Congenital - Cardiothoracic Imaging
Commentary: To see with eyes uncloudedDouble orifice mitral valve (DOMV) can be found in approximately 1% of all patients with congenital heart disease and commonly occurs in association with other cardiovascular malformations.1 If not resulting in relevant regurgitation or stenosis, the malformation can go unnoticed and may be found incidentally. However, severe valvar dysfunction can bear a significant challenge for surgical repair, and a clear understanding of the underlying pathology and valvar structure is necessary to achieve good results.
Coronary artery arteriovenous malformationA 58-year-old woman with a history of giant coronary artery to coronary sinus fistula, status after an attempted surgical closure 11 years ago, presented with worsening dyspnea and dilated cardiomyopathy. Diagnostic workup with cardiac catheterization and computed tomographic angiography revealed a high output circulation with persistent right and left coronary fistulae (Figure 1, Videos 1 and 2). Reoperation was undertaken with right axillary and femoral venous peripheral cannulation for cardiopulmonary bypass because of the retrosternal, massively dilated coronary fistulae.
Intra-aortic chord: A new entity?A 65-year-old woman with hypertension was admitted to the hospital for acute and prolonged anterior chest pain. Clinical evaluation yielded normal results. Transthoracic echocardiography revealed the presence of an apparent intimal flap, located at the distal part of the ascending aorta. Multidetector computed tomographic angiography (MDCTA) showed the presence of a linear, 1- to 2-mm thick flap crossing the aorta wall to wall (Figure 1).
A unique computed tomographic finding: Dissection? Congenital structure? Artifact? New entity?—Significance in diagnosis of the “intra-aortic chord”Precise diagnosis of Stanford type A aortic dissection is crucial and time sensitive, especially in emergency cases. Diagnostic procedures have been conducted by computed tomographic (CT) scan, ultrasonography, or both.1 Diagnosis of type A dissection is sometimes difficult, however, because many unique types of dissection—such as localized small dissection, retrograde dissection, or circumferential dissection, called intimointimal intussusception2—have been reported. Moreover, in cases of dissection, CT scans a few days after the onset sometimes show the dynamic morphologic changes of a small ulcer or a flaplike lesion, which annoys physicians attempting the accurate diagnosis of aortic dissection.
When a coronary artery fistula is not simply a fistula: Using multimodality imaging to demonstrate an unusual embryologic remnantOur approach to this unusual coronary artery fistula underscores complementary roles of multimodality imaging in delineating complex coronary artery anatomy. Murmur evaluation of this infant diagnosed right coronary artery (RCA) ostial atresia with compensatory intercoronary connections from the left anterior descending (LAD) coronary artery to the RCA and a coronary–cameral fistula to the right ventricular outflow tract. Echocardiogram demonstrated coronary–cameral fistulae to the right ventricle (Video 1), a mildly dilated left ventricle, and holodiastolic flow reversal in the descending aorta.