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ABSTRACT: OBJECTIVES: Higher rates of incomplete revascularization (IR) and reduced patency are possible drawbacks of off-pump coronary artery bypass grafting (OPCAB); both may adversely affect outcome after surgery. This study was conducted to shed light on the relationships among IR, angiographic patency, and midterm results after OPCAB surgery. METHODS: A total of 1604 consecutive patients underwent OPCAB during a 6-year period; 1581 patients (95%) underwent systematic postoperative angiography. Complete follow-up was achieved in 99.5% (median, 3.2 years; up to 6.5 years). A total of 216 patients had IR (13%), and 225 had at least 1 graft failure (FitzGibbon B or O). RESULTS: All the event-free survival rates for all-cause mortality (P < .001), cardiac death (P = .020), and major adverse cardiac and cerebrovascular events (P < .001) were lower in the IR group. By using the Cox proportional hazards model, IR was an independent risk factor for all-cause mortality (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.15-2.81). Of those who underwent postoperative angiography, the patients with graft failure experienced reintervention more frequently than those with all grafts patent (HR, 5.49; 95% CI, 3.43-8.77). Even with excluding patients who had undergone reintervention immediately after angiography, graft failure was still an independent risk factor for reintervention afterwards (HR, 2.41; 95% CI, 1.30-4.47). CONCLUSIONS: Incomplete revascularization was relevant to higher midterm mortality after OPCAB, whereas the risk of reintervention was higher for patients with occluded grafts. Complete revascularization, coupled with achievement of a higher patency rate, could be expected to improve follow-up outcomes after OPCAB surgery.
The Journal of thoracic and cardiovascular surgery 04/2013; · 3.41 Impact Factor
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ABSTRACT: OBJECTIVES: Cerebral complications of infective endocarditis (IE) [particularly, mycotic aneurysm, visualized as a hypointense spot on T2*-weighted brain magnetic resonance imaging (MRI)] are associated with a high incidence of postoperative cerebral or subarachnoid hemorrhage. We have adopted a policy of performing elective open heart surgery after performing a MRI enhanced by gadolinium in such patients whenever possible after improvement in inflammatory findings around a cerebral aneurysm. METHODS: Fifty-six patients (35 men and 21 women, mean age 56 years) diagnosed with active-phase IE between January 2000 and December 2010 were analysed retrospectively. RESULTS: Six patients who had not undergone MRI were excluded. The remaining patients were classified into four groups according to preoperative brain MRI findings-Group A (n = 13): cerebral haemorrhage, cerebral infarction, abscess and encephalitis; Group B (n = 7): simple or multiple black dots ( = hypointensive spots) with cerebral haemorrhage or cerebral infarction; Group C (n = 15): simple or multiple black dots alone; Group D (n = 15): no abnormal MRI findings. None of the 12 patients who successfully underwent elective surgery in Groups B and C developed postoperative cerebral complications. CONCLUSIONS: Brain MRI is an important tool for the detection of asymptomatic intracranial abnormalities associated with IE and evaluation of the preoperative bleeding risk of patients. Patients with contrast enhancement around black dots are at high risk for bleeding, and performing open heart surgery in such patients whenever possible after the improvement of inflammatory findings reduces the potential risk of cerebral haemorrhage.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2013; · 2.40 Impact Factor
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ABSTRACT: The stroke rate after coronary artery bypass grafting (CABG) compared to percutaneous coronary intervention (PCI) is generally considered high because cardiopulmonary bypass and aortic manipulations are often associated with cerebrovascular complications. However, an increasing number of CABGs performed without cardiopulmonary bypass (OPCAB) may improve those outcomes. Of 6,323 patients with multivessel and/or left main coronary artery disease, 3,877 patients underwent PCI, 1,381 conventional on-pump CABG, and 1,065 OPCAB. Median follow-up was 3.4 years. Stroke types were classified as early (onset of stroke within 24 hours after revascularization), delayed (within 30 days), and late (after 30 days). Propensity score analysis showed that the incidences of early, delayed, and late stroke did not differ between PCI and OPCAB (0.65, 95% confidence interval 0.08 to 5.45, p = 1.00; 0.36, 0.10 to 1.29, p = 0.23; 0.81, 0.52 to 1.27, p = 0.72, respectively). In contrast, incidence of early stroke after on-pump CABG was higher than after OPCAB (7.22, 1.67 to 31.3, p = 0.01), but incidences of delayed and late stroke were not different (1.66, 0.70 to 3.91, p = 0.50; 1.18, 0.83 to 1.69, p = 0.73). In conclusion, occurrence of stroke was not found to differ in patients after PCI versus OPCAB regardless of onset of stroke. Occurrence of early stroke after OPCAB was lower than that after on-pump CABG, yet occurrences of delayed and late strokes were similar for the 3 revascularization strategies.
