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Pre- and Postoperative Evaluation of Congenital Heart Disease in Children and Adults with 64-Section CT¹

¹ From the Institute of Diagnostic Radiology (S.L., L.H., L.D., B.M., S.W., H.A.), Cardiovascular Center (E.O., R.J.), and Clinic for Cardiovascular Surgery (M.G., R.P.), University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; and Congenital Cardiac Centre for Adults, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada (E.O.). Received April 21, 2006; revision requested July 6 and received August 21; accepted December 6. Supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions (NCCR-CO ME), of the Swiss National Science Foundation; and by the Georg und Bertha Schwyzer-Winiker Stiftung, Zurich, Switzerland. All authors have no financial relationships to disclose.

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 1a.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 1b.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (150K): [in this window] [in a new window] [Download PPT slide]   Figure 1c.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (163K): [in this window] [in a new window] [Download PPT slide]   Figure 1d.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (84K): [in this window] [in a new window] [Download PPT slide]   Figure 1e.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 1f.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 1g.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 1h.  Normal anatomy of the heart, mediastinal vessels, and main bronchi at multidetector CT. (a) Thin-section axial image at the level of the ascending aorta (Ao) and pulmonary valve (PV) demonstrates normal anatomy of the left atrium (LA) and right atrium. The right atrial appendage (RAA) typically has a triangular shape, with a wider opening and larger pectinate muscles (arrows) than those of the left atrial appendage (LAA), which has a fingerlike shape. (b) Thin-section double-oblique image through the left ventricular inflow and outflow tract shows normal anatomy of the morphologic left ventricle with fine trabeculae, the anterolateral and posteromedial papillary muscles, and fibrous continuity (arrowhead) between the aortic valve (AV) and the mitral valve (MV). (c) Thin-section oblique sagittal image depicts the morphologic right ventricle (RV), which is characterized by coarse trabeculae and a muscular crest, the crista supraventricularis (arrowhead), between the tricuspid valve (TV) and the pulmonary valve (PV). (d) Thin-section oblique sagittal image shows the normal anatomy of the ascending aorta (aA), the aortic arch (AoA), the aortic isthmus (Isth), and the descending aorta (dA). The ascending aorta originates from the aortic valve (AV), between the left atrium (LA) and right atrium (RA). (e) Thin-section axial image demonstrates the pulmonary trunk (PT), the left pulmonary artery (lPA), and the right pulmonary artery (rPA). The left pulmonary artery is shorter than the right, and it courses in a more posterior direction. The right pulmonary artery passes behind the ascending aorta and the superior vena cava and in front of the descending aorta (dA). (f) Thin-section coronal image obtained with lung window settings shows a normal bronchial branching pattern. The right upper lobe bronchus (RULB) is superior to the right pulmonary artery (rPA), whereas the left pulmonary artery (lPA) courses over the left upper lobe bronchus (LULB). (g) Thick-section oblique coronal image obtained with a slab thickness of 5 mm demonstrates normal connections of the three systemic veins—the superior vena cava (SVC), inferior vena cava (IVC), and coronary sinus (CS)—to the right atrium (RA). The mixture of highly contrast-enhanced venous blood from the superior vena cava with nonenhanced venous blood from the inferior vena cava is visible in the atrium. LA = left atrium. (h) Volume-rendered image, obtained with reconstruction in an oblique right-posterior plane by using the cut-plane mode, demonstrates the relationship of the superior (SVC) and inferior (IVC) venae cavae to other anatomic structures adjacent to the site of venous connection to the right atrium (RA).

 

View larger version (149K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  Coarctation of the aorta at nongated CT in a 25-year-old man with atypical chest pain. (a) Thick-section oblique sagittal MIP image shows a high-grade aortic coarctation (arrow). AoA = aortic arch, dA = descending aorta, PT = pulmonary trunk. (b) Thin-section volume-rendered image, obtained with reconstruction in an oblique left-posterior plane by using the cut-plane mode, demonstrates narrowing of the aortic isthmus (small arrow) and extensive collateral intercostal and nuchal arteries (large arrow).

