Incremental Value of Cardiac MDCT over Trans-thoracic and Trans-esophageal Echocardiography for Determining Underlying Cause of Pulmonary HTN

Muhammad Ayub, FCPSDiplomate CBNC; Diplomate CBCCT

Department of Cardiovascular ImagingPunjab Institute of Cardiology Lahore, Pakistan

Established pulmonary arterial hypertension (PAH) carries bad prognosis

Early detection of underlying cause of PAH may be of great prognostic and therapeutic importance

Background

Trans-thoracic and trans-esophageal echocardiographies are great tools for diagnosis of cardiac causes of PAH, but have their own limitations

Cardiac MDCT, owing to it high spatial resolution, can provide excellent information about cardiac chambers, shunts, pulmonary vessels and lung parencyma.

Background

To determine incremental diagnostic value of cardiac MDCT over trans-thoracic and trans-esophageal echocardiography in determining secondary cause of PAH

Objectives

15

45

MalesFemales

Patients

Sixty patients (15 m, 45f) aged 32+11 with severe pulmonary arterial hypertension (mean 66.9+11.59 mmHg) without any obvious cause for PAH on trans-thoracic and trans- esophageal echocardiography were selected for the study.

Patients

All patients underwent gated cardiac MDCT on GE Lightspeed VCT after intravenous contrast at a rate of 5-7ml per second

Large field of view was used during data acquisition to include pulmonary vessels and lungs in the field

Scanning was done using 100-120 KV and 500-750 mAs according to patient’s height and weight

Methods

Retrospective ECG gating was used for acquisition and multi-phase data were reconstructed for evaluation of pulmonary vessels and for presence or absence any cardiac or extra-cardiac shunts

Additionally, lung parenchyma were also analyzed for presence or absence any lung pathology.

Methods

Frequency of abnormalities found on MDCT in patients with pulmonary hypertension without any discernable cause on TTE or TEE

PDA ASD PE Lung Disease0

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Cardiac MDCT has incremental diagnostic value over trans-thoracic and trans-esophageal echocardiography for identifying the underlying cause of PAH.

Conclusions

Examples

PDA VR PDA MPR

Examples

SV ASD PAPVD

Examples

Secundum ASD In situ Clot

Examples

VSD VR

Examples

Pulmonary Embolism Pulmonary Embolism

Examples

Lung Disease Lung Disease

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