The American journal of cardiology 09/2012; · 3.58 Impact Factor
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Hiroki Shiomi,
Takeshi Morimoto,
Mamoru Hayano,
Yutaka Furukawa,
Yoshihisa Nakagawa,
Junichi Tazaki,
Masao Imai,
Kyohei Yamaji,
Tomohisa Tada,
Masahiro Natsuaki, [......],
Mitsuomi Shimamoto,
Noboru Nishiwaki,
Yutaka Imoto,
Tatsuhiko Komiya,
Minoru Horie,
Hisayoshi Fujiwara,
Kazuaki Mitsudo,
Masakiyo Nobuyoshi,
Toru Kita,
Takeshi Kimura
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ABSTRACT: The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.
The American journal of cardiology 06/2012; 110(7):924-32. · 3.58 Impact Factor
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ABSTRACT: The management of congenitally corrected transposition of the great arteries and associated lesions is frequently challenging. Restrictive ventricular septal defect and mild pulmonary stenosis are contraindications to the double switch procedure, including the atrial-Rastelli switch procedure, due to the production of postoperative left ventricular outflow tract obstruction. We describe a case of aortic translocation using the hemi-Mustard procedure after left ventricular training in order to prevent postoperative left ventricular outflow obstruction.
The Annals of thoracic surgery 05/2012; 94(3):996-8. · 3.74 Impact Factor
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ABSTRACT: Fibrin glue is effective for maintaining hemostasis after anastomosis and for filling needle holes after cardiothoracic and vascular surgery, but few experimental studies concerning methods of application to obtain more effective hemostasis have been reported.
Bolheal was used as the fibrin glue. Fibrinogen solution (A, 0.3 ml) and thrombin solution (B, 0.3 ml), components of fibrin glue, were applied to the needle holes by the following four methods: group 1 (n = 8), drip method; group 2 (n = 8), spray method; group 3 (n = 8), rub-and-spray method; group 4 (n = 8), rub-andrub method. Additional studies were done in groups 3 and 4 to evaluate the hemostatic effect with different curing times and temperatures.
The pressure at which the fibrin sealant ruptured were significantly higher in group 3 (109 ± 16 mmHg) and group 4 (113 ± 7) (for both groups: P < 0.05 vs. group 1 (22 ± 8) and group 2 (64 ± 10)). The pressure increased with prolongation of the curing time, and significant differences were noted between the pressures at ≥ 2 min and that at 30 s (both groups: P < 0.05 vs. 30 s). The curing temperature had no significant influence in the two groups. Microscopically, the glue effectively plugged the needle holes in groups 3 and 4.
Compared with the current drip and spray methods, more effective hemostasis was obtained by rubbing on the fibrin glue.
General Thoracic and Cardiovascular Surgery 03/2012; 60(3):140-4.