 

View larger version (150K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  Coarctation of the aorta at nongated CT in a 25-year-old man with atypical chest pain. (a) Thick-section oblique sagittal MIP image shows a high-grade aortic coarctation (arrow). AoA = aortic arch, dA = descending aorta, PT = pulmonary trunk. (b) Thin-section volume-rendered image, obtained with reconstruction in an oblique left-posterior plane by using the cut-plane mode, demonstrates narrowing of the aortic isthmus (small arrow) and extensive collateral intercostal and nuchal arteries (large arrow).

 

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Scimitar syndrome at nongated CT performed for preoperative evaluation of pulmonary structures and lung parenchyma in a 16-year-old girl. Thick-section coronal MIP image (a) and thick-section axial MIP image (b) with a slab thickness of 10 mm show an anomalous connection of the right lower pulmonary vein (*) to the inferior vena cava (IVC). Hypoplasia of the right lung also is depicted. lPA = left pulmonary artery, rPA = right pulmonary artery.

 

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Scimitar syndrome at nongated CT performed for preoperative evaluation of pulmonary structures and lung parenchyma in a 16-year-old girl. Thick-section coronal MIP image (a) and thick-section axial MIP image (b) with a slab thickness of 10 mm show an anomalous connection of the right lower pulmonary vein (*) to the inferior vena cava (IVC). Hypoplasia of the right lung also is depicted. lPA = left pulmonary artery, rPA = right pulmonary artery.

 

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 4.  Partial anomalous pulmonary venous connection at ECG-gated CT performed for preoperative evaluation of coronary artery anomalies in a 37-year-old woman. Thin-section axial CT scan shows an anomalous connection of the superior right pulmonary vein (rPV) (arrow) to the right atrium via the superior vena cava (SVC). The origin and course of the coronary arteries (not shown) were normal. lPV = left pulmonary vein, AV = aortic valve.

 

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 5.  Patent ductus arteriosus at non-gated CT performed for follow-up assessment in a 36-year-old woman. Thin-section oblique sagittal image demonstrates a large patent ductus arteriosus (arrowhead) that connects the roof of the common pulmonary artery (CPA) with the descending aorta (dA). AoA = aortic arch.

 

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 6.  Superior sinus venosus defect at non-gated CT performed for preoperative evaluation in a 38-year-old woman. Thin-section axial reformatted image demonstrates interatrial communication between the right atrium (RA) and left atrium (LA) through a large defect in the mouth of the superior vena cava (SVC), at the level of the upper portion of the atrial septum (arrow).

 

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 7.  Ventricular septal defect at ECG-gated CT performed in a 20-year-old man to monitor atrial and ventricular dimensions and function after a Fontan procedure for tetralogy of Fallot in early childhood. Thin-section reformatted image along the short axis of the heart shows a small ventricular septal defect (arrow) that leads to a communication between the left ventricle (LV) and the hypoplastic right ventricle (RV). RA = right atrium, RCA = right coronary artery.

 

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  Childhood surgical repair of a common arterial trunk at ECG-gated CT performed in a 32-year-old woman because of suspicion of a coronary artery anomaly. (a) Thin-section axial CT scan shows a patch (arrow) between the common arterial trunk (CAT) and the right ventricle (RV). RA = right atrium. (b) Thin-section axial CT scan demonstrates a graft implanted from the right ventricle to the pulmonary trunk. The connection to the ascending aorta (aA) was closed with a patch (arrow). The origin and course of the coronary arteries (not shown) were normal. dA = descending aorta, rPA = right pulmonary artery.

