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Pre-Operative Computed Tomography Coronary Angiography to Detect Significant Coronary Artery Disease in Patients Referred for Cardiac Valve Surgery

Willem B. Meijboom, MD^_*,, Nico R. Mollet, MD, PhD^_*,, Carlos A.G. Van Mieghem, MD^_*,, Jolanda Kluin, MD, PhD, Annick C. Weustink, MD^_*,, Francesca Pugliese, MD^_*,, Eleni Vourvouri, MD, PhD^_*,, Filippo Cademartiri, MD, PhD^_*,, Ad J.J.C. Bogers, MD, PhD, Gabriel P. Krestin, MD, PhD and Pim J. de Feyter, MD, PhD, FACC^_*,,_*

^_* Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Radiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Three different types of post-processing techniques are shown: volume-rendered computed tomography coronary angiogram (CTCA) images (A and B), a maximum-intensity projected image (C), and 3 curved multiplanar reconstructed images (E, F, and G), which show a patent right coronary artery, which is confirmed by conventional coronary angiogram (CCA) (D). The bright white spots (C, E, and G) represent calcifications of the stenotic aortic valve.

View larger version (91K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Volume-rendered CTCA images (A and B) reveal the anatomy of the left coronary artery. Two curved multiplanar reconstructed images (E and F) disclose a significant stenosis in the left anterior descending coronary artery, which was corroborated by CCA (C and D). Although the volume-rendered images provide an excellent overview of the coronary anatomy, they should not be used for the diagnostic assessment of presence of coronary stenoses. Abbreviations as in Figure 1.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Discordance between angina pectoris and the presence of significant coronary artery disease. FN = false negative; FP = false positive; TN = true negative; TP = true positive; other abbreviations as in Figure 1.