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ABSTRACT: Atrial cycle length during atrial fibrillation and flutter waves may be correlated with atrial refractoriness and organization. The nature of the frequency by spectral analysis may reflect a profile of atrial cycle length. In this study, we developed a novel body surface 2-dimensional spectral map during fibrillation using vector-projected 187 channel ECG (187ch VP-ECG).The study consisted of 28 patients (24 with atrial fibrillation (AFIB) and 4 atrial flutter (AFL) with valvular heart disease). We performed spectral analysis by maximum entropy modeling (MEM) in 4 second nonaveraged 187ch electrical current waves by 187ch VP-ECG. Body surface spectral features were displayed according to the frequency and power magnitude components. We verified the accuracy of the spectral features by a 64ch magnetocardiography (MCG). The average dominant frequency in AFL by 187ch VP-ECG was lower than those in AFIB (4.6 ± 0.9 Hz in AFL, 7.2 ± 0.9 Hz in AFIB, P < 0.01). Comparison of average dominant frequency between 187ch VP-ECG and 64 ch MCG demonstrated good agreement (y = 0.86x+0.84, r(2) = 0.89, P < 0.0001). Body surface 2-dimensional spectral features demonstrated homogenous spectrum patterns in AFL, and in-homogenous spectrum patterns in AFIB.In conclusion, novel body surface spectral mapping using 187ch VP-ECG may represent a 2-dimensional spectral feature that may be related to atrial refractoriness and organization.
International Heart Journal 01/2012; 53(1):5-10. · 1.16 Impact Factor
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ABSTRACT: A 72-year-old man presented with a papillary fibroelastoma on the non-coronary cusp of the aortic valve. He was asymptomatic, with a history of hypertension and paroxysmal atrial fibrillation. Echocardiography revealed a mobile, round mass (13 × 15 mm) on the non-coronary cusp of the aortic valve. Scanning with 320-slice multi-detector row computed tomography (MDCT) also revealed a mass on the non-coronary cusp of the aortic valve. The tumor was subsequently excised from the aortic valve. In this case, the MDCT images were extremely clear and provided useful information like that obtained with echocardiography.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 07/2011; 17(5):518-20.
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ABSTRACT: Bartonella quintana, known to cause various clinical symptoms, is increasingly recognized as one important cause of culture-negative endocarditis. We report a case of infectious endocarditis with B. quintana on the prosthetic valve, accompanied by proteinase 3-antineutrophil cytoplasmic antibody-positive collagen vascular disease-like symptoms 1 year earlier.
Diagnostic microbiology and infectious disease 07/2011; 70(3):395-8. · 2.45 Impact Factor
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Hitoshi Okabayashi
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ABSTRACT: Treatment for acute myocardial infarction changed with improvement of coronary intervention. Most of acute myocardial infarction can be treated by coronary intervention, and number of emergent coronary artery bypass cases decreased. But, treatment of postinfarction mechanical complication is impossible by catheter intervention, and emergent surgical treatment is necessary. Major postinfarction mechanical complications are cardiac rupture, ventricular septal rupture and papillary muscle rupture. Results of surgical treatment for postinfarction mechanical complications are not satisfactory and early diagnosis and early surgical treatment can improve treatment outcome.
Kyobu geka. The Japanese journal of thoracic surgery 07/2011; 64(8 Suppl):618-23.
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Masahiro Natsuaki,
Yutaka Furukawa,
Takeshi Morimoto,
Yoshihisa Nakagawa,
Masaharu Akao,
Koh Ono,
Tetsuo Shioi,
Satoshi Shizuta,
Ryuzo Sakata, Hitoshi Okabayashi,
Noboru Nishiwaki,
Tatsuhiko Komiya,
Satoru Suwa,
Takeshi Kimura
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ABSTRACT: Among hemodialysis (HD) patients, those who have diabetes have poorer cardiovascular outcomes than non-diabetic patients, but the impact of diabetes on cardiovascular outcomes has not been fully elucidated in HD patients undergoing coronary revascularization.
We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P < 0.0001; adjusted hazard ratio (HR) 1.29, P < 0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P < 0.0001; HR 1.36, P < 0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P < 0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE.
HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes.
Circulation Journal 06/2011; 75(7):1616-25. · 3.77 Impact Factor
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ABSTRACT: Sinus node dysfunction is commonly associated with atrial fibrillation. There is little information about the long-term results of pulmonary vein isolation in relation to sinus node function. The present study was conducted to investigate whether sinus node dysfunction affects the late outcome of pulmonary vein isolation in patients with persistent/permanent atrial fibrillation.
