Evaluation of Ascending Aortic Atherosclerosis with 16-Multidetector Computed Tomography Is Useful before Total Endoscopic Coronary Bypass Surgery
DOI:
https://doi.org/10.1532/HSF98.20051103Abstract
Background. The purpose of this study was to investigate the assessment of ascending aortic atherosclerosis with 16-multidetector computed tomography (16-MDCT) angiography prior to total endoscopic coronary artery bypass (TECAB) surgery.
Methods. Forty-five patients were examined with electrocardiogram-gated, 16-MDCT angiography. The presence of atherosclerosis at the ascending aorta was graduated as severe (>50% of circumference) or as mild (<50% of circumference). Ascending aortic plaque composition was evaluated based on CT densities expressed as Hounsfield units (HU). TECABs using the Da Vinci telemanipulator were performed either on the arrested heart (n = 39) with an intra-aortic cardiopulmonary bypass (CPB) perfusion device or on the beating heart (n = 6) in patients with severe atherosclerosis.
Results. The presence of mild atherosclerosis at the ascending aorta (11/39) was associated with intra-aortic CPB perfusion device-related difficulties such as intra-aortic balloon migration (BM) or balloon rupture (P = .007) in arrested heart TECABs. The CT density of atherosclerotic plaque in patients with BM was mean 58 HU ± 51 standard deviation (SD), suggesting noncalcifying plaque. In patients without BM, CT density of plaque was mean 526 HU ± 306 SD corresponding to calcifying plaque (P < .001). Balloon rupture occurred in 2 patients who had calcifying plaque at the ascending aorta.
Conclusion. Evaluation of ascending aortic atherosclerosis with 16-MDCT angiography is useful prior to TECAB surgery. Even mild atherosclerosis of the ascending aorta is associated with intraoperative difficulties regarding the remote-access perfusion system that is used for arrested heart TECAB surgery.
References
Achenbach S, Moselewski F, Ropers D, et al. 2004. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation 109:14-7.nAmarenco P, Cohen A, Tzourio C, et al. 1994. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 331:1474-9.nCatalano C, Fraioli F, Laghi A. 2004. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology 231:555-63.nde Korte CL, Pasterkamp G, van der Steen AF, et al. 2000. Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro. Circulation 102:617-23.nFlohr T, Bruder H, Stierstorfer K, et al. 2002. New technical developments in multislice CT, part 2. Sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo Fortschr Geb Roentgenstr 174:1023-7.nHerzog C, Dogan S, Diebold T, et al. 2003. Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting. Radiology 229:200-8.nHoffmann U, Moselewski F, Cury RC, et al. 2004. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient-versus segment-based analysis. Circulation 110:2638-43.nHoffmann M, Shi H, Schmitz B, et al. 2005. Non-invasive coronary angiography with multislice computed tomography. JAMA 293:2471-8.nKuettner A, Kopp A, Schroeder S, et al. 2004. Diagnostic accuracy of multidetector computed angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 43:831-9.nLeber AW, Knez A, Becker A, et al. 2004. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol 43:1241-7.nLee RT, Richardson SG, Loree HM, et al. 1992. Prediction of mechanical forces of human atherosclerotic plaque by high-frequency intravascular ultrasound imaging. A vitro study. Arterioscler Thromb 12:1-5.nMollet NR, Cademartiri F, Krestin GP, et al. 2005. Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. J Am Coll Cardiol 45:128-32.nMollet NR, Cademartiri F, Nieman K, et al. 2005. Noninvasive assessment of coronary plaque burden using multislice computed tomography. Am J Cardiol 95:1165-9.nNieman K, Pattynama PMT, Rensing BJ, et al. 2003. Evaluation of patients after coronary artery bypass surgery: angiographic assessment of grafts and coronary arteries. Radiology 229:749-56.nRoos JE, Willmann JK, Weishaupt D, et al. 2002. Thoracic aorta: motion artifact reduction with retrospective and prospective electrocar-diography-assisted multi-detector row CT. Radiology 222:271-7.nSchachner T, Bonaros N, Laufer G, et al. 2004. The ESTECH remote access perfusion cannula in minimally invasive cardiac surgery. Heart Surg Forum 7:E632-5.nSchachner T, Nagele G, Kacani A, Laufer G, Bonatti J. 2004. Factors associated with presence of ascending aortic atherosclerosis in CABG patients. Ann Thorac Surg 78:2028-32.nSchlosser T, Konorza T, Hunold P, et al. 2004. Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography. J Am Coll Cardiol 44:1224-9.nSoler R, Rodriguez E, Requejo I, et al. 1998. Magnetic resonance imaging of congenital abnormalities of the thoracic aorta. Eur Radiol 8:540-6.n
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