 

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  Childhood surgical repair of a common arterial trunk at ECG-gated CT performed in a 32-year-old woman because of suspicion of a coronary artery anomaly. (a) Thin-section axial CT scan shows a patch (arrow) between the common arterial trunk (CAT) and the right ventricle (RV). RA = right atrium. (b) Thin-section axial CT scan demonstrates a graft implanted from the right ventricle to the pulmonary trunk. The connection to the ascending aorta (aA) was closed with a patch (arrow). The origin and course of the coronary arteries (not shown) were normal. dA = descending aorta, rPA = right pulmonary artery.

 

View larger version (113K): [in this window] [in a new window] [Download PPT slide]   Figure 9a.  Double inlet left ventricle with d-transposition of the great arteries, observed at ECG-gated CT performed to supplement postoperative echocardiography in a 30-year-old man after surgical banding of the common pulmonary artery. (a) Thin-section reformatted image along the long axis of the heart shows connection of the left atrium (LA) and right atrium (RA) through a left-sided valve (LSV) and a right-sided valve (RSV), respectively, to a dominant ventricle (DV, morphologic left ventricle). (b) Thin-section oblique sagittal image demonstrates a subaortic outlet chamber (SOC) connected via a bulboventricular foramen (*) to the subpulmonary ventricle (the dominant ventricle in a). There is no atrioventricular connection to the subaortic outlet chamber. Banding of the common pulmonary artery was performed to protect the lung from high systemic blood flow and pressure. The great arteries are in parallel position (d-transposition): The pulmonary artery arises from the morphologic left single ventricle, and the aorta arises from the subaortic outlet chamber. AV = aortic valve, PV = pulmonary valve.

 

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 9b.  Double inlet left ventricle with d-transposition of the great arteries, observed at ECG-gated CT performed to supplement postoperative echocardiography in a 30-year-old man after surgical banding of the common pulmonary artery. (a) Thin-section reformatted image along the long axis of the heart shows connection of the left atrium (LA) and right atrium (RA) through a left-sided valve (LSV) and a right-sided valve (RSV), respectively, to a dominant ventricle (DV, morphologic left ventricle). (b) Thin-section oblique sagittal image demonstrates a subaortic outlet chamber (SOC) connected via a bulboventricular foramen (*) to the subpulmonary ventricle (the dominant ventricle in a). There is no atrioventricular connection to the subaortic outlet chamber. Banding of the common pulmonary artery was performed to protect the lung from high systemic blood flow and pressure. The great arteries are in parallel position (d-transposition): The pulmonary artery arises from the morphologic left single ventricle, and the aorta arises from the subaortic outlet chamber. AV = aortic valve, PV = pulmonary valve.

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  Transposition of the great arteries at ECG-gated CT after an arterial switch operation and reconstruction of the atrial septum in a 17-year-old girl with a previous atrial switch procedure. CT was performed to exclude stenosis of the reimplanted coronary arteries. (a) Thin-section axial CT scan shows the ascending aorta (aA) after its transfer by means of the LeCompte maneuver from an anterolateral position (*) to a position posterior to the pulmonary trunk (PT). As is typical after this procedure, the ascending aorta appears to be embraced by the left pulmonary artery (lPA) and right pulmonary artery (rPA). The dilated right pulmonary artery compresses the superior vena cava (SVC). A stent was implanted into the superior vena cava to relieve the obstruction of blood flow. dA = descending aorta. (b) Thin-section oblique coronal image shows the former aortic root in the anterior position (*) and the pulmonary trunk (PT) embracing the repositioned ascending aorta (aA). IVC = inferior vena cava, LA = left atrium, RA = right atrium. (c) Thin-section oblique sagittal image shows the postsurgical location of the ascending aorta (aA) posterior to the pulmonary trunk (PT), which is dilated and compresses the aorta. RV = right ventricle.

