Imaging Of Pulmonary Veins Research Articles

Venous retrograde approach for endovascular angioplasty in chronic total pulmonary vein occlusion -a case report

IntroductionFibrosing mediastinitis (FM) is a rare disease characterized by excessive proliferation of fibrous tissue in the mediastinum and can cause bronchial stenosis, superior vena cava obstruction, pulmonary artery and vein stenosis, etc.Case presentationAn aging patient with intermittent chest tightness and shortness of breath was diagnosed with FM associated pulmonary hypertension (FM-PH) by echocardiography and enhanced CT of the chest, and CT pulmonary artery (PA)/ pulmonary vein (PV) imaging revealed PA and PV stenosis. Selective angiography revealed complete occlusion of the right upper PV, and we performed endovascular intervention of the total occluded PV. After failure of the antegrade approach, the angiogram revealed well-developed collaterals of the occluded RSPV-V2b, so we chose to proceed via the retrograde approach. We successfully opened the occluded right upper PV and implanted a stent.ConclusionsThis report may provide new management ideas for the interventional treatment of PV occlusion.

CAR and CSTR Cardiac Computed Tomography (CT) Practice Guidelines: Part 2-Non-Coronary Imaging.

The cardiac computed tomography (CT) practice guidelines provide an updated review of the technological improvements since the publication of the first Canadian Association of Radiologists (CAR) cardiac CT practice guidelines in 2009. An overview of the current evidence supporting the use of cardiac CT in the most common clinical scenarios, standards of practice to optimize patient preparation and safety as well as image quality are described. Coronary CT angiography (CCTA) is the focus of Part I. In Part II, an overview of cardiac CT for non-coronary indications that include valvular and pericardial imaging, tumour and mass evaluation, pulmonary vein imaging, and imaging of congenital heart disease for diagnosis and treatment monitoring are discussed. The guidelines are intended to be relevant for community hospitals and large academic centres with established cardiac CT imaging programs.

Diagnosis and treatment of neonatal machete syndrome

Aim: To provide suggestions for clinical diagnosis, treatment and eugenics through the retrospective analysis of a case of neonatal machete syndrome.Methods: The clinical data of a newborn with machete syndrome admitted to the pediatrics department of Baogang Hospital of Inner Mongolia were analyzed, and suggestions of eugenics were provided based on the literatures.Results: The child, male, natural conception, G2P2, gestational age 38+4 weeks, was born by cesarean section (at am 09:24 on November 13th, 2021). He was hospitalized in our department for 9 days and given NCPAP positive pressure ventilation to give oxygen and anti-infection symptomatic treatment. The dyspnea of the child was not significantly alleviated, and the heart murmurs became increasingly obvious. The child was transferred to the neonatology Department of the Seventh Medical Center of the PLA General Hospital for further treatment on 9 days after birth. After admission, piperacillin and tazobactam were treated with anti-infection, high-frequency oscillation mode of invasive ventilator, limited fluid volume and other symptomatic treatments. Fiberbronchoscopy showed atelectasis of right lung and tracheomalacia of left lung. Echocardiography showed partial anomalous pulmonary venous drainage, atrial septal defect (secondary foramina), inferior vena cava dilatation, pulmonary hypertension, initial coronary artery dilatation, and patent ductus arteriosus. CT 3D imaging of pulmonary veins showed: Congenital heart disease: partial anomalous pulmonary venous drainage (subcardial), consideration of "machete syndrome," atrial septal defect, consideration of pulmonary hypertension, right pulmonary artery stenosis, right lower lung receiving abdominal aorta blood supply, right lung tissue dysplasia, and widening of inferior vena cava pulmonary veins. Therefore, the comprehensive diagnosis was "machete syndrome." Considering the high surgical risk of the child, conservative symptomatic treatment was recommended, and the family requested discharge after 22 days of treatment. The patient died at home at 3 months follow-up after discharge.Conclusions: Machete syndrome is a rare congenital property of abnormal partial or complete pulmonary venous drainage from the right or left lung to the inferior vena cava. With an incidence of approximately 2 in 100,000 live births, the syndrome is commonly associated with right lung dysplasia, pulmonary sequestration, persistent left superior vena cava, and right tilt of the heart. In this case, the child had these syndromes after birth, since the primary hospital did not recognize the disease, the child was clearly diagnosed in the higher hospital. Children with machete syndrome can be treated with surgery in the early neonatal period, but the indication of surgical treatment is still controversial, and the need for surgery is evaluated according to the severity of the patient's symptoms and pulmonary circulation blood flow.

