X-ray Contrast Angiography Research Articles

Purpose-Built Transcatheter Cavopulmonary Anastomosis Device Requirements: Multi-Modality Imaging Evaluation

Background/purposePatients with a functional single ventricle undergo multiple, palliative open-heart surgeries. This includes a superior cavopulmonary anastomosis or bidirectional Glenn shunt. A less-invasive transcatheter approach may reduce morbidity. Methods/materialsWe analyzed pre-Glenn X-ray contrast angiography (XA), cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) studies. ResultsOver an eleven-year period (1/2007 – 6/2017), 139 Glenn surgeries were performed at our institution. The typical age range at surgery was 59 – 371 days (median = 163; IQR = 138 – 203). Eight-nine XA, ten CT, and ten CMR studies obtained from these patients were analyzed.Cephalad SVC measurements (millimeters) were 7.3 ± 1.7 (XA), 7.7 ± 1.6 (CT) and 6.9 ± 1.8 (CMR). RPA measurements were 7.3 ± 1.9 (XA), 7.4 ± 1.6 (CT) and 6.6 ± 1.9 (CMR). Potential device lengths were 10.9 ± 6 – 17.4 ± 6.4 (XA), 10.1 ± 2.1 – 17.7 ± 2.4 (CT) and 17.3 ± 4. - 23.7 ± 5.5 (CMR). SVC-RPA angle (degrees) was 132.9 ± 13.2 (CT) and 140 ± 10.2 (MRI).Image quality of all CT (100%), almost all XA (SVC 100%, RPA 99%), and most MRI (SVC 80%, RPA 90%) were deemed sufficient. Parametric modeling virtual fit device with 10 mm diameter and 20 – 25 mm length was ideal. ConclusionsIdeal transcatheter cavopulmonary shunt device for the typical patient would be 10 mm in diameter and 20–25 mm in length.

Rationale and design of the Edwards SAPIEN-3 periprosthetic leakage evaluation versus Medtronic CoreValve in transfemoral aortic valve implantation (ELECT) trial : Arandomised comparison of balloon-expandable versus self-expanding transcatheter aortic valve prostheses.

Background and objectivesPeriprosthetic aortic regurgitation (PPR) after transcatheter aortic valve implantation (TAVI) remains an important issue associated with impaired long-term outcomes. The current randomised study aims to evaluate potential differences between the balloon-expandable Edwards SAPIEN-3 and the self-expanding Medtronic CoreValve system with the main focus on post-TAVI PPR by means of novel imaging endpoints, and an additional focus on other clinical endpoints.EndpointsThe primary endpoint of this study is quantitative assessment of the severity of post-procedural PPR using cardiac magnetic resonance imaging. Several other novel imaging modalities (X-ray contrast angiography, echocardiography) are used as secondary imaging modalities for the assessment of PPR following TAVI. Secondary objectives of the study include clinical outcomes such as cerebral and kidney injury related to TAVI, and quality of life.Methods and designThe ELECT study is a single-centre, prospective, two-armed randomised controlled trial. For the purpose of this study, 108 consecutive adult patients suitable for transfemoral TAVI will be randomly allocated to receive the SAPIEN-3 (n = 54) or the CoreValve system (n = 54).DiscussionThe ELECT trial is the first randomised controlled trial to quantitatively compare the extent of post-TAVI PPR between the SAPIEN-3 and CoreValve. Furthermore, it will evaluate potential differences between the two prostheses with regard to mid-term clinical outcome and quality of life.

Ultrasound diagnostic compared with angiography of carotid arteries in the diagnosis of multifocal atherosclerosis

According to the modern statistics, the isolated atherosclerotic lesion in one arterial region occurs twice less often, than the combined lesion in several regions. Among the last, significant stenoses (>50 %) make up to 25 % of cases. Vascular surgeons need high-informative and noninvasive diagnostic methods for detection of way of surgical treatment of these lesions. So far the X-ray contrast angiography (AG) remains a method of «the gold standard» whereas the screening part is assigned to the duplex scanning (DS). The aim of present study was to compare results of ultrasonic DS and angiography in patients with multifocal atherosclerosis. Sensitivity and specificity of these methods had been evaluated. By means of screening of 565 men of 45-59-years-old, 64 patients with multifocal atherosclerotic lesions in coronary, carotid and low extremity arteries were identified. They were examined using DS and AG. The degree of carotid stenosis was accurately measured both by means of ultrasonic duplex scanning and angiography. Sensitivity and specificity of DS were 86 and 71 %, sensitivity of AG was 97 %, specificity was 86 %. Furthermore duplex scanning provided more information in detecting of unstable plaques compared with angiography. Thus ultrasound diagnostic may be considered a useful method for detecting different characteristics of multifocal atherosclerotic lesion, including the preoperative noninvasive assessment.

