Koroner Arter Çıkış Anomalilerinin Tespitinde 16-Dedektör Bilgisayarlı Tomografinin Önemi

Abstract

Coronary artery origination anomalies are detected during catheter angiography and can rarely be a cause of patient's complaint. In this study, we aimed to investigate the role of ECG-gated 16-detector computed tomography in the detection of coronary artery origination anomalies. Ninehundred and fifty adult patients from January 2005 to June 2006 were evaluated retro spec tively. Coronary CT angiography studies had been routinely performed by 16-detector CT scanners with ECG gating. Detector collimation was 16x1 mm, and reconstruction interval 0.5mm. Patients with pre-scan heart rates greater than 75 beats/min were given oral or intravenous beta-blocker. CT scans were obtained with breath hold after intravenous 120 ml iodinated contrast material was given. The coronary CT angiograms were evaluated by thoracic radiologist on Vitrae workstation using axial, multi planar reformation, and three dimensional images. Fourteen coronary artery anomalies were detected in 950 consecutive coronary CT a ng io gra p h ie s (1.47%). Identified anomalies were as fallows: origin of right coronary artery (RCA) from left sinus of Valsalva =2, hypoplasia of RCA =2, second left anterior descending artery (LAD) from RCA = 1, origin of circumflex artery (CxA) from right sinus of Valsalva =4, origin of LAD and CxA from 2 different ostia in the left sinus of Valsalva =5. 16-detector CTA can non invasively demonstrate accurate depiction of the origin and course of coronary artery anomalies. It is important to detect coronary artery anomalies because they can be compressed by cardiac chambers and great vessels during their aberrant courses. In addition, coronary CT angiography can be helpful to guide bypass surgery and catheter angiography in these patients. Koroner arter çıkış anomalileri genellikle kateter anjiyografi sırasında saptanır ve nadir olarak hastadaki şikayetlerin kaynağı olabilir. Bu çalışmada koroner arter çıkış anomalilerinin tespitinde 16-dedektörlü bilgisayarlı tomografik anjiyografinin (BTA) rolünü ve koroner arter çıkış anomalisi sıklığını araştırmayı amaçladık. Ocak 2005-Haziran 2006 tarihleri arasında toplam 950 hastanın koroner BTA' ları retros-pektif olarak değerlendirildi. Koroner BTA tetkikleri rutin olarak EKG tetikleme özellikli 16 -dedektörlü BT cihazı ile yapıldı. Dedektör kolimasyonu 16x1 mm, rekonstrüksiyon intervali 0.5mm idi. Tetkik öncesi kalp hızları dakikada 75'in üzerinde olan hastalara oral veya intra-venöz beta bloker tatbik edildi. Kesitler 120 ml non iyonik iyotlu kontrast maddenin intra-venöz yoldan verilmesi ardından nefes tutmalı olarak elde edildi. Görüntüler radyoloji uzma-nınca, Vitrae çalışma istasyonunda aksiyel, multiplanar reformat ve üç boyutlu imajlarda değerlendirildi. Dokuzyüzelli koroner BTA tetkikinde 14 koroner arter çıkış anomalisi saptandı (%1.47). Tespit edilen anomaliler ve sayıları şu şekildeydi: sol sinüs valsalva çıkışlı sağ koroner arter =2, sağ koroner arter hipoplazisi =2, sağ koroner arter çıkışlı ikinci sol anterior desendan ar-ter=1, sağ sinüs valsalva çıkışlı sirkumfleks arter=4, sol sinüs valsalva'dan sirkumfleks ve sol anterior desendan arterin ayrı ayrı çıkışı =5. 16-dedektörlü BTA non invaziv olarak koroner arter çıkış anomalilerini doğru bir şekilde ortaya koyar ve onların seyirlerini görüntüleyebilir. Anormal seyir sırasında kalp ana vasküler yapılar tarafından basıya maruz kalabileceklerinden saptanmaları klinik açıdan önemlidir. Ayrıca koroner BTA bu hastalarda by pass cerrahisi ve kateter anjiyografiye yol gösterebilir

Keywords

• -

References

1. Angelini P, Velasco JA, Flamm S. Coronary anom- alies: incidence, pathophysiology, and clinical rele- vance. Circulation 2002; 105: 2449–2454.
2. Garg N, Tewer S, Kapooer A, ve ark. Primary congen- ital anomalies of the coronary arteries: a coronary arteriographic study. Int J Cardiol 2000; 74: 39–46.
3. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126595 patients undergoing coronary angiography. Cathet Cardiovasc Diag 1990; 21: 28–40.
4. Baltaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult popu- lation. Radiology 1977; 122: 47–52.
5. Engel H, Torre C, Page H. Major variations in anatom- ical origin of the coronary arteries: angiographic observations in 4250 patients without associated con- genital heart disease. Cathet Cardiovasc Diag 1975; 1: 157–169.
6. Rodenwaldt J. Multislice computed tomography of the coronary arteries. Eur Radiol 2003; 13: 748–757.
7. Pannu HK, Flohr TG, Corl FM, ve ark. Current con- cepts in multi-detector row CT evaluation of the coro- nary arteries: principles, techniques, and anatomy. Radiographics 2003; 23: 111–112.
8. Data J, White CS, Gilkeson RC, ve ark. Anomalous coronary arteries in adults: Depiction at multi-detec- tor row CT angiography. Radiology 2005; 235: 812–818.

9. Burke AP, Farb A, Virmani R, ve ark. Sports-related and non-sports-related sudden cardiac death in young adults. Am Heart J 1991; 121: 568–575.
10. Shi H, Aschoff AJ, Brambs HJ, ve ark. Multislice CT imaging of anomalous coronary arteries. Eur Radiol 2004; 14: 2172–2181.
11. Benson PA. Anomalous aortic origin of coronary artery with sudden death: case report and review. Am Heart J 1970; 79: 254–257.
12. Frescura C, Basso C,Thiene G, ve ark. Anomalous ori- gin of the coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998; 29: 689–695.
13. Reul RM, Cooley DA, Hallman GL, ve ark. Surgical treatment of coronary artery anomalies: report of a 37? year experience at the Texas Heart Institute, Tex Heart Inst J 2002; 29: 299–307.
14. Connell MV, Ganz P, Selwyn AP, ve ark. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 1995; 92: 3158–3162.
15. Bunce NH, lorenz CH, Keegan J, ve ark. Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography. Radiology 2003; 227: 201–208.
16. Taylor AM, Thorne SA, Rubens MB, ve ark. Coronary artery imaging in grown up congenital heart disease: complementary role of magnetic resonance and x-ray coronary angiography. Circulation 2000; 101: 1670–1678.