Catheter ablation of atrial fibrillation: three-dimensional transesophageal echocardiography versus magnetic resonance imaging for pre-interventioal pulmonary vein imaging (8-year follow-up)

Abstract Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, it is still challenging because of the high degree of variability of the pulmonary vein (PV) anatomy. Three-dimensional transesophageal echocardiography (TEE) is a promising new technique for cardiac imaging. Therefore, we have evaluated the usefulness of 3-D TEE for analysing the left atrial anatomy prior to an ablation procedure in comparison to magnetic resonance imaging (MRI). Methods In 240 patients, 3-D TEE and cardiac MRI were performed immediately prior to an ablation procedure (paroxysmal AF: 110 patients, persistent AF: 130 patients). The image quality provided by 3-D TEE and by cardiac MRI was compared in all patients. Two different ablation strategies were used. In patients with paroxysmal AF, the cryoablation technique was used. In the other patients, a circumferential pulmonary vein ablation was performed using a three-dimensional mapping system. Results A 3-D TEE and a cardiac MRI could be performed successfully in all patients prior to the ablation procedure. Several variations of the PV anatomy could be visualized precisely by 3-D TEE and cardiac MRI (e.g. accessory PVs, common PV ostia, varying diameter of the left atrial appendage and its distance to the left superior PV). The image quality was good in the majority of patients even if AF with rapid ventricular response was present during the examination. The image quality provided by 3-D TEE was acceptable in 230/240 patients (95.8 %). The TEE findings correlated well with the PV angiographies performed using cardiac MRI. There was a good correlation with regard to the diameter of the PV ostia assessed by these two imaging techniques. All ablation procedures could be performed successfully (mean number of completely isolated PVs: 3.9 (cryo group), 3.9 (radiofrequency catheter ablation group)). At 96-month follow-up, 64.6 % of all patients were free from an arrhythmia recurrence (cryo group: 70.0 %, Carto group: 60.0 %). There were no major complications. Conclusions AF ablation procedures can be performed safely and effectively based on prior 3-D TEE imaging. The image quality was acceptable in the vast majority of patients.

Feasibility and image quality of bright-blood and black-blood phase-sensitive inversion recovery (BOOST) sequence in clinical practice using for left atrial visualization in patients with atrial fibrillation

ObjectivesVisualizing left atrial anatomy including the pulmonary veins (PVs) is important for planning the procedure of pulmonary vein isolation with ablation in patients with atrial fibrillation (AF). The aims of our study are to investigate the feasibility of the 3D whole-heart bright-blood and black-blood phase-sensitive (BOOST) inversion recovery sequence in patients with AF scheduled for ablation or electro-cardioversion, and to analyze the correlation between image quality and heart rate and rhythm of patients.MethodsBOOST was performed for assessing PVs both with T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) in 45 patients with paroxysmal or permanent AF scheduled for ablation or electro-cardioversion. Image quality analyses were performed by two independent observers. Qualitative assessment was made using the Likert scale; for quantitative analysis, signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated for each PV. Heart rate and rhythm were analyzed based on standard 12-lead ECGs.ResultsAll MTC-BOOST acquisitions achieved diagnostic quality in the PVs, while a significant proportion of T2prep-BOOST images were not suitable for assessing PVs. SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images.Conclusion3D whole-heart MTC-BOOST bright-blood imaging is suitable for visualizing the PVs in patients with AF, producing diagnostic image quality in 100% of cases. However, image quality was influenced by heart rate and rhythm.Clinical relevance statementThe novel 3D whole-heart BOOST CMR sequence needs no contrast administration and is performed during free-breathing; therefore, it is easy to use for a wide range of patients and is suitable for visualizing the PVs in patients with AF.Key Points• The applicability of the novel 3D whole-heart bright-blood and black-blood phase-sensitive sequence to pulmonary vein imaging in clinical practice is unknown.• Magnetization transfer-bright-blood and black-blood phase-sensitive imaging is suitable for visualizing the pulmonary veins in patients with atrial fibrillation with excellent or good image quality.• Bright-blood and black-blood phase-sensitive cardiac magnetic resonance sequence is easy to use for a wide range of patients as it needs no contrast administration and is performed during free-breathing.

