Aortography

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Aortography
Moenckeberg.jpg
B. Translumbar aortography shows near-total obstruction of the femoral arteries in a patient with Monckeberg's arteriosclerosis.
ICD-9-CM 88.42
MeSH D001027

Aortography involves placement of a catheter in the aorta and injection of contrast material while taking X-rays of the aorta. The procedure is known as an aortogram. The diagnosis of aortic dissection can be made by visualization of the intimal flap and flow of contrast material in both the true lumen and the false lumen. The catheter has to be inserted through the right femoral artery, because in about two-thirds of cases the aortic dissection spreads into the left common iliac artery.

The aortogram was previously considered the gold standard test for the diagnosis of aortic dissection, [1] with a sensitivity of up to 80% and a specificity of about 94%. [2] It is especially poor in the diagnosis of cases where the dissection is due to hemorrhage within the media without any initiating intimal tear.

The advantage of the aortogram in the diagnosis of aortic dissection is that it can delineate the extent of involvement of the aorta and branch vessels and can diagnose aortic insufficiency. The disadvantages of the aortogram are that it is an invasive procedure and it requires the use of iodinated contrast material. [3]

Aortography has largely been replaced by the diagnostic tools of MRI, CT, and transesophageal echocardiography (TEE) all of which have high sensitivities. [4] TEE is favored in emergency situations, as it is relatively non-invasive and a rapid procedure (more so than MRI, which can takes hours). [5] [6]

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Giant cell arteritis Medical condition

Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory autoimmune disease of large blood vessels. Symptoms may include headache, pain over the temples, flu-like symptoms, double vision, and difficulty opening the mouth. Complication can include blockage of the artery to the eye with resulting blindness, aortic dissection, and aortic aneurysm. GCA is frequently associated with polymyalgia rheumatica.

Aortic dissection Injury to the innermost layer of the aorta

Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Also, vomiting, sweating, and lightheadedness may occur. Other symptoms may result from decreased blood supply to other organs, such as stroke or mesenteric ischemia. Aortic dissection can quickly lead to death from insufficient blood flow to the heart or complete rupture of the aorta.

Echocardiography

An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound of the heart. It is a type of medical imaging of the heart, using standard ultrasound or Doppler ultrasound.

Interventional radiology

Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.

Cardiac stress test Measures the hearts ability to respond to external stress in a controlled clinical environment

A cardiac stress test is a cardiological test that measures the heart's ability to respond to external stress in a controlled clinical environment. The stress response is induced by exercise or by intravenous pharmacological stimulation.

Transesophageal echocardiogram Type of echocardiogram

A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It is commonly used during cardiac surgery and is an excellent modality for assessing the aorta, although there are some limitations.

Aneurysm of sinus of Valsalva Medical condition

Aneurysm of the aortic sinus, also known as the sinus of Valsalva, is a rare abnormality of the aorta, the largest artery in the body. The aorta normally has three small pouches that sit directly above the aortic valve, and an aneurysm of one of these sinuses is a thin-walled swelling. Aneurysms may affect the right (65–85%), non-coronary (10–30%), or rarely the left coronary sinus. These aneurysms may not cause any symptoms but if large can cause shortness of breath, palpitations or blackouts. Aortic sinus aneurysms can burst or rupture into adjacent cardiac chambers, which can lead to heart failure if untreated.

Coarctation of the aorta Medical condition

Coarctation of the aorta, also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus inserts. The word coarctation means "pressing or drawing together; narrowing". Coarctations are most common in the aortic arch. The arch may be small in babies with coarctations. Other heart defects may also occur when coarctation is present, typically occurring on the left side of the heart. When a patient has a coarctation, the left ventricle has to work harder. Since the aorta is narrowed, the left ventricle must generate a much higher pressure than normal in order to force enough blood through the aorta to deliver blood to the lower part of the body. If the narrowing is severe enough, the left ventricle may not be strong enough to push blood through the coarctation, thus resulting in a lack of blood to the lower half of the body. Physiologically its complete form is manifested as interrupted aortic arch.

Cardiac catheterization

Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.

Coronary artery anomalies are variations of the coronary circulation, affecting <1% of the general population. Symptoms include chest pain, shortness of breath and syncope, although cardiac arrest may be the first clinical presentation. Several varieties are identified, with a different potential to cause sudden cardiac death.

Computed tomography angiography

Computed tomography angiography is a computed tomography technique used to visualize arterial and venous vessels throughout the body. Using contrast injected into the blood vessels, images are created to look for blockages, aneurysms, dissections, and stenosis. CTA can be used to visualize the vessels of the heart, the aorta and other large blood vessels, the lungs, the kidneys, the head and neck, and the arms and legs.

