ordered to assess for any left ventricular scar that could account for her NSVT and to assess left main coronary anatomy before considering coronary angiogram and an invasive hemodynamic study.
- 3. Incidence is about 1 in 300,000 live births1 0.25-0.5% of children with congenital heart disease1 90% mortality in the first year if not treated1,2 Definitive treatment – surgery1,2 › Direct implantation of left main into the aorta Most common now › Coronary artery bypass grafting › Takeuchi procedure Creating a baffle from the native pulmonary artery to connect the aorta to the left main artery 1. Secinaro A, Ntsinjana H, et al. Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA). Journal of Cardiovascular Magnetic Resonance. 2011. 13:27 2. Ginde S, Earing M, et al. Late Complications After Takeuchi Repair of Anomalous Left Coronary Artery From the Pulmonary Artery: Case Series and Review of Literature. Pediatric Cardiology. 2012. 33; 1115-23.
- 9. CMR helps with delineating anatomy › Using 3-D Heart Navigation CMR to evaluate LV Scar › Characteristically, patients who ALCAPA have sub-endocardial late gadolinium enhancement (LGE) of the basal anterolateral wall and sometimes papillary muscle1 CMR › Extremely valuable tool in defining coronary anatomy in adult patients who have undergone surgery as young children for congenital abnormalities › May obviate the need for invasive procedures 1. Secinaro A, Ntsinjana H, et al. Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA). Journal of Cardiovascular Magnetic Resonance. 2011. 13:27
- 10. Gyanendra Sharma, M.D. – Director of Echocardiogram Laboratory, Professor of Medicine, Division of Cardiology Jayanth H. Keshavamurthy, M.D. – Assistant Professor of Radiology
Editor's Notes
- Aorto-pulmonary Window – Baffle to the LM starting from the aorta
- Aorto-pulmonary Window – Baffle to the LM starting from the aorta (mid baffle)
- Aorto-pulmonary Window – Baffle to the LM starting from the aorta (LM bifurcation)
- Sub-endocardium, anterolateral scar
- Sub-endocardium, anterolateral scar
- an extremely valuable tool in defining coronary anatomy in adult patients who have underwent surgery as young children for congenital abnormalities such as our patient who had undergone the Takeuchi procedure