Magnetization Transfer BOOST Noncontrast Angiography Improves Pulmonary Vein Imaging in Adults With Congenital Heart Disease.

Cardiac MRI plays an important role in the diagnosis and follow-up of patients with congenital heart disease (CHD). Gadolinium-based contrast agents are often needed to overcome flow-related and off-resonance artifacts that can impair the quality of conventional noncontrast 3D imaging. As serial imaging is often required in CHD, the development of robust noncontrast 3D MRI techniques is desirable. To assess the clinical utility of noncontrast enhanced magnetization transfer and inversion recovery prepared 3D free-breathing sequence (MTC-BOOST) compared to conventional 3D whole heart imaging in patients with CHD. Prospective, image quality. A total of 27 adult patients (44% female, mean age 30.9 ± 14.8 years) with CHD. A 1.5 T; free-breathing 3D MTC-BOOST sequence. MTC-BOOST was compared to diaphragmatic navigator-gated, noncontrast T2 prepared 3D whole-heart imaging sequence (T2prep-3DWH) for comparison of vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (vessel wall sharpness and presence and type of artifacts) assessed by two experienced cardiologists on a 5-point scale. Mann-Whitney test, paired Wilcoxon signed-rank test, Bland-Altman plots. P < 0.05 was considered statistically significant. MTC-BOOST significantly improved image quality and CR of the right-sided pulmonary veins (PV): (CR: right upper PV 1.06 ± 0.50 vs. 0.58 ± 0.74; right lower PV 1.32 ± 0.38 vs. 0.81 ± 0.73) compared to conventional T2prep-3DWH imaging where the PVs were not visualized in some cases due to off-resonance effects. MTC-BOOST demonstrated resistance to degradation of luminal signal (assessed by CR) secondary to accelerated or turbulent flow conditions. T2prep-3DWH had higher image quality scores than MTC-BOOST for the aorta and coronary arteries; however, great vessel dimensions derived from MTC-BOOST showed excellent agreement with standard T2prep-3DWH imaging. MTC-BOOST allows for improved contrast-free imaging of pulmonary veins and regions characterized by accelerated or turbulent blood flow compared to standard T2prep-3DWH imaging, with excellent agreement of great vessel dimensions. 1 TECHNICAL EFFICACY: Stage 2.

Intra-procedural three-dimensional rotational angiography in cryoballoon ablation of atrial fibrillation - a randomised clinical trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction To facilitate atrial fibrillation (AF) ablation procedures there is a variety of approaches for pre-procedural imaging of pulmonary veins (PV) and left atrium (LA), including CT angiography and cardiac MRI. Intra-procedural three-dimensional rotational angiography (3DRA) is the least employed method and it can be advantageous regarding efficiency and procedural logistics. Data supporting different practices is still evolving and there is an open question whether LA imaging could improve safety and outcomes of CB ablation. Purpose The aim of this study is to evaluate possible benefits of 3DRA for procedural success, safety and long-term outcomes of CB ablation. Methods We designed a single-centre unblinded randomised clinical trial and recruited 101 patients (65.3% male, 59.3±11.5 years) with paroxysmal (92%) and early-persistent AF. Patients were randomized to no imaging or 3DRA which was performed intra-procedurally after trans-septal puncture. Angiographic images were segmented and overlaid to the fluoroscopy screen to guide the ablation procedure. All patients are followed for 1 year and data concerning procedural characteristics, safety outcomes and AF recurrence are being collected. Results Of all the patients recruited, 48 (47%) underwent 3DRA. In patients who received no imaging (non-3DRA group) one PV couldn’t be isolated while in 3DRA group isolation of one PV could not be achieved in 3 patients (OR 3.47, 95% CI 0.35-34.51). The occurrence of left common PV, an anatomical variation that could have potential to influence results, was similar in both groups (25,4% in non-3DRA and 25.0% in 3DRA group). Procedure time was significantly longer when 3DRA was performed (87.4±27.7 min compared to 69.9±23.0 in non-3DRA group, p&amp;lt;0.001). Total radiation dose (148.2±177.7 vs 387.7±203.8 mGy, p&amp;lt;0.001) and contrast administration (42.5±27.1 vs 133.8±26.8 ml, p&amp;lt;0.001) were significantly lower in the control group. Only minor complications were reported in both groups. Three patients developed large haematoma (2 in 3DRA group vs 1 in control group). In each group there was one incident of transient phrenic nerve palsy. Conclusion 3DRA is a safe and efficient intra-procedural imaging method to guide CB ablation for AF. However, it significantly increases procedure duration, total radiation dose and contrast expenditure. In our trial it did not have any impact on the acute success rate of PV isolation. One-year follow up data is still being collected and will subsequently be presented.