 

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  Transposition of the great arteries at ECG-gated CT after an arterial switch operation and reconstruction of the atrial septum in a 17-year-old girl with a previous atrial switch procedure. CT was performed to exclude stenosis of the reimplanted coronary arteries. (a) Thin-section axial CT scan shows the ascending aorta (aA) after its transfer by means of the LeCompte maneuver from an anterolateral position (*) to a position posterior to the pulmonary trunk (PT). As is typical after this procedure, the ascending aorta appears to be embraced by the left pulmonary artery (lPA) and right pulmonary artery (rPA). The dilated right pulmonary artery compresses the superior vena cava (SVC). A stent was implanted into the superior vena cava to relieve the obstruction of blood flow. dA = descending aorta. (b) Thin-section oblique coronal image shows the former aortic root in the anterior position (*) and the pulmonary trunk (PT) embracing the repositioned ascending aorta (aA). IVC = inferior vena cava, LA = left atrium, RA = right atrium. (c) Thin-section oblique sagittal image shows the postsurgical location of the ascending aorta (aA) posterior to the pulmonary trunk (PT), which is dilated and compresses the aorta. RV = right ventricle.

 

View larger version (192K): [in this window] [in a new window] [Download PPT slide]   Figure 10c.  Transposition of the great arteries at ECG-gated CT after an arterial switch operation and reconstruction of the atrial septum in a 17-year-old girl with a previous atrial switch procedure. CT was performed to exclude stenosis of the reimplanted coronary arteries. (a) Thin-section axial CT scan shows the ascending aorta (aA) after its transfer by means of the LeCompte maneuver from an anterolateral position (*) to a position posterior to the pulmonary trunk (PT). As is typical after this procedure, the ascending aorta appears to be embraced by the left pulmonary artery (lPA) and right pulmonary artery (rPA). The dilated right pulmonary artery compresses the superior vena cava (SVC). A stent was implanted into the superior vena cava to relieve the obstruction of blood flow. dA = descending aorta. (b) Thin-section oblique coronal image shows the former aortic root in the anterior position (*) and the pulmonary trunk (PT) embracing the repositioned ascending aorta (aA). IVC = inferior vena cava, LA = left atrium, RA = right atrium. (c) Thin-section oblique sagittal image shows the postsurgical location of the ascending aorta (aA) posterior to the pulmonary trunk (PT), which is dilated and compresses the aorta. RV = right ventricle.

 

View larger version (93K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.  Congenitally corrected transposition of the great arteries at nongated CT performed to exclude Kartagener syndrome in a 36-year-old man with known dextrocardia and chronic dyspnea. (a) Thin-section axial CT scan shows the ascending aorta (aA) in a position anterior to and left of the pulmonary artery (PA). dA = descending aorta. (b) Thin-section axial CT scan at the level of the ventricle shows that the pulmonary artery arises from the left ventricle (LV) and the aorta arises from the right ventricle (RV). The right atrium, which received flow from the systemic veins, was connected to the morphologic left ventricle (not shown). Thus, the findings included atrioventricular and ventriculoarterial discordant connections. Bronchiectasis indicative of Kartagener syndrome was not found.

 

View larger version (93K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.  Congenitally corrected transposition of the great arteries at nongated CT performed to exclude Kartagener syndrome in a 36-year-old man with known dextrocardia and chronic dyspnea. (a) Thin-section axial CT scan shows the ascending aorta (aA) in a position anterior to and left of the pulmonary artery (PA). dA = descending aorta. (b) Thin-section axial CT scan at the level of the ventricle shows that the pulmonary artery arises from the left ventricle (LV) and the aorta arises from the right ventricle (RV). The right atrium, which received flow from the systemic veins, was connected to the morphologic left ventricle (not shown). Thus, the findings included atrioventricular and ventriculoarterial discordant connections. Bronchiectasis indicative of Kartagener syndrome was not found.

