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Open Access 01-10-2013 | Pictorial Review

The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention

Authors: Prabhakar Rajiah, Paul Schoenhagen

Published in: Insights into Imaging | Issue 5/2013

Abstract

Advances in our knowledge of cardiovascular disorders coupled with technological innovations have enabled the increased use of minimally invasive cardiovascular surgeries and transcatheter interventions, with resultant reduced morbidity and hospital stay. Three-dimensional imaging, particularly computed tomography (CT) is increasingly used for patient selection, providing a roadmap of the anatomy and identifying factors that may complicate these procedures. Advantages of CT are the rapid turnaround time, good spatial and temporal resolutions, wide field of view and three-dimensional multi-planar reconstruction capabilities. This pictorial review describes the role of CT in the pre-operative evaluation of patients undergoing cardiovascular surgeries and intervention.

Main Messages

• CT scan is valuable in pre-operative evaluation for cardiac surgeries

• Cardiovascular structures, including bypass grafts should be located >10 mm from the sternum in patients for reoperative cardiothoracic surgeries

• Knowledge of variations in pulmonary venous anatomy are essential for planning radiofrequency ablation

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Schoenhagen P, Numburi U, Halliburton SS, Aulbach P, von Roden M, Desai MY, Rodriguez LL, Kapadia SR, Tuzcu ME, Lytle BW (2010) Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography; from pre operative oplanning to intra-operative guidance. Eur Heart J 31:2727-2740

Vogel-Claussen J, Pannu H, Spevak PJ, Fishman EK, Bluemke DA (2006) Cardiac valve assessment with MR imaging and 64 section multi-detector row CT. Radiographics 26:1769–84PubMedCrossRef

Neubauer AM, Garcia JA, Messenger JC, Hansis E, Kim MS, Klein AJ, Schonenberg GA, Grass M, Carroll JD (2010) Clinical feasibility of a fully automated 3D reconstruction of rotational coronary X-ray angiograms. Circ Cardiovasc Interv 3:71–79PubMedCrossRef

Gilkeson RC, Markowitz AH, Ciancibello L (2003) Multisection CT evaluation of the Reoperative cardiac surgery patient. Radiographics 23:S3–S17PubMedCrossRef

Gilinov AM, Casselman FP, Lytle BW, Blackstone EH, Parsons EM, Loop FD, Cosgrove DM (1999) 3rd.Injury to a patent left internal thoracic artery graft at coronary reoperation. Ann Thorac Surg 67:382–6CrossRef

Morino Y, Hara K, Tanabe K, Kuroda Y, Ayabe S, Kozuma K, Kigawa I, Fukuda S, Wanibuchi Y, Tamura T (2000) Retrospective analysis of cerebral complications after coronary artery grafting in elderly patients. Jpn Circ J 64:46–50PubMedCrossRef

Roach GW, Kanchuger M, Mangano M, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C (1996) Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 335:1857–63PubMedCrossRef

Hedayati N, Sherwood JT, Schomisch SJ, Carino JL, Markowitz AH (2004) Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli. J Thorac Cardiovasc Surg 128:389–90CrossRef

Roselli EE, Pettersson GB, Blackstone EH, Brizzio ME, Houghtaling PL, Hauck R, Burke JM, Lytle BW (2008) Adverse events during re operative cardiac surgery: frequency, characterization, and rescued. J Thorac Cardiovasc Surg 135:316–23PubMedCrossRef

10.

Kamdar AR, Meadows TA, Roselli EE, Gorodeski EZ, Curin RJ, Sabik JF, Schoenhagen P, White RD, Lytle BW, Flamm SD, Desai MY (2008) Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg 85:1239–45PubMedCrossRef

11.

Maluenda G, Goldstein MA, Lemesle G, Weissman G, Weigold G, Landsman MJ, Hill PC, Pita F, Corso PJ, Boyce SW, Pichard AD, Walsman R, Taylor AJ (2010) Perioperative outcomes in reopreative cardiac surgery guided by cardiac multidetector computed tomographic angiography. Am Heart J 159:301–306PubMedCrossRef

12.

Pflederer T, Achenbach S (2010) Aortic valve stenosis: CT contributions to diagnosis and therapy. J Cardiovasc Comput Tomogr 146:469-470

13.

Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, PARTNER Trial Investigators (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–607PubMedCrossRef

14.