Three-dimensional transesophageal echocardiography versus magnetic resonance imaging for pulmonary vein imaging prior to catheter ablation of atrial fibrillation: extended long-term follow-up

Abstract Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, it is still challenging because of the high degree of variability of the pulmonary vein (PV) anatomy. Three-dimensional transesophageal echocardiography (TEE) is a promising new technique for cardiac imaging. Therefore, we have evaluated the usefulness of 3-D TEE for analysing the left atrial anatomy prior to an ablation procedure in comparison to magnetic resonance imaging (MRI). Methods In 150 patients, 3-D TEE and cardiac MRI were performed immediately prior to an ablation procedure (paroxysmal AF: 65 patients, persistent AF: 85 patients). The image quality provided by 3-D TEE and by cardiac MRI was compared in all patients. Two different ablation strategies were used. In patients with paroxysmal AF, the cryoablation technique was used. In the other patients, a circumferential pulmonary vein ablation was performed using a three-dimensional mapping system. Results A 3-D TEE and a cardiac MRI could be performed successfully in all patients prior to the ablation procedure. Several variations of the PV anatomy could be visualized precisely by 3-D TEE and cardiac MRI (e.g. accessory PVs, common PV ostia, varying diameter of the left atrial appendage and its distance to the left superior PV). The image quality was good in the majority of patients even if AF with rapid ventricular response was present during the examination. The image quality provided by 3-D TEE was acceptable in 144/150 patients (96.0%). The TEE findings correlated well with the PV angiographies performed using cardiac MRI. There was a good correlation with regard to the diameter of the PV ostia assessed by these two imaging techniques. All ablation procedures could be performed successfully (mean number of completely isolated PVs: 3.8 (cryo group), 4.0 (radiofrequency catheter ablation group)). At 48-month follow-up, 69.3% of all patients were free from an arrhythmia recurrence (cryo group: 75.4%, Carto group: 64.7%). There were no major complications. Conclusions AF ablation procedures can be performed safely and effectively based on prior 3-D TEE imaging. The image quality was acceptable in the vast majority of patients. Funding Acknowledgement Type of funding source: None

P1375Catheter ablation of atrial fibrillation: three-dimensional transesophageal echocardiography versus magnetic resonance imaging for pulmonary vein imaging (periprocedural results and long-term follow-u

Abstract Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, it is still challenging because of the high degree of variability of the pulmonary vein (PV) anatomy. Three-dimensional transesophageal echocardiography (TEE) is a promising new technique for cardiac imaging. Therefore, we have evaluated the usefulness of 3-D TEE for analysing the left atrial anatomy prior to an ablation procedure in comparison to magnetic resonance imaging (MRI). Methods In 120 patients, 3-D TEE and cardiac MRI were performed immediately prior to an ablation procedure (paroxysmal AF: 50 patients, persistent AF: 70 patients). The image quality provided by 3-D TEE and by cardiac MRI was compared in all patients. Two different ablation strategies were used. In patients with paroxysmal AF, the cryoablation technique was used. In the other patients, a circumferential pulmonary vein ablation was performed using a three-dimensional mapping system. Results A 3-D TEE and a cardiac MRI could be performed successfully in all patients prior to the ablation procedure. Several variations of the PV anatomy could be visualized precisely by 3-D TEE and cardiac MRI (e.g. accessory PVs, common PV ostia, varying diameter of the left atrial appendage and its distance to the left superior PV). The image quality was good in the majority of patients even if AF with rapid ventricular response was present during the examination. The image quality provided by 3-D TEE was acceptable in 116/120 patients (96.7 %). The TEE findings correlated well with the PV angiographies performed using cardiac MRI. There was a good correlation with regard to the diameter of the PV ostia assessed by these two imaging techniques. All ablation procedures could be performed successfully (mean number of completely isolated PVs: 3.9 (cryo group), 4.0 (radiofrequency catheter ablation group)). At 42-month follow-up, 70.0 % of all patients were free from an arrhythmia recurrence (cryo group: 76.0 %, Carto group: 65.7 %). There were no major complications. Conclusions AF ablation procedures can be performed safely and effectively based on prior 3-D TEE imaging. The image quality was acceptable in the vast majority of patients.

