Identification of Unexpected Nonatherosclerotic Cardiovascular Disease With Coronary CT Angiography
Thomas Knickelbine, MD*,
John R. Lesser, MD*,
Tammy S. Haas, RN ,
Eric R. Brandenburg, BS*,
B. Kelly Gleason-Han, MD ,
Björn Flygenring, MD*,
Terrence F. Longe, MD*,
Robert S. Schwartz, MD*,
Barry J. Maron, MD,*
* Cardiovascular Services, Minneapolis Heart Institute, Minneapolis, Minnesota
Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
Children's Heart Clinic, Minneapolis, Minnesota
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Figure 1 Variety of Structural Cardiac Abnormalities Identified Fortuitously by Multidetector Computed Tomography Angiography
The most common structural cardiac abnormalities were congenital coronary anomalies; aortic aneurysm; and hypertrophic cardiomyopathy (HCM), apical variety. LA = left atrial.
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Figure 2 Congenital Coronary Anomalies Identified by Multidetector Computed Tomography Angiography
(A) From a 56-year-old man with chest pain. Volume-rendered image (in superior to inferior orientation) showing anomalous right coronary artery origin from the left aortic sinus with an interarterial course (between aorta [Ao] and pulmonary artery [PA]) (arrow). (A') Same patient shown in panel A. Coronal-axis plane demonstrates a slit-like right coronary artery ostia situated cephalad to the level of pulmonary valve (blue arrow). (B) Volume-rendered image from a 50-year-old woman with chest pain and exertional dyspnea shows left anterior descending coronary artery (arrows) origin from right aortic sinus, coursing anterior to the pulmonary artery. (C) Volume-rendered image from a 36-year-old man with exertional chest pain while biking, shows long tortuous fistula between left anterior descending coronary artery (LAD) and PA (arrow). AV = aortic valve; CorCTA = coronary computed tomography angiography; DIAG = diagonal coronary artery branch; LV = left ventricle.
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Figure 3 Bicuspid AV
(A) Short-axis view in diastole at the level of the aortic sinuses from a 64-year-old woman showing both aortic leaflets in the closed position (arrow). (B) Short-axis view from a 52-year-old man during systole with the valve open. A fused and calcified raphe is also evident (arrow). (C) Coronal long-axis in diastole from a 64-year-old man presenting with chest pain. Calcified bicuspid aortic valve is associated with dilation of ascending Ao (arrow). Abbreviations as in Figure 2.
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Figure 4 Spectrum of Structural Abnormalities of the LV, Unexpectedly Identified by Multidetector Computed Tomography Angiography
(A) Diastolic coronal view from a 69-year-old woman with HCM and exertional dyspnea shows LV wall thickening located predominantly in the distal (apical) portion of the chamber, associated with a thin-walled apical aneurysm (arrow). (B) Distal short-axis from a 52-year-old man shows "spongy" LV noncompaction with deep sinusoids and a diagnostic ratio of noncompacted (17 mm) to compacted myocardium (5 mm) of 3.4 who subsequently received a prophylactic implantable defibrillator. (B') Long-axis image from same patient with LV noncompaction shown in B. (C) Long-axis from 49-year-old woman with chest pain; left atrial myxoma (arrow) is attached by a short, atypically positioned stalk to the mitral annulus at the base of ventricular septum. The mass was resected surgically. (D) Four-chamber view from a 49-year-old woman with chest pain and small membranous ventricular septal aneurysm with defect (arrows). LV contrast is evident within the aneurysm. VS = ventricular septum; other abbreviations as in Figures 1 and 2.
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