Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2012;70(9):877-82.
Coronary computed tomography (CT) angiography is currently the only alternative to invasive angiography in the evaluation of coronary anatomy. In patients referred for valvular or thoracic aortic disease surgery, invasive coronary angiography remains the gold standard required by cardiac surgeons during the preoperative evaluation. According to the current European Society of Cardiology guidelines, evaluation of coronary anatomy is recommended in all patients above 40 years of age, with a history of coronary artery disease (CAD), in postmenopausal women, patients with left ventricular systolic dysfunction, with suspected ischaemic aetiology of mitral regurgitation, and in patients with one or more risk factors for CAD. The possibility to perform coronary CT angiography to exclude CAD before planned non-coronary cardiac surgery was first allowed in the 2010 Report of the American College of Cardiology Foundation Task Force on Expert Consensus.
To evaluate the usefulness of dual-source CT for the evaluation of coronary anatomy in patients before planned cardiac valvular surgery.
We studied 98 consecutive patients with a haemodynamically significant valvular heart disease and guideline-based indications for coronary angiography to exclude CAD before planned valvular surgery. Exclusion criteria included cardiac arrhythmia (atrial fibrillation, frequent ventricular and supraventricular premature beats), estimated glomerular filtration rate < 60 mL/min/1.73 m(2), allergy to iodine contrast agents, and lack of patient consent. Mean patient age was 58.8 (range 30-78) years. Coronary artery calcium score (CACS) was first determined in all patients. Coronary CT angiography was not performed if CACS was > 1000. In the remaining patients, complete CT evaluation was performed with the administration of a contrast agent. Conventional invasive coronary angiography was subsequently performed in patients with at least one > 50% stenosis, artifacts due to calcifications, or motion artifacts.
In 79 (80.6%) patients, CT angiography excluded the presence of a significant coronary artery stenosis without the need for invasive angiography. Conventional coronary angiography was required in 19 (19.4%) patients, including 13 (13.3%) patients with a > 50% stenosis in CT angiography, 2 (2%) patients with calcification artifacts, 1 (1%) patient with motion artifacts, 2 (2%) patients with CACS > 1000 in whom CT angiography was nor performed, and 1 (1%) patient with allergic symptoms during administration of a test dose of the contrast agent. Ultimately, significant CAD was diagnosed in 9 (9.2%) patients in whom coronary artery bypass surgery was also performed. In addition, vascular anomalies were diagnosed with cardiac CT angiography in 5 (5.1%) patients. In 14 patients, CT angiography was also used for previously planned evaluation of a coexisting aortic aneurysm.
Coronary CT angiography may be useful to exclude significant CAD in patients referred for valvular disease surgery.
冠状动脉计算机断层扫描（CT）血管造影术目前是评估冠状动脉解剖结构的唯一替代侵入性血管造影术的方法。在因瓣膜或胸主动脉疾病而接受手术的患者中，侵入性冠状动脉造影术仍然是心脏外科医生在术前评估时所需的金标准。根据欧洲心脏病学会的现行指南，建议对年龄在 40 岁以上、有冠状动脉疾病（CAD）病史、绝经后妇女、左心室收缩功能障碍患者、疑似缺血性二尖瓣反流病因的患者以及有一个或多个 CAD 危险因素的患者进行冠状动脉解剖评估。在美国心脏病学会基金会专家共识 2010 年报告中，首次允许在计划进行非冠状动脉心脏手术前，使用双源 CT 排除 CAD。
评估双源 CT 对计划行心脏瓣膜手术患者冠状动脉解剖的评估价值。
我们研究了 98 例因血流动力学显著瓣膜性心脏病而行冠状动脉造影术以排除 CAD 适应证的患者。排除标准包括心律失常（心房颤动、频发室性和室上性早搏）、估计肾小球滤过率 < 60 mL/min/1.73 m²、对碘造影剂过敏和患者不同意。平均患者年龄为 58.8（30-78）岁。所有患者均首先测定冠状动脉钙评分（CACS）。如果 CACS > 1000，则不进行冠状动脉 CT 血管造影术。在其余患者中，给予造影剂后行完全 CT 评估。如果存在至少一处> 50%狭窄、因钙化导致的伪影或运动伪影，则随后进行常规有创冠状动脉造影术。
在 79 例（80.6%）患者中，CT 血管造影术排除了存在明显冠状动脉狭窄的可能性，无需进行有创性冠状动脉造影术。在 19 例（19.4%）患者中需要进行常规冠状动脉造影术，包括 13 例（13.3%）CT 血管造影术显示> 50%狭窄的患者、2 例（2%）因钙化导致的伪影的患者、1 例（1%）因运动伪影的患者、2 例（2%）因 CACS > 1000 而未行 CT 血管造影术的患者和 1 例（1%）因给予造影剂试验剂量时出现过敏症状的患者。最终，9 例（9.2%）患者诊断为显著 CAD，对这些患者行冠状动脉旁路移植术。此外，5 例（5.1%）患者的心脏 CT 血管造影术诊断为血管畸形。14 例患者也使用 CT 血管造影术来评估先前计划的并存主动脉瘤。
冠状动脉 CT 血管造影术可用于排除因瓣膜疾病而接受手术的患者中存在显著 CAD。