P5771Comparison of three-dimensional transesophageal echocardiography and magnetic resonance imaging for pulmonary vein imaging prior to catheter ablation of atrial fibrillation: long-term follow-up

P5771Comparison of three-dimensional transesophageal echocardiography and magnetic resonance imaging for pulmonary vein imaging prior to catheter ablation of atrial fibrillation: long-term follow-up

Severe Pulmonary Vein Stenosis Resulting From Ablation for Atrial Fibrillation: Presentation, Management, and Clinical Outcomes.

The frequency of pulmonary vein stenosis (PVS) after ablation for atrial fibrillation has decreased, but it remains a highly morbid condition. Although treatment strategies including pulmonary vein dilation and stenting have been described, the long-term impacts of these interventions are unknown. We evaluated the presentation of severe PVS, and examined the risk for restenosis after intervention using either balloon angioplasty (BA) alone or BA with stenting. This was a prospective, observational study of 124 patients with severe PVS evaluated between 2000 and 2014. All 124 patients were identified as having severe PVS by computed tomography in 219 veins. One hundred two patients (82%) were symptomatic at diagnosis. The most common symptoms were dyspnea (67%), cough (45%), fatigue (45%), and decreased exercise tolerance (45%). Twenty-seven percent of patients experienced hemoptysis. Ninety-two veins were treated with BA, 86 were treated with stenting, and 41 veins were not treated. A 94% acute procedural success rate was observed and did not differ by initial management. Major procedural complications occurred in 4 of the 113 patients (3.5%) who underwent invasive assessment, and minor complications occurred in 15 patients (13.3%). Overall, 42% of veins developed restenosis including 27% of veins (n=23) treated with stenting and 57% of veins (n=52) treated with BA. The 3-year overall rate of restenosis was 37%, with 49% of BA-treated veins and 25% of stented veins developing restenosis (hazard ratio, 2.77; 95% confidence interval, 1.72-4.45; P<0.001). After adjustment for age, CHA2DS2-VASc score, hypertension, and the time period of the study, there was still a significant difference in the risk of restenosis for BA versus stenting (hazard ratio, 2.46; 95% confidence interval, 1.47-4.12; P<0.001). The diagnosis of PVS is challenging because of nonspecific symptoms and the need for dedicated pulmonary vein imaging. There is no difference in acute success by type of initial intervention; however, stenting significantly reduces the risk of subsequent pulmonary vein restenosis in comparison with BA.

Left atrium and pulmonary vein imaging using sub-millisiviert cardiac computed tomography: Impact on radiofrequency catheter ablation cumulative radiation exposure and outcome in atrial fibrillation patients

