Eur J Cardiothorac Surg 2008;33:924. doi:10.1016/j.ejcts.2008.01.033
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
Images in cardio-thoracic surgery |
Flow-related magnetic resonance; visualization of a re-coarctation
Elisabeth Berana,
Heinrich Mächlera,*,
Gert Reiterb,
Rainer Rienmüllerc
a Division of Cardiac Surgery, Medical University Graz, Auenbruggerplatz 29, 8036 Graz, Austria
b Siemens AG Austria, Medical Solutions, Austria
c Division of Radiology, Medical University Graz, Austria
Received 7 December 2007;
received in revised form 12 January 2008;
accepted 14 January 2008.
* Corresponding author. Tel.: +43 316 385 4671; fax: +43 316 385 4672. (Email: Heinrich.maechler{at}meduni-graz.at).
Key Words: MR images • Flow visualization • Coarctation • Extra-anatomical bypass
The presubclavian re-coarctation (Figs. 1 and 2a
) after direct end-to-end anastomosis (35-year-old man) was corrected with an extra-anatomical conduit (Ø 26 mm) connecting the ascending with the descending aorta (Fig. 2b). The left subclavian artery remained perfused via the stenosis. The huge poststenotic aneurysm was excluded from perfusion.
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Fig. 1. The preoperative MR image modified by the method described by Mächler et al. (Eur J Cardiothoracic Surg 2007;32:102–7 and 2004;26:747–53) showed high velocity jets (red) within the stenosis as well as towards the lateral wall of the aneurysmatic sac. This lead to the conclusion that the risk of rupture might not be determined by the increased diameter of the aneurysmatic sac itself but mainly by the jet and consecutive increased wall tension of the lateral wall. With the use of conventional radiological imaging alone this significant flow-related fact would have been ignored.
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Fig. 2. (a) (Top) The preoperative MR image without the visualized flow pattern. (b) (Bottom) The postoperative CT scan mimics two aortic arches: the extra-anatomical conduit lateral to the native aortic arch.
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