Coronary artery wall imaging.

Like X-Ray contrast angiography, MR coronary angiograms show the vessel lumens rather than the vessels themselves. Consequently, outward remodeling of the vessel wall, which occurs in subclinical coronary disease before luminal narrowing, cannot be seen. The current gold standard for assessing the coronary vessel wall is intravascular ultrasound, and more recently, optical coherence tomography, both of which are invasive and use ionizing radiation. A noninvasive, low-risk technique for assessing the vessel wall would be beneficial to cardiologists interested in the early detection of preclinical disease and for the safe monitoring of the progression or regression of disease in longitudinal studies. In this review article, the current state of the art in MR coronary vessel wall imaging is discussed, together with validation studies and recent developments.

Predictive and preventive strategies to advance the treatments of cardiovascular and cerebrovascular diseases: the Ukrainian context.

Despite great efforts in treatments of cardiovascular diseases, the field requires innovative strategies because of high rates of morbidity, mortality and disability, indicating evident deficits in predictive vascular diagnosis and individualized treatment approaches. Talking about the vascular system, currently, physicians are not provided with integrated medical approaches to diagnose and treat vascular diseases. Only an individual global approach to the analysis of all segments in the vascular system of a patient allows finding the optimal way for vascular disease treatment. As for the existing methodology, there is a dominance of static methods such as X-ray contrast angiography and magnetic resonance imaging in angiomode. Taking into account the world experience, this article deals with innovative strategies, aiming at predictive diagnosis in vascular system, personalization of the biomedical treatment approaches, and targeted prevention of individual patient cohorts. Clinical examples illustrate the advances in corresponding healthcare sectors. Recommendations are provided to promote the field.

Carotid Doppler Velocity Measurements and Anatomic Stenosis

Duplex ultrasound with Doppler velocimetry is widely used to evaluate the presence and severity of internal carotid artery stenosis; however, a variety of velocity criteria are currently being applied to classify stenosis severity. The purpose of this study is to compare published Doppler velocity measurements to the severity of internal carotid artery stenosis as assessed by x-ray angiography in order to clarify the relationship between these 2 widely used approaches to assess carotid artery disease. Scatter diagrams or "scattergrams" of correlations between Doppler velocity measurements and stenosis severity as assessed by x-ray contrast angiography were obtained from published articles for native and stented internal carotid arteries. The scattergrams were graphically digitized, combined, and segmented into categories bounded by 50% and 70% diameter reduction. These data were combined and divided into 3 sets representing different velocity parameters: (1) peak systolic velocity, (2) end-diastolic velocity, and (3) the internal carotid artery to common carotid artery peak systolic velocity ratio. The horizontal axis of each scattergram was transformed to form a cumulative distribution function, and thresholds were established for the stenosis categories to assess data variability. Nineteen publications with 22 data sets were identified and included in this analysis. Wide variability was apparent between all 3 velocity parameters and angiographic percent stenosis. The optimal peak systolic velocity thresholds for stenosis in stented carotid arteries were higher than those for native carotid arteries. Within each category of stenosis, the variability of all 3 velocity parameters was significantly lower in stented arteries than in native arteries. Although Doppler velocity criteria have been successfully used to classify the severity of stenosis in both native and stented carotid arteries, the relationship to angiographic stenosis contains significant variability. This analysis of published studies suggests that further refinements in Doppler velocity criteria will not lead to improved correlation with carotid stenosis as demonstrated by angiography.

SYNCOPE IN NON-MASSIVE PULMONARY EMBOLISM AS A PREDICTOR OF HIGH-RISK MORTALITY

Aim. To study the prognostic value of syncope in non-massive pulmonary embolism (PE). Material and methods. Patients (n=64; 35 men and 29 women; aged 52±13 years) with non-massive PE were examined. 13 (20%) patients had a high risk of death according to the ESC criteria, and 51 (80%) — an intermediate risk. PE diagnosis was verified by X-ray contrast angiography or computer angiography of the pulmonary artery. Patients were split into 2 groups: patients of group 1 (n=14) had syncope episodes during the last 24 hours (from 1 to 30), and group 2 (n=50) — did not have. Groups did not differ by age, sex and disease duration. Comparative analysis of clinical and instrumental data, hospital mortality was made. Results. The significant differences for most parameters in the studied groups were not found. Combination of syncope and right bundle branch block on ECG was observed more often in PE patients of high risk mortality: 50% vs 14.2% in groups 1 and 2, respectively (p=0.004). High risk of death was defined 3 times more often in group 1 than this in group 2: 42.8% vs 14% (p=0.017). Syncope at the onset of non-massive PE clinical manifestations associated with more often hypotension development — 42.8% vs 14% in groups 1 and 2, respectively (p=0.017). Patients of group 1 needed in thrombolytic therapy 3 times more often than patients of group 2: 50% vs 16%, respectively. Hospital mortality did not differ significantly — 0 and 2% in groups 1 and 2, respectively. Conclusion. Syncope in non-massive PE, especially in combination with right bundle branch block on ECG, may be considered as a possible criterion for high risk of complications and can be rationale for thrombolytic therapy in addition to standard therapy. Designed studies on prognostic significance of syncope in PE, depending on mass of pulmonary artery lesions and risk stratification are necessary.

Magnetic Resonance Imaging in the Adult with Congenital Heart Disease

Given relatively recent advances in pediatric cardiovascular surgery, catheter-based interventional therapies, intensive care, and medical management, many children with complex congenital heart disease (CHD) are surviving into adulthood. As such, adults with CHD constitute a rapidly growing population. The majority of these adults have complex residual disease requiring serial imaging and often further intervention. There are a number of imaging modalities available to the clinician and radiologist when it comes to these evaluations. Magnetic resonance imaging (MRI) holds a unique and growing position among these. Echocardiography has been a mainstay of imaging in congenital heart disease. Despite its importance in rapid diagnosis and follow-up, it has limitations in the evaluation of the adult with CHD. The presence of postoperative scar, chest wall deformities, overlying lung tissue, and large body size often results in suboptimal transthoracic echocardiographic windows. Transesophageal echocardiography, while providing improved acoustic windows, is limited by its small fieldof-view and more invasive nature, often requiring deep sedation or general anesthesia. Cardiac catheterization, employing X-ray fluoroscopy and contrast angiography, has an expanding role in minimally invasive interventions, but its role as a diagnostic procedure is rapidly diminishing. This is in part due to its limitation as a 2D projection imaging technique with poor soft-tissue contrast and the substantial ionizing radiation exposure involved, and in part because both diagnostic and functional analysis are often better performed with noninvasive imaging techniques. Computed tomography (CT) has been useful in evaluating vascular anatomy, and with the advent of high-resolution CT and cardiac gating, has emerged as a useful tool for assessing intracardiacanatomyandmyocardialfunction.Nevertheless, the temporal resolution of cardiac CT remains limited and advances in CT imaging technology have often come with increases in exposure to ionizing radiation. MRI has emerged over the past few decades as an alternative, complementary, and frequently superior imaging modality for the investigation of anatomy and function in the adult with CHD. It has many advantages over other imaging modalities. It does not require the use of iodinated contrast agents and does not involve exposure to ionizing radiation. This is particularly important in a population of patients who have been, and continue to be, exposed to large doses of contrast agent and radiation during hemodynamic and interventional catheterization. Major advances in MRI hardware and software, including advanced coil design, faster gradients, new pulse sequences, and faster image reconstruction techniques, allow rapid, high-resolution imaging of complex anatomy and accurate, quantitative assessment of physiology and function. This review highlights the MRI techniques frequently employed to evaluate the anatomy and physiology of the adult with CHD. It provides information about the general application of cardiac MRI in this patient population, as well as sample protocols and guidelines for its use in the more commonly encountered lesions referred for MRI.

Carotid artery bruit: association with internal carotid stenosis and intraluminal turbulence.

One hundred and ninety-five consecutive referrals to the vascular laboratory for carotid artery investigation have been studied. Carotid bruits were assessed by the referring clinician and documented. All patients underwent bilateral imaging and spectrum analysis of the extra-cranial carotid vessels using a pulsed Doppler ultrasound technique. Eighty-two were further assessed by X-ray contrast angiography. Of 390 internal carotids examined by ultrasound, 65 exhibited intraluminal turbulence of which 49 (75 per cent) had a bruit. In 62 (56 per cent) of 111 internal carotids in the series which were said to have a bruit on clinical examination, no turbulence was found; in 15 instances the external carotid vessel was shown as the true source of turbulence and in the remainder the bruits may have been transmitted from the heart. One hundred and fifty-six vessels were assessed by X-ray and 55 shown to have significant stenosis; 38 (69 per cent) of these exhibited a bruit. Bruit was often absent at high degrees of stenosis and in occluded vessels. Although a carotid bruit is often a marker of internal carotid intraluminal turbulence and stenosis, this is by no means always so. Cervical bruit may also be due to a diseased external carotid or to sounds transmitted from a more proximal source. Conversely, absence of bruit is a feature not only of normal vessels but of many arteries which are stenosed (especially if this is of high degree) or occluded.

