Imaging Pearls ❯ Chest ❯ Cardiac Surgery
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- “CT is a useful technique as part of a multi-modality approach in the evaluation of LVADs and associated complications. Recent studies continue to build on the prognostic role of measuring skeletal muscle CT attenuation in predicting adverse LVAD outcomes, and on the value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in the evaluation of suspected LVAD infection. Though CT is very useful for the diagnosis of outflow graft obstruction, it often lacks the diagnostic capability to differentiate between intraluminal thrombus and extrinsic compression from biodebris accumulation. Newer CT techniques such as dual-energy CT and metal artifact reduction algorithms, though promising, lack high-quality published literature on their use in LVAD imaging.”
Update on CT Imaging of Left Ventricular Assist Devices and Associated Complications
Pratik S. Velangi et al.
Current Cardiovascular Imaging Reports 2022 (in press) https://doi.org/10.1007/s12410-022-09570-0 - “LVAD infections can occur on body surfaces in proximity to the device or on device hardware itself. Driveline infections can extend deeper to involve the pump or other components. They are often seen as rim-enhancing fluid collections, soft tissue stranding, or gas pockets adjacent to device components. Though the incremental value of cardiac CT in addition to echocardiography is being recognized for the diagnosis of prosthetic heart valve endocarditis in non-LVAD patients its diagnostic accuracy for infection in LVAD patients is limited due to device-related artifacts.”
Update on CT Imaging of Left Ventricular Assist Devices and Associated Complications
Pratik S. Velangi et al.
Current Cardiovascular Imaging Reports 2022 (in press) https://doi.org/10.1007/s12410-022-09570-0 - “Recent studies continue to build on the prognostic role of measuring skeletal muscle CT attenuation in predicting adverse LVAD outcomes, and on the value of 18F-fluorodeoxyglucose positron emission tomographycomputed tomography (FDG PET-CT) in the evaluation of suspected LVAD infection. Though CT is very useful for the diagnosis of outflow graft obstruction, it often lacks the diagnostic capability to differentiate between intraluminal thrombus and extrinsic compression from biodebris accumulation. Newer CT techniques such as dual-energy CT and metal artifact reduction algorithms, though promising, lack high-quality published literature on their use in LVAD imaging.”
Update on CT Imaging of Left Ventricular Assist Devices and Associated Complications
Pratik S. Velangi et al.
Current Cardiovascular Imaging Reports 2022 (in press) https://doi.org/10.1007/s12410-022-09570-0
- “ Postoperative complications seen at CT angiography that require further intervention include pseudoaneurysms, anastomotic stenoses, dissections, and aneurysms.”
Ascending Thoracic Aorta: Postoperative Imaging Evaluation
Prescott-Focht JA et al.
RadioGraphics 2013;33:73-85 - “ Despite advances in prosthetic heart valve design, surgical technique, and postoperative care, complications after aortic valve replacement remain a leading cause of morbidity and mortality. Routine surveillance of prosthetic heart valves with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and fluoroscopy is important, as these techniques allow accurate detection of prosthetic valve dysfunction. However, echocardiography and fluoroscopy may not allow identification of the specific underlying cause, including paravalvular leak, dehiscence, endocarditis, obstruction, structural failure, pseudoaneurysm formation, aortic dissection, and hemolysis.”
Complications of aortic valve surgery: manifestations at CT and MR imaging.
Pham N et al.
Radiographics. 2012 Nov-Dec;32(7):1873-92. - “ However, echocardiography and fluoroscopy may not allow identification of the specific underlying cause, including paravalvular leak, dehiscence, endocarditis, obstruction, structural failure, pseudoaneurysm formation, aortic dissection, and hemolysis.”
Complications of aortic valve surgery: manifestations at CT and MR imaging.
Pham N et al.
Radiographics. 2012 Nov-Dec;32(7):1873-92. - “Magnetic resonance (MR) imaging and computed tomography (CT) have an emerging role as diagnostic tools complementary to conventional imaging for detection and monitoring of complications after aortic valve replacement. The choice between CT and MR imaging depends on individual patient characteristics, the type of prosthetic valve, and the acuity of the clinical situation. In general, screening with TTE followed by TEE is recommended. When results of TTE and TEE are inconclusive, cardiac CT and MR imaging should be considered. The choice between these imaging techniques depends on the presence of patient-specific contraindications to CT or MR imaging.”
Complications of aortic valve surgery: manifestations at CT and MR imaging.
Pham N et al.
