msct-64 0 in diagnosis of coronary anomalies of origin ...hntmmttn.vn/upload/file/dvc 13pm/[cd7.56]...
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MSCT-64 0 IN DIAGNOSIS OF
CORONARY ANOMALIES OF
ORIGIN & COURSE
NGUYEN TUAN VU, MD, PhD
PNT UNIVERSITY
MEDIC HCM
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BACKGROUNDMSCT Assessment of coronary stenosis
Congenital coronary anomalies are rare with an incidence ranging from 0.17% in autopsy cases to 1,2% in angiographycally evaluated cases.
Theses anomalies result in severe cardiovascular events & sudden death.
Some previous studies in Vietnam:
Tung Duy Le (2014 ):164 pts, MSCT-64 and DSA
Nhân Nguyen Thanh Vo (2016 ): 510 pts, MSCT-640
Phat Trieu Lam ( 2019 ): case report of RCA rising from LSV
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End-Points of Study
Prevalence and characteristics of coronary artery anomalies in an population undergoing multi-detector row computed tomography.
Usefulness and limitation of MSCT in diagnosis of Coronary Anomalies of Origin& courses.
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MATERIALS AND METHODSRetrospective study
Patients with cardiac imaging by MSCT-64 in MEDIC HCMC since 10/2006 , MSCT-640 since 05/2013
Instrument:TOSHIBA MSCT-640 Aquilion One
Metoprolol 50-200mg 1h prior to scan
0.5-1mm slice thickness
CE: Ultravist IV 1ml/kg
Wash out technique, single breath-hold.
Gantry rotation: 0,35sec
Volume rendering & Curved 2 D
Compare with DSA or operative results.
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Basic Principles of Computed Tomography
From Pim J de Feyter ( 2005 )
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Spiral CT & MSCT
From U. Joseph Schoepf ( 2005 ),
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Results& Discussion
The study included: 9572 patients
Mean age= 63± 8.4, M / F=1.8
Coronary anomalies were detected
incidentally in most cases.
One young pt presented by cardiac arrest.
MSCT revealed LMCA originating from
RSV with intra-arterial course of LMCA.
The anomalous origins of Circumflex
Artery from the RCA or the right sinus of
Valsalva are most frequently.
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Type of Anomalies n Prevalence
Cx originating fr. RCA/RSV 15 31.9%
0.16%
High taking off of RCA 11 23,4%
0.11%
RCA rising from LSV 8 17%
0.084%
LCA rising from the RSV 5 10.6%
0.052%
RCA arising from LAD 2 4.2%
0.021%
Absent RCA 2 4.2%
0.021%
Single coronary artery fr. LSV 1 2.1%
0.01%
ALCAPA 2 4.2%
0.021%
RCAPA 1 2.1%
0.01%
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Anomalous types of origin and course
of the Left Main Coronary Artery
LMCA arising from RSV with
intra-arterial course.
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LMCA arising from Left Sinus of Valsalva( Intra-Arterial course of LMCA )
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Casr Report
A young male pt, 25 y.o , Long An province
Presented by chest pain, dyspnea, syncope then
cardiac arrest ( successful CPR )
No risk factors of CAD in past history
Previous diagnosis: primary dilated cardiomyopathy.
Pt underwent MSCT-640 coronary angiography to
rule out coronary artery disease.
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Sinus rythm, QS in V1,V2
ST depression V4-V6
ECG
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Chest X ray: normal
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Echocardiography
Dilated LV, Akinesia of IVS, EF=35%
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MSCT Coronary Angiography
Curved 2D Images
LAD KHÔNG HẸP
LMCA
LAD
CX
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RCA KHÔNG HẸP
LCX KHÔNG HẸP
RCA
LM
Cx
LAD
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Anomalous origin and course of LMCA.
PA
AO
ĐMV trái chính bị kẹp giữa 2 đại động mạch
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LMCA originating from RSV
Gập gócAO
RVOT
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Treatment and sequence
CABG to LAD and LCx
Post-op. was favourable
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Single Coronary Artery
Bn nữ, 52 tuổi, đến khám vì đau ngực không điển hình
Thân chung ĐMV duy nhất xuất phát từ xoang Valsalva trái
Tác giả Prashanth Panduranga (2016 ) cũng mô tả một ca ĐMV độc nhất từ
xoang Valsalva phải đi khám vì đau ngực khi gắng sức.
Dị dạng này chiếm 0,024% đưa đến Đau TN, Đột tử, Đau ngực không điển
hình dù không tìm thấy chứng cứ tmct trên DSA và tử thiết.
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Anomalies of origin and course
of RCA
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High taking off RCA
High taking off of RCA, some time causes myocardial
infarction due to excessive angulation between RCA and
Aorta. We have in our study one young patient of 24 y.o that
had been transferred to the hospital by cardiac arrest , related
to this anomaly. Operative re-implanted had been indicated to
save the patient.
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INTRA ARTERIAL COURSE OF RCA
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RCA arising from LSV
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RCA rising from LSand Intra-arterial course of RCA
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LCx originating from RSV( Retro Aortic Course of LCx )
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LCA ARISES FROM PA
( Anomalous Origin of Left Coronary Artery from
Pulmonary Artery )
PA LAD
LM PALCA
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RCAPAAnomalous Origin of the Right Coronary Artery off The
Pulmonary Artery.
RCA
PAAO
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Case reportA male pt of 50 y.o, presented by chest pain over 30mn
ECG Blood test
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MSCT coronary angiography
LM& LAD LCX
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No coronary stenosis detected
RCA RAMUS INTERMEDIUS
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3D MSCT-Angiography
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Myocardial Bridge
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Anomalous intramural courses
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CONCLUSION
Coronary anomalies of origin and course are rare, the
exact incidence of these anomalies in population are
unknown currently.
Most patients with these anomalies are asymptomatic,
the early detection of coronary anomalies of origin and
course are highly important.
Anomalous origin from opposite Valsalva sinus usually
cause severe cardiac events and sudden death.
Contrast enhanced ECG-gated 640-row MDCT coronary
angiography is an accurate diagnostic method that can
precisely detect the coronary anomalies of origin and
course.
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References
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3-Christos Graidis et al ( 2015 )."Prevalence and
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