Endovascular aneurysm repair Surgery used to treat abdominal aortic aneurysm

Endovascular aneurysm repair (EVAR), is a type of minimally-invasive endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). When used to treat thoracic aortic disease, the procedure is then specifically termed TEVAR for "thoracic endovascular aortic/aneurysm repair." The procedure involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. In 2003, EVAR surpassed open aortic surgery as the most common technique for repair of AAA, and in 2010, EVAR accounted for 78% of all intact AAA repair in the United States.

Cardiac magnetic resonance imaging

Cardiovascular magnetic resonance imaging is a medical imaging technology for non-invasive assessment of the function and structure of the cardiovascular system. Conventional MRI sequences are adapted for cardiac imaging by using ECG gating and high temporal resolution protocols. The development of CMR is an active field of research and continues to see a rapid expansion of new and emerging techniques.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.

Familial aortic dissection Medical condition

Familial aortic dissection or FAD refers to the splitting of the wall of the aorta in either the arch, ascending or descending portions. FAD is thought to be passed down as an autosomal dominant disease and once inherited will result in dissection of the aorta, and dissecting aneurysm of the aorta, or rarely aortic or arterial dilation at a young age. Dissection refers to the actual tearing open of the aorta. However, the exact gene(s) involved has not yet been identified. It can occur in the absence of clinical features of Marfan syndrome and of systemic hypertension. Over time this weakness, along with systolic pressure, results in a tear in the aortic intima layer thus allowing blood to enter between the layers of tissue and cause further tearing. Eventually complete rupture of the aorta occurs and the pleural cavity fills with blood. Warning signs include chest pain, ischemia, and hemorrhaging in the chest cavity. This condition, unless found and treated early, usually results in death. Immediate surgery is the best treatment in most cases. FAD is not to be confused with PAU and IMH, both of which present in ways similar to that of familial aortic dissection.

Double aortic arch is a relatively rare congenital cardiovascular malformation. DAA is an anomaly of the aortic arch in which two aortic arches form a complete vascular ring that can compress the trachea and/or esophagus. Most commonly there is a larger (dominant) right arch behind and a smaller (hypoplastic) left aortic arch in front of the trachea/esophagus. The two arches join to form the descending aorta which is usually on the left side. In some cases the end of the smaller left aortic arch closes and the vascular tissue becomes a fibrous cord. Although in these cases a complete ring of two patent aortic arches is not present, the term ‘vascular ring’ is the accepted generic term even in these anomalies.

Cardiac imaging

Cardiac imaging refers to non-invasive imaging of the heart using ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or nuclear medicine (NM) imaging with PET or SPECT. These cardiac techniques are otherwise referred to as echocardiography, Cardiac MRI, Cardiac CT, Cardiac PET and Cardiac SPECT including myocardial perfusion imaging.

A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional surgical part with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy imaging in a hybrid OR without interruption. A wider definition includes a clinically connected succession of a catheter intervention and a surgical procedure with a time gap.

Cardiac allograft vasculopathy Medical condition

Cardiac allograft vasculopathy (CAV) is a common accelerated type of coronary artery disease in people who have had a heart transplantation. This long-term complication affects up to half of heart transplant recipients within 10 years. It arises when the blood vessels supplying the transplanted heart gradually narrow and restrict its blood flow, subsequently leading to impairment of the heart muscle or sudden death. The other major causes of death following heart transplantation include graft failure, organ rejection and infection.

References

  1. Holloway, B J; Rosewarne, D; Jones, R G (December 2011). "Imaging of thoracic aortic disease". The British Journal of Radiology. 84 (3): S338–S354. doi:10.1259/bjr/30655825. PMC   3473913 . PMID   22723539.
  2. Wilbers, Christopher R.H.; Carrol, Clark L.; Hnilica, Mark A. (1990). "Optimal Diagnostic Imaging of Aortic Dissection". Texas Heart Institute Journal. 17 (4): 271–278. ISSN   0730-2347. PMC   324936 . PMID   15227519.
  3. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) (1 November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases". European Heart Journal. 35 (41): 2873–2926. doi: 10.1093/eurheartj/ehu281 . PMID   25173340.
  4. Creager, Mark A.; Braunwald, Eugene (2013). Atlas of Vascular Disease. Springer Science & Business Media. p. 40. ISBN   9781475745641.
  5. Khan, Ali Nawaz (13 May 2016). "Aortic Dissection Imaging". Medscape. WebMD.
  6. Neskovic, A. N.; Hagendorff, A.; Lancellotti, P.; Guarracino, F.; Varga, A.; Cosyns, B.; Flachskampf, F. A.; Popescu, B. A.; Gargani, L.; Zamorano, J. L.; Badano, L. P. (13 December 2012). "Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations". European Heart Journal - Cardiovascular Imaging. 14 (1): 1–11. doi: 10.1093/ehjci/jes193 . PMID   23239795.