Background-Computed tomography has been shown to be useful in the evaluation of aortocoronary bypass grafts (CABG). This is the first prospective study to evaluate the accuracy of a new-generation scanner in the detection of patency and significant stenoses (Ͼ50% decrease in diameter) of venous and arterial grafts in patients with previous CABG. Methods and Results-In 96 patients (80 males, mean age 62 years) with previous CABG, a multislice computed tomography (MSCT) scan was performed (collimation 16ϫ0.625 mm). Patients with atrial fibrillation, renal failure, severe respiratory disease, severe heart failure, heart rate Ͼ70 bpm despite therapy, or unstable angina were excluded. A total of 285 conduits implanted on the native coronary arteries at the time of CABG were evaluated. MSCT data were analyzed by 2 independent radiologists and compared with the results of conventional angiography. Three patients were excluded from analysis. All conduits were judged evaluable in 84 patients. Among these patients, MSCT correctly diagnosed 54 occluded grafts and 4 significant stenoses on the body of the grafts. Of the 17 significant anastomotic lesions, MSCT correctly diagnosed 15. For these 84 patients, diagnostic accuracy was 99%, sensitivity was 97%, and specificity was 100%. When all 93 patients were considered, the sensitivity of MSCT in diagnosing significant stenoses was 96%. Conclusions-MSCT with the new-generation scanner allows for accurate assessment of venous and arterial conduits in patients with previous CABG with a high degree of sensitivity and specificity. Exclusion criteria and radiation exposure remain limitations of the method.

In patients with multivessel coronary disease and chronic occlusion of a major epicardial vessel, achieving of a complete revascularization by reopening or bypassing the occluded vessel is associated with a significantly better long-term prognosis.

Single coronary artery (SCA) is a rare coronary anomaly occurring in 0.024-0.066% of the population. Lipton and Yamanaka [1,2] have proposed an angiographic classification based on the origin of the SCA, the distribution of the main branches and the course of the anomalous arteries which can be, as far the position of the aorta and the pulmonary artery is concerned, anterior, posterior, in between, or with a combined course. In terms of clinical outcome, a main trunk or a left anterior descending artery (LAD) running between the aorta and the pulmonary artery predisposes to myocardial ischemia and sudden death usually during or immediately after exercise because of multiple factors such as compression, a slit-like origin and/or an intramural course of the LAD [3,4]. We present for the first time, to our knowledge, a case of an SCA, type R-III C, imaged by spiral computed tomography (CT) (General Electric VCT, 64 slices/ rotation scanner; General Electric Milwaukee, Wisconsin, USA) (Figs 1-4) performed in a 70-year-old man without a history of ischemic heart disease. The coronary computed angiography was indicated by the vascular surgeons (aortic aneurism surgical repair) to rule out the presence of significant coronary stenoses. Images in cardiovascular medicineFig. 1The volume rendering reconstruction (75% R to R ECG interval reconstruction), antero-posterior view, shows that the left anterior descending artery runs initially behind the pulmonary artery; the distal part of the LAD runs normally in the interventricular groove. LAD, left anterior descending artery; RCA, right coronary artery. Fig. 2The volume rendering reconstruction (75% RR interval reconstruction), after removing the pulmonary artery, shows that the course of the LAD is anterior to the aorta and posterior to the pulmonary artery; the first, second and third parts of the RCA run in the atrioventricular groove, as usual. LAD, left anterior descending artery; RCA, right coronary artery; RVB, right ventricle branch; SCAT, main trunk of the single coronary artery.

We present two patients revascularized by coronary stents and evaluated by multislice computed tomography (CT). In first patient, angio-CT (16 slices/rotation scanner) detected a high-grade restenosis on the distal part of a drug-eluting stent; conventional coronary angiography confirmed the diagnosis. In second patient, angio-CT (64 slices/rotation) showed a tissue proliferation, non-flow-limiting, in the proximal part of a bare metal stent; conventional angiography confirmed the diagnosis. Blooming effects and partial volume averaging still limit the widespread application of this method. New scanners and the use of a special convolution kernel are likely to improve the accuracy of CT angiography in patients with stents.

No abstract