1
|
Goo HW. Pediatric three-dimensional quantitative cardiovascular computed tomography. Pediatr Radiol 2024:10.1007/s00247-024-05931-7. [PMID: 38755443 DOI: 10.1007/s00247-024-05931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024]
Abstract
High-resolution, isotropic, 3-dimensional (D) data from pediatric cardiovascular computed tomography (CT) offer great potential for the accurate quantitative evaluation of pediatric cardiovascular and pulmonary vascular diseases. Recent pilot studies using pediatric 3-D cardiovascular CT have shown promising results in assessing cardiac function in conditions such as tetralogy of Fallot, cardiac defects with a hypoplastic ventricle, Ebstein anomaly, and in quantifying myocardial mass. In addition, the quantitative assessment of pulmonary vascularity is useful for evaluating differential right-to-left pulmonary vascular volume ratio, the effectiveness of pulmonary angioplasty, and predicting pulmonary hypertension. These initial experiences could broaden the role of pediatric cardiovascular CT in clinical practice. Furthermore, the current barriers to its widespread use, pertinent solutions to these problems, and new applications are discussed. In this review, the 3-D quantitative evaluations of cardiac function and pulmonary vascularity using high-resolution pediatric cardiovascular CT data are illustrated.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
2
|
Safian RD. Computed Tomography-Derived Physiology Assessment: State-of-the-Art Review. Cardiol Clin 2024; 42:101-123. [PMID: 37949532 DOI: 10.1016/j.ccl.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization.
Collapse
Affiliation(s)
- Robert D Safian
- The Lucia Zurkowski Endowed Chair, Center for Innovation & Research in Cardiovascular Diseases (CIRC), Department of Cardiovascular Medicine, Oakland University, William Beaumont School of Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA.
| |
Collapse
|
3
|
Aubry P, du Fretay XH, Zendjebil S, Koutsoukis A, Farnoud R, Hyafil F, Ou P, Laissy JP, Adjedj J, Ferrag W, Dupouy P. [ANOCOR registry]. Ann Cardiol Angeiol (Paris) 2023; 72:101690. [PMID: 37944222 DOI: 10.1016/j.ancard.2023.101690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Anomalous aortic origin of the coronary arteries are congenital anomalies with many anatomical forms. Due to the varying risk of sudden death, these abnormalities must be classified accurately. There are still questions about the mechanism and individual risk of sudden death, the natural history of these abnormalities and the benefits of a surgical correction. Large-scale observational registries may provide more evidence-based data to practitioners caring for the patients concerned. The ANOCOR registry, the largest in size published to date, enrolled 472 patients (mean age 63 years) with 496 coronary abnormalities. The angiographic representation (with invasive coronary angiography or coronary CT angiography) according to the coronary artery and initial ectopic course could be specified with the identification of two main phenotypes: the circumflex artery (n = 235) with a retroaortic course in 97% of cases and the right coronary artery (n = 165) with an interarterial course in 89.7% of cases. Two left coronary anatomical forms have been confused by non-expert cardiologists: those with a retropulmonary or interarterial course. Sudden death related to coronary anomaly was a very rare mode of presentation (3 patients or 0.6% of the cohort) in this population with very few young patients < 35 years (11 cases or 2.3% of the cohort).
Collapse
Affiliation(s)
- P Aubry
- Département de cardiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude-Bernard, 75018 Paris, France; Service de cardiologie, Centre Hospitalier de Gonesse, 95500 Gonesse, France.