Stolzmann P, Knigh J, Desboilles L, Maier W, Scheffel H, Plass A, Kurtcuoglu V, Leschka S, Poulikakos D, Marincek B, Alkhadhi H (2009) Remodelling of aortic root in severe tricuspid aortic stensois; implicatiosn for transcatheter aortic valve implantation. Eur Radiol 19:1316–23PubMedCrossRef

15.

Bleiziffer S, Ruge H, Horer J, Hutter A, Geisbusch S, Brockmann G, Mazzitelli D, Bauernschmitt R R, Lange R (2010) Predictors for new onset complete heart block after transcatheter aortic valve implantation. JACC Cardiovasc Interv 3:524–30PubMedCrossRef

16.

Detaint D, Lepage L, Himbert D, Brochet E, Messika-Zeitoun D, Iung B, Vahanian A (2009) Determinants of significant paravalvular regurgitation after transcatheter aortic valve; implantation impact of device and annulus decongruence. JACC Cardiovasc Interv 2:821–7PubMedCrossRef

17.

Geisbüsch S, Bleiziffer S, Mazzitelli D, Ruge H, Bauernschmitt R, Lange R (2010) Incidence and management of CoreValve dislocation during transcatheter aortic valve implantation. Circ Cardiovasc Interv 3:531–536PubMedCrossRef

18.

Tops LF, Wood DA, Delgado V (2008) Non invasive evaluation of the aortic root with multislice computed tomography; implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging 1:321–330PubMedCrossRef

19.

Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA (2012) SCCT Expert consensus document on computed tomographic imaging before transcutaneous aortic valve implantation/transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 6:366–380PubMedCrossRef

20.

Willman JK, Weishaupt D, Lachat M, Kobza R, Roos JE, Seifert B, Lüscher TF, Marincek B, Hilfiker PR (2002) Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis. Radiology 225:120–8CrossRef

21.

Liu F, Coursey CA, Grahame-Clarke C, Sciacca RR, Rozenshtein A, Homma S, Austin JH (2006) Aortic valve calcification as an incidental finding at CT of the elderly. Severity and location as predictors of aortic stenosis. AJR Am J Roentgenol 186:342–9PubMedCrossRef

22.

Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D (2010) Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 97:721-726

23.

Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999) Association of aortic sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–7PubMedCrossRef

24.

Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M, Maurer G, Baumgartner H (2000) Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 343:611–7PubMedCrossRef

25.

Delgado V, Ng AC, van de Veire NR, van der Kley F, Schuijf JD, Tops LF, de Weger A, Tavilla G, de Roos A, Kroft LJ, Schalij MJ, Baxx JJ (2010) Transcatheter aortic valve implantation; role of multidetector row computed tomography to evaluate prosthesis position and deployment in relation to valve function. Eur Heart J 31:1114–23PubMedCrossRef

26.

Mahabadi AA, Bamberg F, Toepker K, Schlett CL, Rogers IS, Nagurney JT, Brady TJ, Hoffmann U, Truong QA (2009) Association of aortic valve calcification to the presence, extent, and composition of coronary artery plaque burden; From the rule out myocardial infarction using computed associated tomography (ROMICAT) trial. Am Heart J 158:562–8PubMedPubMedCentralCrossRef

27.

Abbara S, Pena AJ, Maurovich-Horvat P, Butler J, Sosnovik DE, Lembcke A, Cury RC, Hoffmann U, Ferencik M, Brady TJ (2007) Feasibitliy and optimization of aortic valve planimetry with MDCT. AJR Am J Roentgenol 188:356–60PubMedCrossRef

28.

Feuchtner GM, Muller S, Bonatti J, Schachner T, Velik-Salchner C, Pachinger O, Dichtl W (2007) Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. AJR Am J Roentgenol 189:197–203PubMedCrossRef

29.

Kurra V, Kapadia SR, Tuzcu EM, Halliburton SS, Svensson L, Roselli EE, Schoenhagen P (2010) Pre-procedural imaging of aortic root orientation and dimsensions; comparison between X-Ray angiographic planar imaging and 3-dimensional multidetector row computed tomography. JACC Cardiovasc Interv 3:105–113PubMedCrossRef

30.

Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, Akhtar M, Desai MY, Flamm SD, Halliburton SS, Svensson LG, Sola S (2008) Prevalence of significant peripheray artery disease in patients evaluated for aortic valve insertion; preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg 137:1258–1264CrossRef

31.

Murphy DA, Miller JF, Langford DA, Snyder AB (2006) Endoscopic robotic mitral valve repair. Endoscopic robotic mitral valve surgery. J Thorac Cardiovasc Surg 132:776–81PubMedCrossRef

32.

Delgado V, Tops LF, Schuijf JD, de Roos A, Brugada J, Schalij MJ, Thomas JD, Bax JJ (2009) Assessment of mitral valve anatomy and geometry with multislice computed tomography. JACC Cardiovasc Imaging 2:556–565PubMedCrossRef

33.

Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, Whitlow PL, Gray W, Low R, Herrmann HC, Lim S, Foster E, Glower D (2009) EVEREST Investigators. Percutaneous mitral repair with the MitraClip systm. Safety and midterm durability in the initial EVEREST (Endovascular valve edge-to-edge Repair study) cohort. J Am Coll Cardiol 54(8):666–94CrossRef

34.

Van Mieghem NM, Piazza N, Anderson RH, Tzikas A, Nieman K, De Laat LE, McGhie JS, Geleijnse ML, Feldman T, Serruys PW, de Jaegere PP (2010) Anatomy of the mitral valvular complex and its implications for transcatheter interventions for mitral regurgitation. J Am Coll Cardiol 56:617–26PubMedCrossRef

35.

Tops LF, van de Veire NR, Schuijf JD, de Ross A, van der Wall EE, Schalij MJ, Bax JJ (2007) Non invasive evaluation of coronary sinus anatomy and its relation to the mtiral valve annulus. Implications for percutaneous mitral annuloplasty. Circulation 115:1426–1432PubMedCrossRef

36.

Ko SF, Liang CD, Yip HK, Huang CC, Ng SG, Huang CF, Chen MC (2009) Amplatzer septal occluder closure of atrial septal defect: evaluation of transthoracic echocardiography, cardiac CT, and transesophageal echocardiography. AJR Am J Roentgenol 193:1522–1529PubMedCrossRef

37.

Webb G, Gazouilis MA (2008) Atrial septal defects in the adult; recent progress and overview. Circulation 119:e518–520

38.

Ivens E, Hamilton-Craig C, Aroney C, Clarke A, Jalali H, Burstow DJ (2009) Early and late cardiac perforation by Amplatzer atrial septal defect and patent foramen ovale devices. J Am Soc Echocardiogr 22:1067–70PubMedCrossRef

39.

Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, Felberg R, Herrmann H, Kar S, Landzberg M, Raizner A, Wechsler L (2010) CLOSURE I. Investigators. Study design of the CLOSURE I Trial: a prospective, multicenter, randomized, controlled trial to evaluate the safety and efficacy of the STARFlex septal closure system versus best medical therapy in patients with stroke or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale. Stroke 41(12):2872–83PubMedCrossRef

40.

Ho SY, McCarthy KP, Rigby ML (2004) Morphology of Perimembranous ventricular septal defects: implications for transcatheter device closure. J Interv Cardiol 17:99–108PubMedCrossRef

41.

Rajiah P, Kanne JP (2010) Computed tomography of septal defects. J Cardiovasc Comput Tomogr 4:231–245PubMedCrossRef

42.

Cronin P, Sneider MB, Kazerooni EA, Kelly AM, Scharr C, Oral H, Morady F (2004) MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation in planning radiofrequency ablation for atrial fibrillation: a how-to-guide. AJR Am J Roentgenol 183(3):767–768PubMedCrossRef

43.

Joshi SB, Blum AR, Mansour M, Abbara S (2009) CT applications in electrophysiology. Cardiol Clin 27:619–631PubMedCrossRef

44.

Maksimovic R, Dill T, Ristic AD, Seferovic PM (2006) Imaging in percutaneous ablation for atrial fibrillation. Eur Radiol 16:2491–1504PubMedCrossRef

45.

Martinek M, Nesser HJ, Aichinger J, Boehm G, Purerfellner H (2007) Impact of integration of multislice computed tomography imaging into three dimensional electroanatomic mapping in clinical outcomes, safely and efficacy using radiofrequency ablation for atrial fibrillation. Pacing Clic Electrophysiol 30:1215–1223CrossRef

46.