 

View larger version (134K): [in this window] [in a new window] [Download PPT slide]   Figure 12a.  Double outlet right ventricle with d-transposition of the great arteries at ECG-gated CT performed for follow-up evaluation of complex anatomy in a 17-year-old girl after a Damus-Kaye-Stansel procedure, patch closure of an atrial septal defect and tricuspid valve, and a Fontan-Kreutzer procedure. (a) Thin-section oblique coronal image shows the connections of the systemic veins to the dilated right atrium (RA), which was surgically anastomosed to the left pulmonary artery (lPA) and right pulmonary artery (rPA). The tricuspid valve was closed with a patch. In the postsurgical circulation, blood flows directly from the systemic veins to the pulmonary arteries, without a subpulmonary ventricle (Fontan-Kreutzer procedure). The pulmonary veins are connected to the left atrium, which is connected to the hypoplastic left ventricle. The morphologic left ventricle is connected to the morphologic right ventricle (RV) via a ventricular septal defect. (b) Thin-section oblique sagittal image demonstrates connection of the right ventricle (RV) to the left ventricle (LV) via a ventricular septal defect (*). (c) Thin-section oblique sagittal image shows a hypoplastic morphologic left ventricle (LV) and a normal-sized right ventricle (RV). Both the ascending aorta (aA) and the pulmonary trunk (PT) arise from the morphologic right ventricle, with the pulmonary trunk overriding the ventricular septal defect. The pulmonary trunk was surgically connected to the ascending aorta with the Damus-Kaye-Stansel procedure. LA = left atrium.

 

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 12b.  Double outlet right ventricle with d-transposition of the great arteries at ECG-gated CT performed for follow-up evaluation of complex anatomy in a 17-year-old girl after a Damus-Kaye-Stansel procedure, patch closure of an atrial septal defect and tricuspid valve, and a Fontan-Kreutzer procedure. (a) Thin-section oblique coronal image shows the connections of the systemic veins to the dilated right atrium (RA), which was surgically anastomosed to the left pulmonary artery (lPA) and right pulmonary artery (rPA). The tricuspid valve was closed with a patch. In the postsurgical circulation, blood flows directly from the systemic veins to the pulmonary arteries, without a subpulmonary ventricle (Fontan-Kreutzer procedure). The pulmonary veins are connected to the left atrium, which is connected to the hypoplastic left ventricle. The morphologic left ventricle is connected to the morphologic right ventricle (RV) via a ventricular septal defect. (b) Thin-section oblique sagittal image demonstrates connection of the right ventricle (RV) to the left ventricle (LV) via a ventricular septal defect (*). (c) Thin-section oblique sagittal image shows a hypoplastic morphologic left ventricle (LV) and a normal-sized right ventricle (RV). Both the ascending aorta (aA) and the pulmonary trunk (PT) arise from the morphologic right ventricle, with the pulmonary trunk overriding the ventricular septal defect. The pulmonary trunk was surgically connected to the ascending aorta with the Damus-Kaye-Stansel procedure. LA = left atrium.

 

View larger version (164K): [in this window] [in a new window] [Download PPT slide]   Figure 12c.  Double outlet right ventricle with d-transposition of the great arteries at ECG-gated CT performed for follow-up evaluation of complex anatomy in a 17-year-old girl after a Damus-Kaye-Stansel procedure, patch closure of an atrial septal defect and tricuspid valve, and a Fontan-Kreutzer procedure. (a) Thin-section oblique coronal image shows the connections of the systemic veins to the dilated right atrium (RA), which was surgically anastomosed to the left pulmonary artery (lPA) and right pulmonary artery (rPA). The tricuspid valve was closed with a patch. In the postsurgical circulation, blood flows directly from the systemic veins to the pulmonary arteries, without a subpulmonary ventricle (Fontan-Kreutzer procedure). The pulmonary veins are connected to the left atrium, which is connected to the hypoplastic left ventricle. The morphologic left ventricle is connected to the morphologic right ventricle (RV) via a ventricular septal defect. (b) Thin-section oblique sagittal image demonstrates connection of the right ventricle (RV) to the left ventricle (LV) via a ventricular septal defect (*). (c) Thin-section oblique sagittal image shows a hypoplastic morphologic left ventricle (LV) and a normal-sized right ventricle (RV). Both the ascending aorta (aA) and the pulmonary trunk (PT) arise from the morphologic right ventricle, with the pulmonary trunk overriding the ventricular septal defect. The pulmonary trunk was surgically connected to the ascending aorta with the Damus-Kaye-Stansel procedure. LA = left atrium.