| | - X Halna du Fretay
- Département de cardiologie, Pôle Santé Oreliance, 45770 Saran, France
| | - S Zendjebil
- Département de cardiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude-Bernard, 75018 Paris, France
| | - A Koutsoukis
- Pôle cardiovasculaire imagerie et interventionnel, Clinique les Fontaines, 77000 Melun, France
| | - R Farnoud
- Département de cardiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude-Bernard, 75018 Paris, France
| | - F Hyafil
- Département de médecine nucléaire, Assistance Publique-Hôpitaux de Paris, DMU IMAGINA, Hôpital Européen Georges Pompidou, Université Paris Cité, 75015 Paris, France
| | - P Ou
- Service de radiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude-Bernard, 75018 Paris, France
| | - J-P Laissy
- Service de radiologie, Centre Hospitalier de Gonesse, 95500 Gonesse, France
| | - J Adjedj
- Service de cardiologie, Institut Arnault Tzanck, 06700 Saint-Laurent-du-Var, France
| | - W Ferrag
- Département de cardiologie et de chirurgie cardiaque, Institut Mutualiste Montsouris, 75014 Paris, France
| | - P Dupouy
- Pôle cardiovasculaire imagerie et interventionnel, Clinique les Fontaines, 77000 Melun, France
| |
Collapse
|
4
|
DeCampli WM. Invited Commentary: Notwithstanding the Significance of Anatomy in Anomalous Aortic Origin of a Coronary Artery, Physiology Is Important, Too. World J Pediatr Congenit Heart Surg 2023; 14:749-751. [PMID: 37933695 DOI: 10.1177/21501351231190085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The management strategies for anomalous aortic origin of a coronary artery (AAOCA) are based on anatomy, symptoms, and stress tests for evidence of ischemia. These strategies remain associated with low levels of evidence. Stress tests for ischemia or ventricular dysfunction, the only widely used physiological tests, are not adequately reliable. Additional physiological metrics are needed to build reliable strategies. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are physiological measurements that are used in assessing acquired coronary artery disease (CAD). In this commentary, we describe FFR and iFR and review studies supporting their utility in assessing CAD. We describe a few small studies of their use in assessing AAOCA. Finally, we comment on the unique features of AAOCA that mandate further investigation on how to conduct and interpret FFR/iFR measurements. Even at a point where we understand how to do this, determining the effectiveness of these measurements in improving outcomes and guiding management will require lengthy and challenging trials. A collective effort of institutions that manage AAOCA will be essential.
Collapse
Affiliation(s)
- William M DeCampli
- Division of Pediatric Cardiac Surgery, Orlando Health/Arnold Palmer Hospital for Children, Orlando, FL, USA
- Department of Clinical Sciences, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
5
|
Stark AW, Giannopoulos AA, Pugachev A, Shiri I, Haeberlin A, Räber L, Obrist D, Gräni C. Application of Patient-Specific Computational Fluid Dynamics in Anomalous Aortic Origin of Coronary Artery: A Systematic Review. J Cardiovasc Dev Dis 2023; 10:384. [PMID: 37754814 PMCID: PMC10532130 DOI: 10.3390/jcdd10090384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart condition with fixed and dynamic stenotic elements, potentially causing ischemia. Invasive coronary angiography under stress is the established method for assessing hemodynamics in AAOCA, yet it is costly, technically intricate, and uncomfortable. Computational fluid dynamics (CFD) simulations offer a noninvasive alternative for patient-specific hemodynamic analysis in AAOCA. This systematic review examines the role of CFD simulations in AAOCA, encompassing patient-specific modeling, noninvasive imaging-based boundary conditions, and flow characteristics. Screening articles using AAOCA and CFD-related terms prior to February 2023 yielded 19 publications, covering 370 patients. Over the past four years, 12 (63%) publications (259 patients) employed dedicated CFD models, whereas 7 (37%) publications (111 patients) used general-purpose CFD models. Dedicated CFD models were validated for fixed stenosis but lacked dynamic component representation. General-purpose CFD models exhibited variability and limitations, with fluid-solid interaction models showing promise. Interest in CFD modeling of AAOCA has surged recently, mainly utilizing dedicated models. However, these models inadequately replicate hemodynamics, necessitating novel CFD approaches to accurately simulate pathophysiological changes in AAOCA under stress conditions.
Collapse
Affiliation(s)
- Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.W.S.); (I.S.); (A.H.); (L.R.)
| | - Andreas A. Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091 Zurich, Switzerland;
| | | | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.W.S.); (I.S.); (A.H.); (L.R.)
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.W.S.); (I.S.); (A.H.); (L.R.)
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.W.S.); (I.S.); (A.H.); (L.R.)
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, 3008 Bern, Switzerland;
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.W.S.); (I.S.); (A.H.); (L.R.)
| |
Collapse
|
6
|
Gao X, Zhou Z, Gao Y, Sun Z, Xu L. Noninvasive fractional flow reserve derived from computed tomography angiography in a patient with abnormal origin of the left main artery and cardiac death. Quant Imaging Med Surg 2023; 13:5374-5378. [PMID: 37581075 PMCID: PMC10423394 DOI: 10.21037/qims-22-1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/11/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Xuelian Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, Curtin Medical School, Curtin University, Perth, Australia
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Safian RD. Computed Tomography-Derived Physiology Assessment: State-of-the-Art Review. Interv Cardiol Clin 2023; 12:95-117. [PMID: 36372465 DOI: 10.1016/j.iccl.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization.
