Eur J Cardiothorac Surg 2006;30:813-814
© 2006 Elsevier Science NL
Coronary artery imaging with 64-slice computed tomography from cardiac surgical perspective
Ronit Lavia,*,
Shahar Lavib
a Divisions of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First St. S.W., Rochester, MN 55905, USA
b Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St. S.W., Rochester, MN 55905, USA
Received 29 June 2006;
received in revised form 29 June 2006;
accepted 23 August 2006.
* Corresponding author. Tel.: +1 507 2547510; fax: +1 507 2800325. (Email: lavi.ronit{at}mayo.edu).
Key Words: Cardiac CT • Cardiovascular surgeon • Coronary artery disease • Cardiac surgery
We read with great interest the article by Plass and colleagues [1].
We have the following comments:
- 1. As mentioned in the text, there is a significant bias in the CT interpretation since a radiologist conducted a preselection of CT images for the surgeons. It is mentioned that the cardiac surgeons were blinded to the patients’ medical history but not the radiologist. Moreover, patients with coronary disease had relatively significant disease, while the control group had valvular disease and could be relatively easily identified. This potential bias increases the accuracy of the CT.
It might be interesting to compare the cardiovascular surgeons and experienced cardiologist/radiologist interpretations in both methods.
- 2. There was no need to administer B blockers, but the average heart rate was 65 beats/min. How many of the patients were on beta blockers? What was the heart rate of patients in the 23% (11/50) group? How many of the impaired image quality groups were of the control valvular disease group?
- 3. One of the best qualities of cardiac CT is its ability to rule out coronary artery disease. This was previously found to be useful in the evaluation of patient before aortic valve replacement [2,3]. The negative predictive value in this article is high in both groups.
This is an important conclusion that we believe should be emphasized.
- 4. The focus of the article is the coronary evaluation of the cardiac patient performed by a cardiovascular surgeon with two different methods. Although most surgeons are familiar with coronary angiograms, this is not the case for cardiac CT. It is not mentioned what was the training of the surgeons for interpretation of the cardiac CT. We believe it is worth mentioning other data that can be measured from the cardiac CT and is valuable for the cardiovascular surgeon. A cardiac CT is an excellent method for the assessment of the aortic valve area and structure. In patients undergoing reoperative cardiac surgery, the cardiac CT can localize vital mediastinal structures, identify patients at higher risk for injury to the aorta and right ventricle and prevent left internal mammary artery graft injury during sternal reentry [4]. Quantification of RV and LV volumes and systolic function was proved to be accurate with multi detector cardiac CT [5].
This data is invaluable for the cardiovascular surgeon in order to help the physician tailor the most suitable surgery plane for each patient.
References
- Plass A, Grunenfelder J, Leschka S, Alkadhi H, Eberli FR, Wildermuth S, Zund G, Genoni M. Coronary artery imaging with 64-slice computed tomography from cardiac surgical perspective. Eur J Cardiothorac Surg 2006;30:109-116.[Abstract/Free Full Text]
- Gilard M, Cornily J-C, Pennec P-Y, Joret C, Le Gal G, Mansourati J, Blanc J-J, Boschat J. Accuracy of multislice computed tomography in the preoperative assessment of coronary disease in patients with aortic valve stenosis. J Am Coll Cardiol 2006;47:2020-2024.[Abstract/Free Full Text]
- Feuchtner GM, Dichtl W, Friedrich GJ, Frick M, Alber H, Schachner T, Bonatti J, Mallouhi A, Frede T, Pachinger O. Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. J Am Coll Cardiol 2006;47:1410-1417.[Abstract/Free Full Text]
- Gasparovic H, Rybicki FJ, Millstine J, Unic D, Byrne JG, Yucel K, Mihaljevic T. Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization. Eur J Cardiothorac Surg 2005;28:244-249.[Abstract/Free Full Text]
- Raman SV, Shah M, McCarthy B, Garcia A, Ferketich AK. Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance. Am Heart J 2006;151:736-744.[CrossRef][Medline]
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A. Plass, J. Grunenfelder, and M. Genoni
Reply to Lavi and Lavi
Eur. J. Cardiothorac. Surg.,
November 1, 2006;
30(5):
814 - 815.
[Full Text]
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