 

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 13a.  Left pulmonary isomerism at ECG-gated cardiac CT and nongated chest and abdominal CT performed for suspicion of situs inversus in a 38-year-old man after unknown surgical procedures in early childhood. (a) Thin-section reformatted image along the long axis of the heart reveals morphologic left atria on both sides, with ventricular inversion: a morphologic left atrium with right-sided pulmonary venous atrium (LA*); a morphologic left atrium with right-sided atrial appendage (LAA*); a morphologic left atrium and left-sided systemic venous atrium (LA); a morphologic left atrium and right-sided left ventricle (LV); and a morphologic right atrium and left-sided right ventricle (RV). The left-sided systemic venous atrium is connected via the tricuspid valve to the left-sided right ventricle and the pulmonary artery; the right-sided pulmonary venous atrium is connected via the mitral valve to the right-sided left ventricle and the aorta. (b) Thick-section oblique coronal MIP image with a slab thickness of 10 mm shows direct connection of the hepatic veins (arrows) to the left-sided systemic venous atrium (LA). LA* = morphologic left atrium with right-sided pulmonary venous atrium, LV = left ventricle, RV = right ventricle. (c) Thin-section coronal reformatted image demonstrates an abnormal bronchial branching pattern, with the left pulmonary artery (lPA) and right pulmonary artery (rPA) coursing over the upper lobe bronchus on the left and right sides, respectively (hyparterial bronchus). AoA = aortic arch, AV = azygos vein, dA = descending aorta, LB = left-sided (morphologic left) bronchus, RB = right-sided (morphologic left) bronchus, SVC = left-sided superior vena cava. (d) Thin-section axial CT scan through the upper abdomen shows a large, predominantly midline liver and right-sided polysplenia (*).

 

View larger version (147K): [in this window] [in a new window] [Download PPT slide]   Figure 13b.  Left pulmonary isomerism at ECG-gated cardiac CT and nongated chest and abdominal CT performed for suspicion of situs inversus in a 38-year-old man after unknown surgical procedures in early childhood. (a) Thin-section reformatted image along the long axis of the heart reveals morphologic left atria on both sides, with ventricular inversion: a morphologic left atrium with right-sided pulmonary venous atrium (LA*); a morphologic left atrium with right-sided atrial appendage (LAA*); a morphologic left atrium and left-sided systemic venous atrium (LA); a morphologic left atrium and right-sided left ventricle (LV); and a morphologic right atrium and left-sided right ventricle (RV). The left-sided systemic venous atrium is connected via the tricuspid valve to the left-sided right ventricle and the pulmonary artery; the right-sided pulmonary venous atrium is connected via the mitral valve to the right-sided left ventricle and the aorta. (b) Thick-section oblique coronal MIP image with a slab thickness of 10 mm shows direct connection of the hepatic veins (arrows) to the left-sided systemic venous atrium (LA). LA* = morphologic left atrium with right-sided pulmonary venous atrium, LV = left ventricle, RV = right ventricle. (c) Thin-section coronal reformatted image demonstrates an abnormal bronchial branching pattern, with the left pulmonary artery (lPA) and right pulmonary artery (rPA) coursing over the upper lobe bronchus on the left and right sides, respectively (hyparterial bronchus). AoA = aortic arch, AV = azygos vein, dA = descending aorta, LB = left-sided (morphologic left) bronchus, RB = right-sided (morphologic left) bronchus, SVC = left-sided superior vena cava. (d) Thin-section axial CT scan through the upper abdomen shows a large, predominantly midline liver and right-sided polysplenia (*).