Among 76 consecutive patients with persistent/permanent atrial fibrillation who had undergone cut-and-sew pulmonary vein isolation, 66 patients without evidence of intra-atrial thrombus by transesophageal echography, and who were able to tolerate cardioversion, were enrolled. Sinus node recovery time after cardioversion was examined intraoperatively. All of the patients underwent valvular surgery concomitantly (mitral in 62).
Sinus node dysfunction was detected in 18 patients. These patients had a significantly lower f wave voltage in V(1) of the electrocardiogram and a larger cardiothoracic ratio than patients with normal sinus node function. Hospital mortality was 3%, and 3 late deaths were observed. Follow-up was conducted for up to 72 months (mean 30 months), with a 100% complete follow-up rate. There were no significant differences in actuarial survival and freedom from cardiac events between patients with normal and abnormal sinus node function. No thromboembolic events occurred. A significantly higher proportion of patients with normal sinus node function (82%) were free of atrial fibrillation at 4 years than patients with sinus node dysfunction (25%; P < .0001).
The atrial fibrillation cure rate after pulmonary vein isolation may be influenced by sinus node function in both the early and late stages. Although further examinations are required, pulmonary vein isolation may be an adequate treatment for persistent/permanent atrial fibrillation in patients with normal sinus node function.
The Journal of thoracic and cardiovascular surgery 06/2011; 141(6):1455-60. · 3.41 Impact Factor
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ABSTRACT: We performed echocardiographic tissue tracking to investigate whether mitral valve repair preserves left ventricular function.
We studied 16 subjects without heart disease (11 male; mean age, 54.6 ± 15.1 years) and 18 patients in normal sinus rhythm undergoing solitary mitral valve repair (12 male; mean age, 53.6 ± 16.6 years). Transthoracic echocardiography was performed before and after surgery, and left ventricular apical and basal short-axis images were recorded. Left ventricular rotation angle was measured with off-line Vector Velocity Imaging (Siemens Medical Solutions USA Inc, Mountain View, Calif) at each slice level.
Left ventricular ejection fraction was significantly higher in the control (68.4% ± 3.6%) and preoperative groups (70.9% ± 6.5%) than the postoperative group (59.4% ± 11.4%, P < .05). Left ventricular end-diastolic and end-systolic volumes were significantly greater in the preoperative group than the control group (130.0 ± 41.5 mL and 41.6 ± 16.6 mL vs 80.0 ± 16.7 mL and 26.6 ± 9.2 mL, respectively, P < .05). Left ventricular end-diastolic volume normalized postoperatively. Left ventricular twist was significantly greater in the preoperative group than the other groups (11.7° ± 4.1° versus 7.1° ± 3.8° and 8.2° ± 5.7°, P < .05). Left ventricular twist did not differ significantly between control and postoperative groups. New York Heart Association functional class improved from 1.6 ± 0.5 to 1.0 ± 0.0 after surgery (P < .05).
Although preoperative left ventricular ejection fraction seemed normal, left ventricular twist was greater. Left ventricular twist normalized after surgery, suggesting that it preserves left ventricular function.
The Journal of thoracic and cardiovascular surgery 03/2011; 141(3):716-24. · 3.41 Impact Factor
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ABSTRACT: Case 1 was a 20-year-old male who had been involved in a traffic accident and developed aortic regurgitation (AR) eight months later. He was admitted with dilatation of the left ventricle. Transesophageal echocardiography (TEE) showed severe AR with perforation of the right coronary cusp. Case 2 was a 50-year-old male who had fallen from a height four months previously, and was admitted with congestive heart failure due to severe AR. TEE showed severe AR due to rupture of the right coronary cusp. In the former patient, valve repair was performed with a patch of autologous pericardium. In the latter patient, cusp reconstruction was performed with autologous pericardium and the commissural plication technique, achieving successful aortic valve repair.
Interactive cardiovascular and thoracic surgery 02/2011; 12(5):869-71.
