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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3752_Библиотеки_им_академика_М_И_Перельмана
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Fig. 22.35 Congenital atresia of the left main coronary artery. 3-D
reconstructions ( upper and lower left panel ) demonstrate absence of
left main coronary artery with a single coronary artery ostium off of the
right coronary sinus. This single ostium gives off a right coronary artery
right coronary artery and immediately after the ostium gives off a vessel
which courses prepulmonic branching into a conus branch as well as
two large collateral branches supplying a diminutive left coronary system with an underdeveloped left anterior descending coronary artery
and circumfl ex. A 2-D double oblique thick maximum intensity projection view ( lower right panel ) shows lack of connection between the left
anterior descending coronary artery and circumfl ex and the left coronary sinus. This single ostium gave off the right coronary artery that
provided large collateral branches supplying a diminutive left coronary
system with an underdeveloped left anterior descending coronary artery
and circumfl ex. Cardiac catheterization demonstrated other small rightto-left collaterals to the diminutive left anterior descending coronary
artery and circumfl ex. Surgical management was challenging since the
left anterior descending coronary artery and circumfl ex were underdeveloped. Coronary artery bypass was performed off pump with a free
left internal mammary artery anastomosed distally to a diagonal branch
and anastomosed proximally to the aorta. AO aorta, COLL collateral,
CX circumfl ex coronary artery, LAD left anterior descending coronary
artery, LA left atrium, LM left main coronary artery, RCA right coronary
artery (Reprinted from Shinbane et al. [
35 ] with permission from SAGE
Publications)
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ab
Fig. 22.36 Anomalous coronary artery anatomy with a single coronary ostium arising from the right coronary sinus giving off a left main taking
a retroaortic course and a right coronary artery. ( a ) 3-D reconstruction of the coronary arteries. ( b ) Double-oblique maximal intensity projection
a
b
Fig. 22.37 Origin of the right coronary artery from the pulmonary
artery in a 38-year-old man with chest pain and anomalous anatomy at
cardiac catheterization. Oblique coronal CCTA image (Panel a ) and
volume rendered image (Panel b ) show origin of the right coronary
artery ( arrows ) from the main pulmonary artery. Note the dilated ves-
sels in the septum ( arrowheads in a ), which likely represent dilated
left-to-right collateral arteries that formed due to increased fl ow.
Usually, the left main coronary artery is the more common anomalous
coronary artery originating from the pulmonary artery. The patient’s
presentation in adulthood was also unusual. PA pulmonary artery
(Reprinted from Shriki et al. [ 71 ]; Reproduced with permission from
the Radiological Society of North America, RSNA®.)
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ab
cd
Fig. 22.38 Takeuchi repair of anomalous left coronary artery from the
pulmonary artery with an aortopulmonary window with an intrapulmonary tunnel baffl ing aortic fl ow to the left coronary artery. Panel ( a ) A
3-D reconstruction demonstrating the relationship of the aorta and pulmonary artery to the coronary artery. Panel ( b ) A 3-D reconstruction
with the pulmonary artery made more translucent demonstrating the
aortic baffl e to the left coronary artery. Panels ( c , d ) 2-D double oblique
views demonstrating the baffl ing of aortic fl ow ( black arrows ) to the
left coronary artery tunneled through the pulmonary artery. Ao aorta, PA
pulmonary artery
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a
cd
b
Fig. 22.39 Magnetic resonance imaging assessment in a patient with
ischemic cardiomyopathy showing transmural mid to distal anterior and
inferior wall myocardial infarctions ( arrows ) on delayed gadolinium
enhancement views with viability of basal segments of these walls and
of the lateral territory. Panel ( a ) 4 chamber delayed gadolinium
enhanced view. Panel ( b ) 2 chamber delayed gadolinium enhanced
view. The patient underwent coronary artery bypass graft surgery and
ventricular aneurysmectomy. Panel ( c ) Pre-surgical steady state free
precession 4 chamber view. Panel ( d ) Post-surgical steady state free
precession 4 chamber view
Fig. 22.40 Delayed CT contrast enhancement imaging performed
immediately after cardiac catheterization without contrast reinjection
demonstrating inferior and inferolateral delayed enhancement ( arrows )
on a short axis view
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ab
c
d
Fig. 22.41 CCTA for pre-surgical planning prior to left ventricular
assist device placement. Panel ( a ) A 3-D reconstruction in the context
of skeletal structure. Panel ( b ) A 3-D reconstruction with skeletal struc-
tures removed. Panel ( c ) 2-D axial view demonstrating the location of
the left internal mammary artery graft to the left anterior descending
coronary artery in relation to the sternum. Panel ( d ) 2-D axial view
demonstrating the location of a saphenous vein graft to the circumfl ex
coronary artery in relation to the sternum. Cx circumfl ex coronary
artery, LIMA left internal mammary artery, SVG saphenous vein graft
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Fig. 22.42 Left ventricular assist device for advanced heart failure.
Panel ( a ) A 2-D double oblique thick maximum intensity projection
view demonstrating infl ow conduit/valve ( back arrow ) to the pump, left
ventricular assist device pump ( black double arrow ), and outfl ow con-
duit from the pump ( white arrow ). Panel ( b ). 3-D reconstruction in con-
text of skeletal structures demonstrating infl ow conduit/valve ( back
arrow ) to the pump, left ventricular assist device pump ( black double
arrow ), and outfl ow conduit from the pump ( white arrow )
ab
c
Fig. 22.43 CCTA demonstrating a solitary low attenuation lobulated
left atrial mass measuring 2.4 cm (craniocaudal) with a narrow stalk
attached to the interatrial septum near the fossa ovalis. There were
hyperlucent areas and heterogeneous enhancement with contrast as
well as areas of calcifi cation. There was no involvement of other cardiac structures. Surgical excision was performed with histologic diagnosis of left atrial myxoma with organizing thrombus formation.
Panel ( a ) 3-D reconstruction demonstrating the left atrial mass ( arrow ).
Panel ( b ) 2-D double oblique view demonstrating characteristics of the
mass ( arrow ), including lobulation, a narrow stalk attached to the inter-
atrial septum near the fossa ovalis, and heterogeneity with hyperlucent
areas and heterogeneous enhancement with contrast. Panel ( c ) 3-D
reconstruction of the coronary arteries demonstrating no evidence of
coronary artery disease
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a b
Fig. 22.44 Panel ( a ) Oblique 2-D image demonstrating the relation-
ship of the right coronary artery ( black arrow ) to thickened pericardium
( white arrow ) prior to pericardiectomy in a patient with constrictive
pericarditis. Panel ( b ) Calcifi c constrictive pericarditis ( white arrow ) in
a patient with rheumatic heard disease, mitral valve replacement, and a
dual chamber pacemaker
Fig. 22.45 A large
circumferential effusion
( arrows ) with tissue
attenuation, consistent
proteinaceous material, and
complexity of structure which
required open surgical
dissection
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a
cde
b
Fig. 22.46 A large aortic aneurysm which may impede invasive cardiac catheterization, with multimodal views including Panel ( a ) 3-D
view; Panel ( b ) Curved multiplanar reformat view visualizing the left
anterior descending coronary artery; Panel ( c ) Axial view; Panel ( d )
Coronal view; Panel ( e ) Sagittal view
ab
Fig. 22.47 Aortic dissection making cardiac catheterization challenging for assessment for coronary artery disease. Panel ( a ) 3-D view. Panel ( b )
double oblique 2-D view of an aortic dissection
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