Radiographics. 2012 Nov-Dec;32(7):1873-92. - “Magnetic resonance (MR) imaging and computed tomography (CT) have an emerging role as diagnostic tools complementary to conventional imaging for detection and monitoring of complications after aortic valve replacement. The choice between CT and MR imaging depends on individual patient characteristics, the type of prosthetic valve, and the acuity of the clinical situation.”
Complications of aortic valve surgery: manifestations at CT and MR imaging.
Pham N et al.
Radiographics. 2012 Nov-Dec;32(7):1873-92. - “MDCT and transthoracic echocardiography (TTE) were done to evaluate pannus formation, prosthetic valve dysfunction, suture loosening (paravalvular leak) and pseudoaneurysm formation. Patients indicated for surgery received an operation within 1 week. The MDCT findings were compared with the operative findings. One patient with a Björk-Shiley valve could not be evaluated by MDCT due to a severe beam-hardening artifact; thus, the exclusion rate for MDCT was 3.2% (1/31). Prosthetic valve disorders were suspected in 12 patients by either MDCT or TTE. Six patients received an operation that included three redo aortic valve replacements, two redo mitral replacements and one Amplatzer ductal occluder occlusion of a mitral paravalvular leak.”
Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard
Tsai IC et al.
Eur Radiol. 2009 Apr;19(4):857-67. - “The concordance of MDCT for diagnosing and localizing prosthetic valve disorders and the surgical findings was 100%. Except for images impaired by severe beam-hardening artifacts, MDCT provides excellent delineation of prosthetic valve disorder.”
Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard
Tsai IC et al.
Eur Radiol. 2009 Apr;19(4):857-67. - “Coronary artery anastomotic dehiscence is a rare complication following aortic root repair in Marfan's disease. In this patient who presented several years after surgery with mediastinal and chest wall hematoma, gated IV contrast enhanced cardiac CT was able to noninvasively localize left main coronary artery anastomotic dehiscence as the source of bleeding.”
Dehiscence of coronary artery graft presenting as a right breast mass
Samet JD, Johnson PT, Fishman EK Cardiovasc Comput Tomogr. 2011 May-Jun;5(3):180-2 - “Currently, there are two main types of surgical correction, the Bentall procedure or composite graft with aortic valve replacement, and aortic valve-sparing. Both procedures have low operative risk. Since a prosthetic valve is used in the Bentall procedure, it is associated with higher rates of thromboembolism, and thus these patients must be anti-coagulated. The valve-sparing procedure has lower rates of thromboembolism given the native aortic valve, but re-operation rates have been shown to be higher than the Bentall procedure. Patients who undergo the Bentall procedure have lower late survival rates, but this is likely due to its preferred use in emergent higher risk cases.”
Dehiscence of coronary artery graft presenting as a right breast mass
Samet JD, Johnson PT, Fishman EK Cardiovasc Comput Tomogr. 2011 May-Jun;5(3):180-2 - Acute Mediastinitis: Etiology
- Postoperative complications
- Esophageal perforation
- Extension of osteomyelitis from adjacent bone
- Descending necrotizing mediastinitis
- Hematogenous spread of infection - Acute Mediastinitis: CT Findings
- Increased attenuation of mediastinal fat
- Free gas bubbles in the mediastinum
- Localized fluid collections
- Enlarged lymph nodes
- Pleural effusions
- Empyema
Nonvascular, Nontraumatic Mediastinal Emergencies in Adults: A Comprehensive Review of Imaging Findings
Katabathina VS et al.
RadioGraphics 2011; 31:1141-1160 - “ Acute mediastinitis occurs in 0.5%-5% of patients who underwent median sternotomy and has a reported mortality rate of 7%-80%. Staphylococcus aureus is the most common causitive microorganism of postoperative acute mediastinitis.”
Nonvascular, Nontraumatic Mediastinal Emergencies in Adults: A Comprehensive Review of Imaging Findings
Katabathina VS et al.
RadioGraphics 2011; 31:1141-1160 - “ The presence of mediastinal gas bubbles and fluid collections on CT images after the 14th postoperative day has sensitivity and specificity approaching 100% for the diagnosis of acute mediastinitis.”
Nonvascular, Nontraumatic Mediastinal Emergencies in Adults: A Comprehensive Review of Imaging Findings
Katabathina VS et al.
RadioGraphics 2011; 31:1141-1160 - Sternal Dehiscence on CT
- Displacement of sternal wires
- Rotation of sternal wires
- Fracture of sternal wires
- Widening of mediastinal stripe