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ABSTRACT: Spinal cord ischemia (SCI) is one of the most serious complications in patients who undergo thoracic endovascular aortic repair (TEVAR). The incidence of SCI after TEVAR has been supposed to be lower than the one after traditional open surgical repair. However, not a few cases regarding SCI after TEVAR have been reported recently. Since the detailed mechanism of the SCI is still not fully understood, preventive strategies against SCI including preoperative identification of critical segmental artery (CSA) applying the artery of Adamkiewicz, preservation of the CSA, motor evoked potential (MEP) monitoring, and cerebrospinal fluid (CSF) drainage are routinely performed during TEVAR in our practice.
Kyobu geka. The Japanese journal of thoracic surgery 01/2011; 64(1):56-61.
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Katsuo Nishi,
Kiyoyuki Eishi,
Yoshisada Shibata,
Jun Amano,
Tatsuo Kaneko, Hitoshi Okabayashi,
Yoshiharu Takahara,
Shuichiro Takanashi,
Kazuo Tanemoto,
Hiroki Yamaguchi,
Kohei Kawazoe
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ABSTRACT: To elucidate the effects of prosthetic valve sound on a patient's quality of life (QOL).
We compared the valve sounds of ATS, SJM, and Carbomedics (CM) based on assessments by 248 patients who underwent mechanical valve replacements from January 2000 to August 2003 at seven facilities in Japan. We used a self-administered questionnaire for evaluating patients' assessments of valve sounds and the Japanese version of SF-36 for measuring their health-related QOL.
With respect to the valve-sound level perceived immediately after surgery, we considered the ATS and SJM valves quieter than the CM valve, but others have considered the ATS valve quieter than the SJM and CM valves. Regarding the time when the valve sound stopped bothering patients, a significant difference was observed between the ATS and CM valves and between the SJM and CM valves. The logistic regression analysis on patients' perceptions of valve sounds indicated that the influences of age, gender, and valve position are significant. Furthermore, a survey with SF-36 indicated that a long valve sound will affect a patient's health-related QOL.
The present study suggested that the ATS valve surpassed the other two valves on the whole in audibility of valve sound and patient health-related QOL. However, further studies, including the ongoing prospective study, are necessary for a more comprehensive and accurate evaluation of the ATS valve.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 12/2010; 16(6):410-6.
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ABSTRACT: Takayasu's aortitis patients present a variety of symptoms, including angina pectoris, aortic valve regurgitation, and aortic branch stenosis. The case described in this paper primarily presented with angina pectoris. Close investigation revealed a left coronary artery ostium lesion, an aortic root aneurysm, and a mild aortic regurgitation. The patient underwent a modified Bentall operation with saphenous vein graft (SVG) replacement of the left main trunk. The postoperative course was uneventful, and the patient received oral steroid therapy. SVG is a useful option in treating aortic root aneurysm with an ostium lesion.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 10/2010; 16(5):373-5.
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Kenji Nakai,
Shin Takahashi,
Atsushi Suzuki,
Nobuhisa Hagiwara,
Keisuke Futagawa,
Morio Shoda,
Tsuyoshi Shiga,
Ken Takahashi, Hitoshi Okabayashi,
Manabu Itoh,
Hiroshi Kasanuki
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ABSTRACT: The noninvasive evaluation of ventricular T-wave alternans (TWA) in patients with lethal ventricular arrhythmias is an important issue. In this study, we propose a novel algorithm to identify T-wave current density alternans (TWCA) using synthesized 187-channel vector-projected body surface mapping (187-ch SAVP-ECG). We recorded 10 min of 187-ch SAVP-ECG using a Mason-Likar lead system in the supine position. A recovery time (RT) dispersion map was obtained by averaging the 187-ch SAVP-ECG. The TWCA value was determined from the relative changes in the averaged current density in the T-wave zone (Tpeak ± 50 ms) for two T-wave types. We registered 20 ECG recordings from normal controls and 11 ECG recordings from nine subjects with long QT syndrome (LQT). We divided LQT syndrome subjects into two groups: group 1 provided 9 ECG recordings without visually apparent TWAs, and group 2 provided 2 ECG recordings with visually apparent TWAs. The QTc interval values in the LQT groups were higher than those in the control (515 ± 60 ms in LQT G-1, 600 ± 27 ms in LQT G-2 vs. 415 ± 19 ms in control, P < 0.001). The RTendc dispersion values among the LQT subjects were higher than those of the control subjects (48 ± 19 ms in LQT G-1, 65 ± 30 ms in LQT G-2 vs. 24 ± 10 ms in control, P < 0.01). The mean TWCA value was significantly higher in the LQT G-2 group with visually apparent TWCAs (0.5 ± 0.2% in control, 2.1 ± 1.2% in LQT G-1, and 32.3 ± 6.9% in LQT G-2). Interestingly, the two-dimensional distribution of TWCA in LQT was inhomogeneous and correlated with the distribution of increased RT dispersion. We conclude that a novel algorithm using 187-ch SAVP-ECG might provide new insights into body surface TWCA.
