Simultaneous sizing and preoperative risk stratification for thoracic endovascular aneurysm repair: role of gated computed tomography.
OBJECTIVE
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.


CONCLUSIONS
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.
Schlösser
Felix J V
FJ
Section of Vascular Surgery, Yale University, New Haven, Connecticut 06510, USA.
Mojibian
Hamid R
HR
Dardik
Alan
A
Verhagen
Hence J M
HJ
Moll
Frans L
FL
Muhs
Bart E
BE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011873:Radiology Information Systems; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed