Angio CT Research Articles

Association Between Severity of Peripheral Artery Disease Angio CT-derived Coronary Syntax Score in Patients with Critical Limb Ischemia

Abstract Introduction: Peripheral artery disease, a frequent consequence of atherosclerosis, is usually associated with concomitant ischaemic coronary artery disease and with a high rate of cardiovascular mortality. Material and methods: The study population consisted of 24 patients, admitted to our clinic with peripheral artery disease, 10 of them with critical limb ischaemia. In all cases, cardiovascular risk factors, left ventricular dysfunction and ejection fraction were analyzed. Peripheral Multislice Angio CT examination was used to determine the TASC class and to assess the peripheral arterial lesions. The Coronary Calcium Score and the Syntax Score were determined with angio CT of the coronary arteries. Results: Patients were between 39 and 84 years of age, and 54% were in Fontaine class 2B, 21% in Fontaine class 3 and 25% in Fontaine class 4. 12.5% of patients presented TASC class A, 33.3% TASC class B, and 54.2% TASC class C. Coronary Calcium Scores were between 0 and 100 in 16.6% of patients, between 100 and 400 in 41.8%, and >400 in 41.6% of patients. The SYNTAX Score was <22 in 54% of patients, between 22 and 32 in 37.5%, and >32 in 8.5% of patients. A significant correlation was found between the Coronary Calcium Score and the SYNTAX Score (r = 0.82, p = 0.03). The Syntax Score was 22.43 ± 3.2 in TASC A patients, 26.2 ± 5.4 in TASC B patients, 32.1 ± 2.3 in TASC C patients (p = 0.005). Conclusions: The severity of coronary artery disease characterized by the Syntax Score, by the presence of left main stenosis and segmental left ventricular hypokinesis presents significant correlation with the severity of peripheral artery disease, characterized by the TASC classification.

Characteristics of Neoatherosclerosis Within Implanted Coronary Stents in Patients with Acute Coronary Syndromes

Abstract Introduction: In-stent restenosis (ISR) is traditionally associated with neointimal hyperplasia. However, recent studies have suggested that an underlying progression of the atherosclerotic process called neoatherosclerosis, different from intimal proliferation, could be involved in ISR development. In this study the aim was to compare the characteristics of the neoatheromatous plaque evidenced by Multislice Angio Computed Tomography, Optical Coherence Tomography (OCT) and Virtual Histology Intravascular Ultrasound (VH-IVUS) with the characteristics of de-novo lesions in native coronary vessels of patients with ISR. Material and methods: This is a prospective single-center pilot study in which patients presenting with acute chest pain and having at least one symptomatic bare-metal stent (BMS) restenosis at six months to one year after BMS implantation, were enrolled. The characteristics of the neointimal tissue developed within the implanted stents using Acio CT, OCT and VH-IVUS were studied. Results: In total, 27 patients with 38 coronary BMS were included in the study, in whom 27 ISR lesions and 43 lesions in native coronary vessels were identified. Angio CT examination revealed that atheromatous plaques responsible for ISR tend to have a larger volume compared with native lesions located in the same coronary vessel (plaque volume 91.2 mm3 for ISR vs. 60.4 mm3 for native vessels, p <0.0001). Additionally, they show more low density plaques compared to native coronary lesions located in the same coronary vessel (33.9 mm3 vs. 18.2 mm3 for the volume of the plaque with density <30 HU, p <0.0001). Plaques responsible for ISR exhibit a higher lipid content than native ones (41.1% vs. 22.9%, p = 0.05). OCT analysis indicated an irregular shaped vascular lumen in 44.4% of ISR lesions compared to 25.6% of de-novo lesions (p = 0.1). Conclusions: Neoatherosclerosis within the implanted coronary stents is associated with signs of plaque vulnerability to a significantly higher extent than the atheromatous plaques in native coronary arteries in patients with ISR presenting with an acute coronary syndrome.

Inferior Vena Cava Hypoplasia Associated with Deep Vein Thrombosis – Case Presentation

Abstract Introduction: We present the case of a patient suffering from inferior vena cava hypoplasia complicated with Phlegmasia cerulean dolens. Imaging techniques allow precise diagnosis of inferior vena cava hypoplasia, providing essential structural details on the degree of damage of the vena cava and for the other branches. Case presentation: A 58 years old, obese and diabetic male patient presented with intense pain in the lower limbs, with the onset 24h before presentation. The patient presented generalized edema, cyanosis and functional impotence. Angio CT examination revealed hypoplasia of the inferior vena cava, with extensive DVT (deep vein thrombosis). In emergency conditions, with the agreement of the patient, we initiated the thrombolytic therapy (streptokinase for 72h) associated with anticoagulants (heparin). The evolution was favorable: a significant reduction in leg circumference was recorded, together with pain relief and reduction of local inflammation in the lower limbs. Conclusion: Severe cases of inferior vena cava hypoplasia complicated with deep vein thrombosis can present a good prognosis if appropriate treatment with anticoagulants and thrombolytics is initiated in time.

Isolated congenital coronary fistula in adult population: discussion a clinical case and review of current literature

We describe a case of a 56 year-old man with a history of chest pain. No evidence of myocardial ischemia or arrhytmias was observed. Echocardiographic examination in Emergency Department evidenced aortic root dilatation. Angio CT excluded aortic dissection. Trans esophageous Echocardiography (TEE) correctly identified an arterial fistula between the right coronary artery and superior vena cava, confirmed by angio CT 3-D reconstruction and coronarography. The definitive diagnosis was made after integrated approach (using TTE, TEE, CT, coronarography). The anatomic features of the fistula and the aortic root were examinated. Actually the patient is being followed with serial clinical and echocardiography examination for monitoring hemodynamic overload by fistula and size of aortic root for potential surgical correction. Current literature for incidence, diagnosis and the treatment of coronary fistulas is discussed.

Rare Cause of Colostomy Bleeding: A Parastomal Pseudoaneurysm

Patient diagnosed with rectal cancer underwent low anterior resection with protective sigmoid colostomy. He developed intractable bleeding from colostomy site on 10th post-op day. He went into haemorrhagic shock, resuscitated with massive blood transfusion. Emergent CT angio of abdomen showed a well defined, bilobed, fusiform dilated sac with smooth homogenous contrast opacification seen in the operative stomal site with a small feeding artery arising from left iliac artery? possibly an aneurysmal sac with feeding artery. The patient was successfully treated with an endovascular approach.

Response to “The Value of Angio CT Multislice for Pre-operative Assessment and Prediction of Post PCI Successful Intervention in Acute Coronary Syndromes Associated by Left Main Disease”

Response to “The Value of Angio CT Multislice for Pre-operative Assessment and Prediction of Post PCI Successful Intervention in Acute Coronary Syndromes Associated by Left Main Disease”

Rare Cause of Cephalalgia in a Young Woman - a Case Report

Abstract Background: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, nonatherosclerotic and noninflammatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. Fibromuscular dysplasia is much more common than previously thought and is a treatable cause of secondary hypertension. Case presentation: We present the case of an 18 y.o. young woman, with headache and high blood pressure. “White coat hypertension” was suspected. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis. Renal ultrasound and digital subtraction angiography confirmed the aspect of FMD. Sequential percutaneous renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled blood pressure below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, no other FMD typical lesions were identified. Conclusions: Medical treatment is first indicated for the hypertensive patient. In this particular case percutaneous renal artery angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Further monitoring and management of this patient will include blood pressure measurements at 3-month intervals and renal function measurements annual, as well as non-invasive duplex ultrasonography at 12-month intervals, follow-up is indefinite. It remains challenging whether the patient can be medically managed on antihypertensive medication alone.

63. Pulmonary atresia with intact ventricular septum, associated with intracranial calcifications and left parietal hemangioma (Sturge–Weber Syndrome)

Case report Neurocutaneous disorders are characterized by skin lesions (port wine stain, hypopigmented patches) associated with intracranial features (ipsilateral leptomeningeal angiomas, intracranial calcifications and subsequent seizures). Some of these patients will also have opthalmological findings.These disorders are occasionally accompanied by congenital heart disease. Example: PHACE syndrome which is associated with aortic coarctation. On the contrary, Sturge–Weber syndrome, apart from one single case report, is usually not described with congenital heart disease. In the mentioned case report, 13 year old female had along with this syndrome, pulmonary atresia with ventricular septal defect. As the author of this case report questioned whether this might be a new association, we would like to report our patient. This is a 14 months old boy with pulmonary atresia/intact ventricular septum along with intracranial calcification, seizures along with strabismus and tunnel vision. Clinical findings were similar to Sturge–Weber syndrome, though cutaneous features were not present. Brain CT angio with contrast was diagnostic for Sturge–Weber and showed calcifications as well as left parietal hemangioma. As far as we know, this specific association has never been reported before and might be a new constellation as suggested by Huseyin Tan et al. (2003).

The Value of Angio CT Multislice for Pre-operative Assessment and Prediction of Post PCI Successful Intervention in Acute Coronary Syndromes Associated by Left Main Disease

Abstract Introduction: The location of culprit lesions on the left main is associated with an increased procedural risk in acute coronary syndromes. Our study aims to evaluate the utility of CT angiography determined Syntax score (CCTA) in comparison with the classical angiographic Syntax score for predicting the procedural success in percutaneous coronary interventions (PCI) of left main lesions. Methods: We included 23 patients presenting to the Cardiology Clinic with an acute coronary syndrome. All patients underwent coronary angiography ± angio CT multisclice for assessment of the target lesion, defined as a significant (>50%) left main disease. Patient population consisted in: group 1 – 13 patients (56.52%), in whom revascularization indication was based on lesion severity assessment by CCTA score correlated with the angio Syntax score (SS), and group 2 – 10 patients (43.48%), in whom revascularization indication was based only on angio SS. According to the SS, the study population was divided into subgroup A – low SS (<22), subgroup B – intermediate SS (23–32) and subgroup C –high SS (>32). All patients were followed for 1 year. Results: Despite similar SS in both groups (35.38 in group 1 vs. 32.4 in group 2), the use of Angio CT multislice increased the rate of PCI indication – 76.92% PCI in group 1 versus 50% PCI in group 2. In patients with high SS, PCI rate was 66.66% in group 1 compared with 50% in group 2 (p<0.05). High calcium score >100 was recorded in 50% of patients in the low SS subgroup (<22), 50% in the medium SS subgroup (23–32) and 22.22% in the high SS (>33) subgroup. One-year follow-up showed an overall mortality of 8.69%, slightly higher in group 2 (10%), as compared to group 1 (mortality of 7.69%). Conclusions: Additional evaluation by angio CT of culprit left main stenoses in acute coronary syndromes provides more information about the complexity of atherosclerotic plaques in this location, and could be extremely useful in establishing the indication for PCI in high risk stenoses, showing a predictive significance for post-procedural 1 year follow up mortality.

324 Thrombo-embolic disease in CF patients: Difficult to diagnose, difficult to treat

The diagnosis of thrombo-embolic disease in CF patients is often difficult because of overlapping symptoms/signs with CF lung disease. We, here, report on the 3 cases to raise awareness about this complication. Patient 1 is waitlisted for lung transplantation (LTx). He receives regular intravenous (iv) antibiotic courses via peripherally inserted central catheters (PICCs). Recently, 24 hrs after removal of a PICC he presented with acute respiratory distress and left-sided thoracic pain. Angio CT demonstrated pulmonary embolism (PE) in the left lower lobe. Echocardiography showed new pulmonary hypertension (PH) and right heart overload. Patient 2 is also waitlisted for LTx. She receives regular iv courses via a port-a-cath (PAC). During an iv course she deteriorated and developed new significant hemoptysis. Angio CT showed bilateral PE. Echocardiography revealed an echogenic structure at the tip of the PAC, which was believed to be a thrombus. Patient 3, a 17-yr-old girl with severe CF lung disease, developed fever, dyspnea and thoracic pain after a transatlantic flight. Chest X-ray showed a pneumothorax. Additionally, angio CT revealed bilateral pulmonary emboli. In none of the patients deep venous thrombosis was found. Patients 1 and 3 received subcutaneous heparin; in Patient 2 the PAC was replaced, heparin was not given because of persisting hemoptysis. The possible diagnosis of PE should be kept in mind in CF patients presenting with new respiratory symptoms and signs, especially in sicker patients and those equipped with removable/implanted central venous catheters. Treatment is not always straightforward because of the possibility of significant hemoptysis.

Multiple Segmental Hemangiomas Over One Half of the Body - A Rare Feature of PHACES Syndrome

To the Editor: PHACES syndrome (OMIM 606529) is an association of large, plaque-like, Bsegmental^ hemangiomasH of the face, with one or more of the following anomalies: Pposterior fossa brain malformations, A-arterial lesions, C-cardiac abnormalities/ coarctation of aorta, E-eye abnormalities and S-sternal defect. An 1y 3mo old girl presented to us with history of reddish raised skin lesions on the face, since age of 15d. Gradually, similar multiple lesions appeared on left half of the body. They increased in size upto 5mo of age and later ulcerated, followed by healing with scarring. On examination, her radial pulses were well felt; femoral and dorsalis pedis pulses were weak. Multiple large segmental hemangiomas were present over left half of the body (Fig. 1). Written informed consent was obtained from the patient for publication of this case report and any accompanying images. On MRI, these lesions showed T1 isointensity, T2 hyperintensity with areas of blooming within. CT angio showed complete interruption of aortic arch type B, descending thoracic aorta supplied by patent ductus arteriosus (PDA) and persistent left sided superior venacava arising from coronary sinus without bridging veins. MRA brain showed hypoplastic left vertebral artery. MRI brain, thyroid function tests, ultrasound abdomen and lumbosacral spine were normal; stool for occult blood was negative. Hemangiomas are the most common benign tumors of infancy and may be mistaken for other conditions depending on their stage of development. Nascent lesions may be confused with capillary malformations; naevus anaemicus or naevus depigmentosus. Superficial hemangiomas may resemble pyogenic granulomas, congenital hemangiomas, tufted angiomas or kaposiform hemangioendotheliomas. Deeper tumors may mimic venous or lymphatic malformations, dermoid cysts, infantile myofibromatosis, lipomas or soft tissue sarcomas. The correct diagnosis is based on typical features of hemangioma namelyonset after birth; followed by phases of proliferation, plateau and involution. On MRI they appear isointense (T1), hyperintense (T2), homogeneously enhancing soft tissue mass, with flow voids within and around. Histologically they stain positively for the glucose transporter protein,

Dizziness With Exertion In An Ice Hockey Athlete

HISTORY: 20 yo women’s ice hockey athlete with hx of absence seizures presents with dizziness, SOB & palpitations with exertion. Pt developed symptoms during first practice after winter break. Initially thought she was “out of shape”. When she could not continue due to symptoms she reported to the Athletic Trainer. Irregular rhythm noted; 140-150bpm. Remainder of the evaluation by AT was normal. Pt began to feel normal after 30 minutes in supine. Prior episode of mental status changes one month prior felt to be related to seizure disorder. No hx of syncope/pre-syncope, CP. PMH: Partial complex seizures dx 2nd grade, grand mal sz 2010. ROS: (-) recent fever, chills, illness. Meds: Keppra, recently started on Lamictal, Sorynx. Allergies: Dilantin (rash). SH: student, no ETOH/drugs. FH: F-HTN, valve dz. PHYSICAL EXAMINATION: WDWN; NAD; 120/60; HR 74; HEENT wnl; Thyroid nm; Cardiac- PMI nml, RRR, no M/R/G, normal HJR; Lungs clear; Abd nml; Ext nml. DIFFERENTIAL DIAGNOSIS: Cardiac vs Neurologic vs Metabolic vs Infectious TESTS AND RESULTS: Initial: Lab- CBC, Chem panel, TFTs nml. EKG- NSR, 53bpm, nml intervals, ST-T wave abnormalities Referral to Cardiology: Echo- nml valves, chambers, EF 45%, mild global LV hypokinesis WORKING DIAGNOSIS: Cardiomyopathy- Post-infectious, arrhythmia-induced, infiltrative, anomalous coronary, vs. CAD Additional Tests: CT angio- normal coronary arteries; Ca+ score 0; LVEF 43%; no evidence of RV dysplasia ETT- Resting PVC’s which normalize with higher levels exertion; Into Stage V Bruce asymptomatic 30d Holter monitor: NSR, avg HR 58 (40-169), 5312 PVC’s (6.8 %). 12 couplets. Multiform PVS’s noted MRI: Bi-ventricular mod enlargement, ED dimension 67mm, low nml systolic fn. No regional wall motion abnormalities. LV trabeculated myocardium, ratio 3:1. No perfusion defects. No myocardial delayed enhancement. EF 58% LV, 52% RV Labs: EBV panel, Coxsackie, Lyme, CMV, TFT’s, ESR/CRP, Chem panel, CBC, Iron studies FINAL DIAGNOSIS: Non-compaction Cardiomyopathy TREATMENT AND OUTCOMES: Pt referred to heart failure specialist. Pt initially treated with Beta-blocker, and dc OCP. Did not return to competitive sport. When seen by second specialist, dc B-blocker and initiated baby ASA and ACE inhibitor. Pt has been followed by second specialist.

An Uncommon Cause of Dyspnea

Abstract: We introduce the case of a previously smoker 58-years old lady who presented to us suffering from dyspnea with repeatedly normal cardiac and pulmonary function test. After ruling out typical causes, uncommon differential diagnostic options should be considered. Keywords: Dyspnea; Mediastinum; Vascular malformation A 58 year-old woman, previously smoker, presented with a three month story of short of breath. She was sent by his pulmonologist, because of an elevated D-dimer while he was non respondent to standard treatment with oral steroids and inhaled bronchodilators. Except for a pectoral angioma presented 20 years ago, her physical examination was otherwise normal. Lab results, chest X ray, respiratory function test and echocardiogram were unremarkable. An angio CT scan to rule out pulmonary embolism was performed and found a 30 x 40 mm mediastinal mass (Figure 1a). A thoracic MRI confirmed the extension of the mass to the thoracic wall being compatible with a low-flow venous malformation (Figure 1b). Gathering all the data, we consulted the radiologist and referred the patient to the respiratory clinics in order to assess full resection surgery. Although vascular malformation have been reported previously in the literature, most of them are asymptomatic and presented out of the mediastinum [1,2]. We highlight here, the concurrence of a rare location and a rare presentation of a venous malformation. This abnormal communications between pulmonary arteries and veins may appear throughout the economy, are usually asymptomatic and because of that, they are not always subsidiary of definitive therapy. As just 25% of them grow slowly (usually at a rate of 0.3 to 2 mm/ear), symptoms like headache, seizures, stroke, massive hemoptysis or a big-sized malformation would give the indication of therapeutic assessment. Embolization, surgical excision or lung transplantation are validate treatment options [3].

Effects of the Timing of Venous Thromboembolic Events on Survival of Patients with Uterine Cancer

Background: Cancer patients are at high risk for venous thromboembolic event (VTE), and the occurrence of VTE can affect the prognosis. However, it is unclear if the timing of VTE can influence the prognosis. The purpose of this study was to evaluate the incidence and impact of the timing of VTE (early vs late) on the survival of patients with uterine cancers.Methods: A retrospective cohort study was conducted. The study population included all uterine cancer patients who had newly diagnosed episode of VTE from January 1st 2006 to December 31st2007 at MD Anderson Cancer Center. Medical records of these patients were reviewed for cancer diagnosis, patient demographics, metastasis, date of diagnosis of VTE, type of VTE, the site of VTE, and any recurrences during the follow up period of 2 years since the first VTE. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was defined as the time from the date of cancer diagnosis to the date of death, or to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models.Results: Of the 2151 patients with newly diagnosed VTEs within the 2 years study period, 33 patients were found to have uterine cancers. The median age was 60 years (range 41-84 years). Among all the primary VTEs, 42% were pulmonary embolus (PE); 45% were deep vein thrombosis (DVT), and 12% were concurrent PE/DVT (diagnosed on the same day). The median time of VTE from the date of cancer diagnosis was 8 months (range 0 - 88 months). The majority of these VTE events (55%) were found to occur within 1 year from the date of cancer diagnosis. A total of 8 patients had 10 recurrent episodes of VTE (2 patients had 2 recurrent VTE episodes) during the follow up period. The median survival time was 33 months (range 2.6-121.6 months); 82% of these patients had a metastatic disease. Multivariate proportional hazards model showed that the diagnosis of VTE within 6 months from the cancer diagnosis [Hazard ratio: 3.8, 95% CI (1.1-12.9), p=0.03] and the presence of baseline white blood cell (WBC) count of greater than 11,000/uL [Hazard ratio: 3.5, 95% CI (1.0-12.2), p=0.045] were statistically significant independent predictors for 2 year survival adjusting for age, presence of central venous catheter (CVC), and the baseline platelet count of greater than 350,000/uL.Conclusion: These findings suggest that the timing of VTE is an important indicator of prognosis in patients with uterine cancer; patients who had VTE within 6 months from cancer diagnosis had a shorter 2 year survival. Future larger studies may better define the impact of timing of VTE on survival of patients with Uterine Cancers. DisclosuresNo relevant conflicts of interest to declare.

Tackling cardiovascular co-morbidities in HIV-positive patients: who, how and where?

IntroductionCardiovascular disease (CVD) is a significant cause of non-AIDS-related morbidity and mortality in HIV-positive individuals [1]. Management of CVD and associated risk factors in HIV are complicated by drug interactions [2]. Optimal management can require specialist input. A previous cohort review highlighted CVD, comorbidity and cardiovascular (CV) risk in our patients [3]. In response, a combined HIV and cardiovascular monthly clinic was established: an HIV consultant works in real time with a cardiologist. The clinic manages CV disease, complex CV co-morbidities e.g. refractory hypertension, hyperlipidaemia, and assesses primary prevention. A dietician works alongside the clinic.AimsDescribe the clinic caseload; record clinic interventions and outcomes; recommend service development.Materials and MethodsWe conducted a retrospective notes review of patients attending the co-morbidity clinic from January 2012 to May 2014. Data collected: demographic, HIV, CVD, CV risk, investigations and clinical interventions.ResultsFrom a cohort of approximately 960 patients (70% African), 60 (6%) were seen in the co-morbidity clinic over the specified time period. Median age was 53 (range 24-80). Although 60% of our cohort is female, 43% (26/60) of the CVD clinic were female. 42 (70%) were African. The mean CD4 was 560 (range 48-1339). All patients were on ART and 6 (10%) had a detectable viral load > 400 copies/mL. Clinic caseload: i) CVD: 9 had a prior CV event (ACS or CVA); 5 had CCF; new diagnoses included LVH (2), cardiac dysfunction (6); AF (2); atrial thrombus (1). ii) Co-morbidities: 48(80%) had hypertension – 10 (16.6%) were on quadruple therapy; 17 (28%) had diabetes; 35 (58%) were on a statin. Three had their smoking status clearly documented. Seventeen (28%) were referred to the dietician. Investigations included echo, 24-hour BP/ tape, CT angio, cardiac MR.ConclusionsThe joint clinic facilitated real-time decision making on clinical interventions. Patient access to cardiac investigations was expedited. Patients attended fewer outpatient appointments. Both cardiology and HIV clinicians preferred the benefits of joint working. Clinical outcomes were difficult to assess and will need further definition. Recommendations for development include: improved CV risk assessment, improved outcome measures, links to smoking cessation services.

Conexión anómala total de venas pulmonares a la vena porta: Valor de la angiotomografía multicorte. Informe de tres casos

We present three female patients with infracardiac total anomalous pulmonary venous connection (TAPVC) with the portal vein. Angio CT scan reconstructions and a correlation be- tween tomographic and echocardiographic findings were conducted. Multi-slice angio CT scan has been a valuable tool for the study of vessels in children with congenital heart disease. It is performed rapidly and it obtains high quality images, showing the vessels and the adjacent organs, which supply excellent information. The term TAPVC includes a group of malformations in which the four pulmonary veins connect in such a way that the arterialized blood in the lungs drains into the right atrium, either directly or by way of tributary veins. Thus, systemic and pulmonary blood mix in the right atrium; and atrial septal defect must exist in order for patients to survive. These malformations represent 0.4 to 2.0 % of all congenital heart diseases, with an incidence of 6.8 patients in every 100,000 births. Sixty eight percent of the cases are diagnosed in newborns, which indicates that most patients are symptomatic early in life. The infracardiac TAPVC represent 15 to 25% of all TAPVC.

Prognostic criteria and treatment for patients candidates for surgery or percutaneous carotid reperfusion

Background. Atherosclerosis is a systemic disease involved in cerebrovascular disease (CVD), coronary arterial disease (CAD), and peripheral arterial disease (PAD). Atherosclerotic carotid artery stenosis is an important cause of ischemic stroke, accounting for approximately 20-30% of all ischemic strokes. Carotid endarterectomy (CEA) and Carotid angioplasty stent (CAS) are interventional treatment for symptomatic and asymptomatic patients with severe carotid artery stenosis. Purpose. The purpose of this study was to evaluate the prognostic and treatment criteria in patients with severe carotid uni/bilateral stenosis in different circumstances: symptomatic/asymptomatic, with recent or old ischemic stroke, candidates for (CEA) or stent (CAS), with/without involvement of coronary arteries and peripheral endothelial function. Material and methods. The study included 85 patients with severe carotid stenosis (over 70%) that have been evaluated for CEA or CAS. Patients were evaluated with Carotid Doppler and/or Angio CT of the cervical region, cardiac ultrasound and cerebral/coronary/peripheral angiography, thus assessing the degree of coronary and peripheral involvement. The following have been calculated: ejection fraction (EF) (%), telediastolic volume (TDV) (ml), overall cardiovascular risk - blood pressure score (Score BP), (ranging 1-4 according to severity) and 2 composite scores: global cardiovascular and hemodynamic risk score (GCVHRS), (ranging 1-10 according to risk factors summation) and organic vascular risk score (OVRS), (ranging 1-10 according to the number and topographic status of stenosis). Patients were divided into four groups: a) with carotid stenosis only (CaAS), b) with CaAS damage and coronary stenosis (CoAS), c) with CaAS damage and peripheral stenosis (PAS) and d) global vascular involvement (CaAS,CoAS,PAS). All study patients were compared with 85 matched patients with cardiovascular risk factors without signs of clinical organ damage. Results. Among the 85 patients with severe carotid stenosis, 52 (61.2%) patients had ICA stenosis between 90%-99%, 37 (43.5%) patients had CaAS involvement and 14(16.5%) patients had multiple organ vascular damage. GCVHRS was significantly higher in the patient group with both CaAS and CoAS (scoring 5.80+/-2.33*) and also OVRS in patients with severe multiple organ vascular involvement (scoring of 6.78+/-1.42*), compared to the other groups of patients (p < 0.05). The hemodynamic risk evaluation in CaAS had a EF mean of 52.27+/-7.56 (%) and a TDV mean of 92.13+/-30.27* (ml) while in the global vascular involvement group EF dropped to a mean of 45.71+/-13.56 (%) and TDV increased to a mean of 124.28+/-51.38 (ml). Conclusions. Higher composite scores (GCVHRS and OVRS) and decrease of EF best correlated with: the degree of carotid stenosis, with the presence of left internal carotid involvement, with the presence of a contralateral involvement (stenosis/occlusion). Secondary vascular disease prevention is mandatory in patients with carotid, coronary and peripheral arterial disease. A composite vascular risk evaluation is useful for individually tailoring our interventional treatment strategy thus improving the global functional outcome of any given patient.*P < 0.05

ANGIO TC EN LA IDENTIFICACIÓN PREOPERATORIA DE VASOS PERFORANTES

Introduction: Perforator flaps have become a coverage option validated and increasingly used in reconstructive surgery. These flaps require preoperative identification and intraoperative dissection of the perforator vessels. The aim of this study was to evaluate the use of Angio CT in the preoperative assessment of perforating vessels and its correlation with intraoperative findings. Material and Methods: We retrospec-tively reviewed all perforator flaps performed at the Division of Plastic Surgery, University of Chile Clinical Hospital between June 2009 and June 2012. All patients were asked for an Angio CT according to the protocol of the University of Gent (Belgium). Data points were used and a specific coordinate system to locate the point at which the perforator vessel fenestrate the deep fascia. The information provided in the Angio CT was compared with surgical findings. Results: A total of 41 patients underwent perforator flap planning during the study period. 40 underwent surgery: 18 women and 22 men, with a mean age of 46.6 ± 5.7 years. Flaps were performed as follows: anterolateral thigh (ALT) = 14, inferior epigastric (DIEP) = 18, superior gluteal (SGAP) = 5, posterior tibial (PTAP) = 4 and thoracodorsal (TDAP) = 2. In all cases the Angio CT identified one or more perforator vessel with a 100% concordance with intraoperative findings. Conclusions: CT Angio is a test with high performance in preoperative characterization of perforator vessels. It is a helpful tool that must be considered whenever planning this type of flaps.Key words: Perforator vessels, flaps, Angio CT, reconstructive surgery.ResumenIntroduccion: Los colgajos de perforantes se han convertido en una opcion de cobertura valida cada vez mas utilizada en cirugia reconstructiva. Se caracterizan porque requieren de la identificacion preoperatoria y diseccion intraoperatoria del vaso perforante. El objetivo del presente trabajo fue evaluar el Angio TC en el estudio preoperatorio de los vasos perforantes y su correlacion con los hallazgos intraoperatorios. Material

0050: Oversizing, undersizing or just the right sizing for TAVI patients?

Oversizing strategies to avoid post-procedural aortic leak following TAVI are developing. The purpose of the study was to investigate if the oversizing strategy compared with normal sizing was deleterious on the immediate and late post-procedural outcomes. From January 2010 to August 2013, consecutive severe symptomatic aortic stenosis patients were referred for TAVI. They all underwent preoperative MultiSlice- angio CT scan (MSCT) and the procedures were achieved using Edwards Sapien ® or Corevalve devices ® . Early and late follow-up were completed. Retrospectively, according to pre-procedural MSCT and the valve size, patients were classified into three continuous groups: normal sizing, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and calculated on MSCT. Main endpoint was the all-cause and cardiovascular mortality and secondary endpoints corresponded to the VARC2 endpoints. 268 patients had a MSCT and underwent TAVI procedure, with mainly Corevalve ® . While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pace-maker implantation rate was significantly higher in the severe oversizing group (p=0.03), while we observed more in-hospital congestive heart-failure (p=0.02) and tamponade (p=0.02) in the normal sizing group. There was also a trend toward more moderate to severe AR in the normal sizing group (p=0.12). At 1 month there was significantly more MACCE in the normal sizing group (p=0.03). Oversizing based on this ratio is a safe and feasible strategy to reduce aortic leak with lower rates of immediate post-procedural complications and a similar long-term survival. Abstract 0050 – Figure: All-cause mortality Survival curve

Rescue EVAR for ruptured AAA: Clinical success does not mean technical success

We report a clinical evolution of a 85-years old male admitted to our Emergency Department for ruptured abdominal aortic aneurysm (rAAA). One month later a huge type I proximal endoleak was detected and corrected by proximal aortic extension. We decided to fix the stent-graft to the aortic wall using EndoAnchors. However, an asymptomatic type III endoleak due to controlateral limb disconnection was detected at the followed schedulated CT angio and corrected by a relining of the endograft. The patient is now in good clinical condition with no evidence of endoleaks at 1-year follow-up.