Three-dimensional respiratory-gated magnetic resonance angiography of coronary arteries compared with conventional X-ray contrast angiography

Three-dimensional respiratory-gated magnetic resonance angiography of coronary arteries compared with conventional X-ray contrast angiography

Magnetic resonance imaging of coronary arteries and coronary stenosis

Coronary artery imaging is an important investigation for the management of coronary artery disease. Alternative noninvasive imaging would be useful, but the small caliber and tortuosity of the coronary vessels and cardiac and respiratory motion create formidable imaging problems. We first studied 21 normal subjects and 5 with coronary artery disease established by X-ray contrast angiography, of whom 2 had undergone bypass grafting. Of these, 22 were imaged successfully. Identification of the artery was possible for the left main stem, left anterior descending, right coronary, and left circumflex arteries respectively in 95%, 91%, 95%, and 76%. The arterial diameter at the origin could be measured in 77%, 77%, 81%, and 63%. The mean ±SD arterial diameter in each case (4.8±0.8, 3.7±0.5, 3.9±0.9, and 2.9±0.6 mm) was not significantly different from reference values (allp=ns). The mean length of artery visualized was 10.4±5.2,46.7±22.8,53.7±27.9, and 26.3±17.5 mm. In 12 normal males, the total coronary area was 30.9±9.2 mm2 and the ratio compared with body surface area was 16.4±4.4 mm2 m−2 (bothp=ns compared with reference values). In seven patients, with X-ray contrast coronary angiography, the proximal arterial diameter measured by magnetic resonance was 3.9±1.1 mm, and by X-ray contrast angiography 3.7±1.0 mm (p=ns). We then studied 17 patients with angina. Imaging of just the relevant artery was performed and analysis was blinded to the X-ray angiography results. Stenosis was identified on the magnetic resonance (MR) images by localized reduction in vessel signal intensity. Stenosis location by MR was assessed by measurement of its distance from a reference vessel, with correlation to the X-ray findings. X-ray coronary angiography showed 23 stenoses of which 15 (65%) were correctly located by blind assessment of the MR images. Of the eight remaining stenoses, a further 5 (63%) were correctly located on the MR images after retrospective comparison (overall sensitivity 87%). There were three lesions thought to represent stenosis by MR, which on review of the X-ray angiogram proved to be a minor stenosis <50% (two cases) or a tortuous vessel (one case). Greater signal loss was seen in the more severe stenoses. The stenosis length by MRI was greater than by X-ray (8.4 versus 5.1 mm,p<0.001). The overestimation of stenosis length may be due to turbulence.

Comparison of gradient echo with spin echo magnetic resonance imaging and echocardiography in the evaluation of major aortopulmonary collateral arteries

This study compared gradient echo magnetic resonance imaging, spin echo magnetic resonance imaging, echocardiography, and echocardiography with x-ray cineangiography in the evaluation of major aortopulmonary collateral arteries. Twelve patients (ages 9 months to 35 years, mean 11 ± 11 years) with known or suspected major aortopulmonary collateral arteries were studied. The aortic insertion and proximal course of 29 major aortopulmonary collateral arteries demonstrated by x-ray contrast angiography were shown in all 29 cases by gradient echo magnetic resonance imaging but in only 23 of the 29 cases by spin echo magnetic resonance imaging. Color Doppler echocardiography detected aortopulmonary collateral arteries in four patients but did not define the proximal course or distal anatomy. Gradient echo images of distal aortopulmonary collateral anatomy were qualitatively superior to spin echo images. The contrast-to-noise ratio between the vessel lumen and adjacent lung was greater for gradient echo (6.06 ± 2.91) than for spin echo (1.45 ± 1.13) ( p < 0.05). Gradient echo magnetic resonance imaging is a useful method for identification and characterization of aortopulmonary collateral arteries in patients of all ages and is superior to spin echo magnetic resonance imaging and echocardiography.