 

View larger version (153K): [in this window] [in a new window] [Download PPT slide]   Figure 13c.  Left pulmonary isomerism at ECG-gated cardiac CT and nongated chest and abdominal CT performed for suspicion of situs inversus in a 38-year-old man after unknown surgical procedures in early childhood. (a) Thin-section reformatted image along the long axis of the heart reveals morphologic left atria on both sides, with ventricular inversion: a morphologic left atrium with right-sided pulmonary venous atrium (LA*); a morphologic left atrium with right-sided atrial appendage (LAA*); a morphologic left atrium and left-sided systemic venous atrium (LA); a morphologic left atrium and right-sided left ventricle (LV); and a morphologic right atrium and left-sided right ventricle (RV). The left-sided systemic venous atrium is connected via the tricuspid valve to the left-sided right ventricle and the pulmonary artery; the right-sided pulmonary venous atrium is connected via the mitral valve to the right-sided left ventricle and the aorta. (b) Thick-section oblique coronal MIP image with a slab thickness of 10 mm shows direct connection of the hepatic veins (arrows) to the left-sided systemic venous atrium (LA). LA* = morphologic left atrium with right-sided pulmonary venous atrium, LV = left ventricle, RV = right ventricle. (c) Thin-section coronal reformatted image demonstrates an abnormal bronchial branching pattern, with the left pulmonary artery (lPA) and right pulmonary artery (rPA) coursing over the upper lobe bronchus on the left and right sides, respectively (hyparterial bronchus). AoA = aortic arch, AV = azygos vein, dA = descending aorta, LB = left-sided (morphologic left) bronchus, RB = right-sided (morphologic left) bronchus, SVC = left-sided superior vena cava. (d) Thin-section axial CT scan through the upper abdomen shows a large, predominantly midline liver and right-sided polysplenia (*).

 

View larger version (174K): [in this window] [in a new window] [Download PPT slide]   Figure 13d.  Left pulmonary isomerism at ECG-gated cardiac CT and nongated chest and abdominal CT performed for suspicion of situs inversus in a 38-year-old man after unknown surgical procedures in early childhood. (a) Thin-section reformatted image along the long axis of the heart reveals morphologic left atria on both sides, with ventricular inversion: a morphologic left atrium with right-sided pulmonary venous atrium (LA*); a morphologic left atrium with right-sided atrial appendage (LAA*); a morphologic left atrium and left-sided systemic venous atrium (LA); a morphologic left atrium and right-sided left ventricle (LV); and a morphologic right atrium and left-sided right ventricle (RV). The left-sided systemic venous atrium is connected via the tricuspid valve to the left-sided right ventricle and the pulmonary artery; the right-sided pulmonary venous atrium is connected via the mitral valve to the right-sided left ventricle and the aorta. (b) Thick-section oblique coronal MIP image with a slab thickness of 10 mm shows direct connection of the hepatic veins (arrows) to the left-sided systemic venous atrium (LA). LA* = morphologic left atrium with right-sided pulmonary venous atrium, LV = left ventricle, RV = right ventricle. (c) Thin-section coronal reformatted image demonstrates an abnormal bronchial branching pattern, with the left pulmonary artery (lPA) and right pulmonary artery (rPA) coursing over the upper lobe bronchus on the left and right sides, respectively (hyparterial bronchus). AoA = aortic arch, AV = azygos vein, dA = descending aorta, LB = left-sided (morphologic left) bronchus, RB = right-sided (morphologic left) bronchus, SVC = left-sided superior vena cava. (d) Thin-section axial CT scan through the upper abdomen shows a large, predominantly midline liver and right-sided polysplenia (*).

 

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