BackgroundThe outcome of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has improved thanks to left atrium (LA) anatomy reconstruction by cardiac computed tomography (CCT). A new model-based iterative reconstruction algorithm (MBIR) provides image noise reduction achieving effective radiation dose (ED) close to chest X-ray exposure. Aim of this study was comparing RFCA procedural characteristics, AF recurrence and radiation exposure between patients in whom RFCA was guided by CCT image integration with MBIR versus a CCT standard protocol. MethodsThree-hundred consecutive patients with drug-refractory AF were studied with CCT using MBIR (Group 1; N:150) or CCT with standard protocol (Group 2; N:150) for LA evaluation and treated by image integration-supported RFCA. Image noise, signal to noise ratio (SNR), contrast to noise ratio (CNR), RFCA procedural characteristics, rate of AF recurrence and radiation exposure were compared. ResultsGroup 1 showed higher SNR (25.9±7.1 vs. 16.2±4.8, p<0.001) and CNR (23.3±7.1 vs. 12.2±4.2, p<0.001) and lower image noise (22.3±5.2 vs. 32.6±8.1 HU, p<0.001), fluoroscopy time (21±12 vs. 29±15min, p<0.01) and procedural duration (135±89 vs. 172±55, p<0.001). Group 1 showed a 94% reduction of ED as compared to Group 2 (CCT-ED related: 0.41±0.04 vs. 6.17±4.11mSv, p<0.001; cumulative CCT+RFCA-ED related: 21.9±17.9 vs. 36.0±24.1mSv, p<0.001) with similar rate of AF recurrence (25% vs. 29%, p=0.437). ConclusionsCCT with MBIR allows accurate reconstruction of LA anatomy in AF patients undergoing RFCA with a sub-millisievert ED and comparable success rate of RFCA as compared to a standard CCT scan protocol.

Ultra-low-dose CT for left atrium and pulmonary veins imaging using new model-based iterative reconstruction algorithm

To evaluate the feasibility of ultra-low-dose CT for left atrium and pulmonary veins using new model-based iterative reconstruction (MBIR) algorithm. Two hundred patients scheduled for catheter ablation were randomized into two groups: Group 1 (100 patients, Multidetector row CT (MDCT) with MBIR, no ECG triggering, tube voltage and tube current of 100 kV and 60 mA, respectively) and Group 2 [100 patients, MDCT with adaptive statistical iterative reconstruction algorithm (ASIR), no ECG triggering, and kV and mA tailored on patient BMI]. Image quality, CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of left atrium (LA) and pulmonary veins, and effective dose (ED) were evaluated for each exam and compared between two groups.No significant differences between groups in terms of population characteristics, cardiovascular risk factors, anatomical features, prevalence of persistent atrial fibrillation and image quality score. Statistically significant differences were found between Group 1 and Group 2 in mean attenuation, SNR, and CNR of LA. Significantly, lower values of noise were found in Group 1 versus Group 2. Group 1 showed a significantly lower mean ED in comparison with Group 2 (0.41 ± 0.04 versus 4.17 ± 2.7 mSv). The CT for LA and pulmonary veins imaging using MBIR is feasible and allows examinations with very low-radiation exposure without loss of image quality.

Ultra low dose CT for left atrium and pulmonary veins imaging using VEO (model-based iterative reconstruction)

Ultra low dose CT for left atrium and pulmonary veins imaging using VEO (model-based iterative reconstruction)

Pulmonary Venous Anatomy Imaging With Low-Dose, Prospectively ECG-Triggered, High-Pitch 128-Slice Dual-Source Computed Tomography

The efforts to reduce radiation from cardiac computed tomography (CT) are essential. Using a prospectively triggered, high-pitch dual-source CT protocol, we aim to determine the radiation dose and image quality in patients undergoing pulmonary vein (PV) imaging. In 94 patients (61±9 years; 71% male) who underwent 128-slice dual-source CT (pitch 3.4), radiation dose and image quality were assessed and compared between 69 patients with sinus rhythm and 25 patients with atrial fibrillation. Radiation dose was compared in a subset of 19 patients with prior retrospective or prospectively triggered CT PV scans without high pitch. In a subset of 18 patients with prior magnetic resonance imaging for PV assessment, PV anatomy and scan duration were compared with high-pitch CT. Using the high-pitch protocol, total effective radiation dose was 1.4 (1.3, 1.9) mSv, with no difference between sinus rhythm and atrial fibrillation (1.4 versus 1.5 mSv; P=0.22). No high-pitch CT scans were nondiagnostic or had poor image quality. Radiation dose was reduced with high-pitch (1.6 mSv) compared with standard protocols (19.3 mSv; P<0.0001). This radiation dose reduction was seen with sinus rhythm (1.5 versus 16.7 mSv; P<0.0001) but was more profound with atrial fibrillation (1.9 versus 27.7 mSv; P=0.039). There was excellent agreement of PV anatomy (κ 0.84; P<0.0001) and a shorter CT scan duration (6 minutes) compared with magnetic resonance imaging (41 minutes; P<0.0001). Using a high-pitch dual-source CT protocol, PV imaging can be performed with minimal radiation dose, short scan acquisition, and excellent image quality in patients with sinus rhythm or atrial fibrillation. This protocol highlights the success of new cardiac CT technology to minimize radiation exposure, giving clinicians a new low-dose imaging alternative to assess PV anatomy.

