X-ray angiography and magnetic resonance imaging to distinguish interarterial from septal courses of anomalous left coronary artery: an ex vivo heart model.
Publication/Presentation Date
12-1-2009
Abstract
OBJECTIVE: We sought to demonstrate the distinguishing features between interarterial and intraseptal courses of an anomalous left coronary artery from the right sinus of Valsalva (RSV) on X-ray angiography, using an ex vivo model.
BACKGROUND: An anomalous left main coronary artery (LMCA) arising from the RSV can take prepulmonary, retro-aortic, interarterial (IA) or intraseptal (IS) courses, of which only the IA course is associated with sudden death. Anomalous LMCA is usually identified during catheter angiography. On Xray angiography, IA and IS courses have common characteristics that makes their distinction challenging. We hypothesized that the cranialcaudal orientation of the vessel on X-ray angiography allows these pathways to be distinguished, and tested this hypothesis using an ex vivo heart model.
METHODS: Plastic tubing was inserted along the IA and IS courses in an ex vivo normal pig heart. X-ray imaging in standard views and MRI on a 3-T scanner were performed.
RESULTS: In a normally formed heart, an anomalous LMCA with IA path must take a cephalad course, superior to the pulmonary valve. Conversely, an IS vessel will pass caudally, at or below the level of the infundibular septum. These findings were demonstrated in the X-ray angiograms and confirmed by magnetic resonance imaging.
CONCLUSIONS: X-ray angiography can differentiate IA and IS courses of an anomalous LMCA in the normally formed heart. This may obviate the need for further cross-sectional imaging in many cases.
Volume
21
Issue
12
First Page
648
Last Page
652
ISSN
1557-2501
Published In/Presented At
Desai, R. V., Gupta, R., Litovsky, S. H., Nath, H., Gupta, H., Singh, S. P., & ... Lloyd, S. G. (2009). X-ray angiography and magnetic resonance imaging to distinguish interarterial from septal courses of anomalous left coronary artery: an ex vivo heart model. The Journal Of Invasive Cardiology, 21(12), 648-652.
Disciplines
Cardiology | Medical Sciences | Medical Specialties | Medicine and Health Sciences
PubMedID
19966369
Department(s)
Department of Medicine, Cardiology Division, Department of Medicine Faculty
Document Type
Article