Kim YY, Klein AL, Halliburton SS, Popovic ZB, Kuzmiak SA, Sola S, Garcia MJ, Schoenhagen P, Natale A, Desai MY (2007) Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation; a comparison with transesophageal echocardiography. Am Heart J 154(6):1199–205PubMedCrossRef

47.

Mahabadi AA, Samy B, Seneviratne SK, Toepker MH, Bamberg F, Hoffman U, Truong QA (2009) Quantitative assessment of left atrial volume by echocardiographic-gated contrast-enhanced multidetector computed tomography. J Cardiovasc Comput Tomogr 3:80–87PubMedPubMedCentralCrossRef

48.

Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, Diamond PM, Marra MA, Gersh BJ, Wiebers DO, Petty GW, Seward JB (2001) Left atrial volume; important risk marker for incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 76:467–75PubMedCrossRef

49.

Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A, Weinsaft JW, Shaw LI, Berman DS, Callister TQ, Min JK (2008) Cardiac chamber volumes, function and mass as determined by 64 multidetector row computed tomography; mean values among healthy adults free or hypertension and obesity. JACC Cardiovasc Imaging 1:782–6PubMedCrossRef

50.

Daoud EG, Hummel JD, Houmsse M, Hart DT, Weiss R, Liu Z, Augostini R, Kalbfleisch S, Smith MC, Mehta R, Gangasani A, Raman SV (2008) Comparison of computed tomographic imaging with intraprocedural contrast esophagogram. Implications for catheter ablation of atrial fibrillation. Hear Rhythm 5(7):975–80CrossRef

51.

Van de Veire NR, Schuijf JD, De Sutter J, Schuijf JD, Bleeker GB, Wijffels MC, van Erven L, Holman ER, De Sutter J, van der Wall EE, Schalij MJ, Bax JJ (2006) Non invasive visualization of the cardiac venous system in coronary artery disease patients using 64 slice computed tomography. J Am Coll Cardiol 48:1832–8PubMedCrossRef

52.

Abbara S, Cury RC, Nieman K, Reddy V, Moselewski F, Schmidt S, Ferencik M, Hoffmann U, Brady TJ, Achenbach S (2005) Non invasive evaluation of cardiac veins with 16-MDCT angiography. AJR Am J Roentgenol 185(4):1001–6PubMedCrossRef

53.

Boonyasrinant T, Rajiah P, Schoenhagen P, Halliburton SS, Flamm SD (2009) Relationship of coronay sinus tributaries with myocardial infarction in ischemic versus non ischemic cardiomyopathy; A comprehensive MDCT assessment with implications for cardiac resynchronization therapy. J Cardiovasc Comput Tomogr 3(4):S23–24

54.

Svensson LG, Kouchoukos NT, Miller DC et al (2008) Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 85(1 Suppl):S1–S41PubMedCrossRef

55.

United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362(20):1863–71CrossRef

56.

United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D (2010) Endovascular repair of aortic aneurysm in patients ineligible for open repair. N Engl J Med 362:1872–80CrossRef

57.

Bean MJ, Johnson PT, Roseborough GS, Black JH, Fishman EK (2008) Thoracic aortic stent-grafts; Utility of multidetector CT for pre and post procedure evaluation. Radiographics 28:1835–1851PubMedCrossRef

58.

Latsios G, Gerckens U, Buellesfield L, Mueller R, John D, Yuecel S, Syring J, Sauren B, Grude B (2010) “Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI. Catheter Cardiovasc Interv 76:431–9PubMedCrossRef

59.

Khambadkone S (2012) Percutaneous pulmonary valve implantation. Ann Pediatr Cardiol 5(1):53–60PubMedPubMedCentralCrossRef

60.

Lurz P, Coats L, Khambadkone S, Nordmeyer J et al (2008) Percutaneous pulmonary valve implantation: Impact of evolving technology and learning curve on clinical outcome. Circulation 117:1964–72PubMedCrossRef

61.

Shievano S, Coats L, Migliavacca F et al (2007) Variations in right ventricular outflow morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation. J Cardiovasc Magn Reson 9:687–695CrossRef

Title: The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention
Authors: Prabhakar Rajiah
Paul Schoenhagen
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 5/2013
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-013-0270-8

At a glance: The STEP trials

Springer Medicine

The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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