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Low dose 320-row CT for left atrium and pulmonary veins imaging—the feasibility study

To evaluate the feasibility of low dose target-CTA volume scan for left atrium and pulmonary veins imaging using 320-row CT. Forty-two patients (females 12, males 30; mean age 55.2 years; mean body mass index (BMI) 25.7 kg/m(2)) with persistent or intermittent atrial fibrillation before catheter ablation were enrolled in this study. Scan protocol was target-CTA volume scan under prospective ECG-gating. The target of the exposure was only set at 40% of the R-R interval (which was at the left atrium maximal volume). The exposure time was minimal setting (350 ms). Tube voltage 100 kV (BMI ≤ 25 kg/m(2)) or 120 kV (BMI>25 kg/m(2)), tube current 350-420 mA, and field of view of 180 mm × 180 mm-200 mm × 200 mm were used. The scanning range was from the level of the tracheal bifurcation to the diaphragm, and enabled to cover the left atrium and central pulmonary veins (120-140 mm). All of patients were divided into two groups according kV setting (100 kV and 120 kV). The image quality (good, moderate and poor) was evaluated by two reviewers. The CT-attenuation, image noise and contrast to noise ratio (CNR) of left atrium and every pulmonary vein branch were evaluated, respectively. The effective dose (ED) was calculated using a conversion coefficient for the chest 0.017. Of 42 patients, the image quality was good in 26 cases (62%) and moderate in 16 cases (38%). There was no statistical difference in the CT-attenuation and CNR of left atrium and central pulmonary veins between the two groups (P>0.05). The mean ED was 1.90 ± 0.19 mSv (range 1.57-2.25 mSv) in 100 kV group, and 3.83 ± 0.31 mSv (range 3.39-4.54 mSv) in 120 kV group. The low dose target-CTA volume scan is feasible in pulmonary veins and left atrium imaging using 320-row CT. Slim patients can be scanned at 100 kV setting without loss of image quality.

Multimodality imaging of anomalous pulmonary veins

Partial anomalous pulmonary venous connection (PAPVC) is an extremely rare congenital condition where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with unexplained right ventricular enlargement on transthoracic echocardiography (TTE), cardiac MRI is able to delineate the anatomical variant. We present a case of a 65-year-old male diagnosed with left sided PAPVC using multimodality cardiac imaging.

Intraprocedural Imaging of Left Atrium and Pulmonary Veins with Rotational Angiography: A Comparison of Anatomy Obtained by Cardiac Computed Tomography

Background: Contrast-enhanced three-dimensional rotational angiography (3DRA) is a novel method for three-dimensional reconstruction of the left atrium (LA) and pulmonary veins (PVs) during catheter ablation for atrial fibrillation (AF). The purpose of this study was to assess the feasibility and accuracy of anatomy obtained by 3DRA compared with computed tomography (CT). Methods: Patients with an indication for AF ablation were included. Contrast enhanced cardiac CT was performed within 24 hours prior to ablation. Intraprocedural 3DRA was performed with power injected contrast medium (20 cc per 1 sec for 4 sec, 240 degree angle). We compared LA volume and circumferences of four PVs obtained from each imaging method. Results: Total 16 patients (mean age: 55±9.3 year old) were prospectively included. Five patients were paroxysmal, while 11 patients were persistent. LA volume measured by 3DRA and CT was well correlated (r=0.94, p<0.00). The circumference of four PVs for each imaging method was well correlated in left superior PV (r=0.62) and right superior PV (r=0.52) (p<0.05) but was less in right inferior PV (r=0.39) and left inferior PV (r=0.45), respectively. (p=NS). Conclusions: Intraprocedural imaging, 3DRA provides anatomical accuracy of the LA and superior PVs comparable to cardiac CT. However, special attention is required to assess inferior PVs using 3DRA.