Heart and Vessels 10/2010; 26(2):160-7. · 2.05 Impact Factor
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ABSTRACT: Scar formation in the carotid sheath is often identified during carotid endarterectomy (CEA) in patients with previous cardiac surgery, and dissection of the carotid sheath and exposure of the carotid arteries in such patients are difficult. The purpose of the present study was to investigate factors related to scar formation identified during CEA in patients with previous cardiac surgery.
Twenty-three patients with internal carotid artery stenosis (≥ 70%) and previous cardiac surgery underwent CEA. A patient was prospectively defined as having scar formation during CEA when scissors were required throughout dissection of the carotid sheath and exposure of the carotid arteries.
Scar formation was identified during dissection of the carotid sheath in 7 patients (30.4%). In all 7 patients, the side of CEA was identical to the side on which the Swan-Ganz catheter was inserted during cardiac surgery, and the incidence of previous ipsilateral Swan-Ganz catheter insertion was significantly higher in patients with the scar formation (100%) than in those without (31.3%). Seven (58.3%) of 12 patients with a history of ipsilateral Swan-Ganz catheter insertion had scar formation. Two of the 7 patients with scar formation experienced complications after CEA, including one patient with hemiparesis due to artery-to-artery embolism during surgery, and another patient with transient vocal cord paralysis.
A history of Swan-Ganz catheter insertion during previous cardiac surgery is associated with the presence of scar tissue in the ipsilateral carotid sheath and a higher risk of complications during CEA.
Journal of Neurosurgery 10/2010; 113(4):885-9. · 2.96 Impact Factor
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ABSTRACT: This study was conducted to assess the diagnostic value of cardiac CT for the evaluation of patients with bicuspid aortic valve disease.
Fifty consecutive patients with aortic stenosis who underwent surgical valve repair between September 2005 and November 2006 were examined by ECG-gated CT and echocardiography. A 64-MDCT scanner was used. The image findings regarding the number of leaflets (bicuspid or tricuspid) were compared against the intraoperative findings and were statistically analyzed by one-way univariate analysis of variance. The aortic valve area (AVA) was also measured by CT and echocardiography, and the measured values were statistically compared by use of the paired Student's t test.
Seventeen patients had a bicuspid aortic valve, and 33 had a tricuspid aortic valve. In 10 of the 50 patients, echocardiography was unable to depict the type of aortic valve because of extensive calcification. The sensitivity, specificity, positive predictive value, and negative predictive value for the detection of a bicuspid aortic valve were 76.5%, 60.6%, 68.4%, and 95.2%, respectively, for echocardiography and 94.1%, 100%, 100%, and 97.1%, respectively, for CT. The CT findings were not significantly different from the intraoperative findings (p = 0.99), but the echocardiographic findings were (p < 0.05). The AVA measurements obtained by CT and echocardiography were 0.940 ± 0.44 cm(2) and 0.659 ± 0.234 cm(2), respectively, showing a significant difference (p < 0.05).
ECG-gated cardiac CT is useful for the accurate morphologic assessment of bicuspid aortic stenosis, especially in patients with severe valve calcification.
American Journal of Roentgenology 10/2010; 195(4):895-9. · 2.78 Impact Factor