Collapse
Affiliation(s)
- Robert D Safian
- The Lucia Zurkowski Endowed Chair, Center for Innovation & Research in Cardiovascular Diseases (CIRC), Department of Cardiovascular Medicine, Oakland University, William Beaumont School of Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA.
| |
Collapse
|
8
|
Patient-Specific Fluid-Structure Simulations of Anomalous Aortic Origin of Right Coronary Arteries. JTCVS Tech 2022; 13:144-162. [PMID: 35711199 PMCID: PMC9196314 DOI: 10.1016/j.xjtc.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
Objectives Anomalous aortic origin of the right coronary artery (AAORCA) may cause ischemia and sudden death. However, the specific anatomic indications for surgery are unclear, so dobutamine-stress instantaneous wave-free ratio (iFR) is increasingly used. Meanwhile, advances in fluid–structure interaction (FSI) modeling can simulate the pulsatile hemodynamics and tissue deformation. We sought to evaluate the feasibility of simulating the resting and dobutamine-stress iFR in AAORCA using patient-specific FSI models and to visualize the mechanism of ischemia within the intramural geometry and associated lumen narrowing. Methods We developed 6 patient-specific FSI models of AAORCA using SimVascular software. Three-dimensional geometries were segmented from coronary computed tomography angiography. Vascular outlets were coupled to lumped-parameter networks that included dynamic compression of the coronary microvasculature and were tuned to each patient's vitals and cardiac output. Results All cases were interarterial, and 5 of 6 had an intramural course. Measured iFRs ranged from 0.95 to 0.98 at rest and 0.80 to 0.95 under dobutamine stress. After we tuned the distal coronary resistances to achieve a stress flow rate triple that at rest, the simulations adequately matched the measured iFRs (r = 0.85, root-mean-square error = 0.04). The intramural lumen remained narrowed with simulated stress and resulted in lower iFRs without needing external compression from the pulmonary root. Conclusions Patient-specific FSI modeling of AAORCA is a promising, noninvasive method to assess the iFR reduction caused by intramural geometries and inform surgical intervention. However, the models’ sensitivity to distal coronary resistance suggests that quantitative stress-perfusion imaging may augment virtual and invasive iFR studies.
Collapse
|
9
|
Affiliation(s)
- Stephen Dolgner
- Adult Congenital Heart Program, Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA .,Coronary Anomalies Program, Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Edward Hickey
- Adult Congenital Heart Program, Department of Surgery, Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Silvana Molossi
- Coronary Anomalies Program, Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
10
|
Adjedj J, Hyafil F, Halna du Fretay X, Dupouy P, Juliard J, Ou P, Laissy J, Muller O, Wijns W, Aubry P. Physiological Evaluation of Anomalous Aortic Origin of a Coronary Artery Using Computed Tomography-Derived Fractional Flow Reserve. J Am Heart Assoc 2021; 10:e018593. [PMID: 33728970 PMCID: PMC8174353 DOI: 10.1161/jaha.120.018593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.
Collapse
Affiliation(s)
- Julien Adjedj
- Cardiology DepartmentArnault Tzanck InstituteSaint Laurent Du VarFrance
- Cardiology DepartmentLausanne University HospitalLausanneSwitzerland
| | - Fabien Hyafil
- Department of Nuclear MedicineDepartement medico Universitaire IMAGINAAssistance Publique Hopitaux de ParisHopital Européen Georges PompidouUniversity of ParisFrance
| | | | - Patrick Dupouy
- Interventional Imaging Cardiovascular UnitAntony Private HospitalAntonyFrance
| | - Jean‐Michel Juliard
- Cardiology DepartmentBichat–Claude‐Bernard HospitalAssistance Publique–Hôpitaux de ParisParisFrance
| | - Phalla Ou
- Radiology DepartmentBichat–Claude‐Bernard HospitalAssistance Publique–Hôpitaux de ParisParisFrance
| | - Jean‐Pierre Laissy
- Radiology DepartmentLariboisière HospitalAssistance Publique–Hôpitaux de ParisParisFrance
| | - Olivier Muller
- Cardiology DepartmentArnault Tzanck InstituteSaint Laurent Du VarFrance
| | - William Wijns
- The Lambe Institute for Translational Medicine and CuramNational University of IrelandGalwayIreland
- Saolta University Healthcare GroupGalwayIreland
| | - Pierre Aubry
- Cardiology DepartmentBichat–Claude‐Bernard HospitalAssistance Publique–Hôpitaux de ParisParisFrance
| | | |
Collapse
|