cardiac and coronary artery anatomy no disclosures

1

CARDIAC AND CORONARY CARDIAC AND CORONARY ARTERY ANATOMYARTERY ANATOMY

NASCI MEETING, ORLANDO FLORIDA 2009NASCI MEETING, ORLANDO FLORIDA 2009

KOSTAKI G. BIS, MD, FACRKOSTAKI G. BIS, MD, FACRDEPARTMENT OF RADIOLOGYDEPARTMENT OF RADIOLOGY

WILLIAM BEAUMONT HOSPITALWILLIAM BEAUMONT HOSPITALRoyal Oak, MichiganRoyal Oak, Michigan

NO DISCLOSURESNO DISCLOSURES

OBJECTIVESOBJECTIVES

CARDIAC ANATOMYCARDIAC ANATOMY-- VARIOUS IMAGING PLANESVARIOUS IMAGING PLANESNORMAL, VARIANT and SOME ANOMALOUS ANATOMY NORMAL, VARIANT and SOME ANOMALOUS ANATOMY OF CORONARY ARTERIES AND SUBJACENT VEINSOF CORONARY ARTERIES AND SUBJACENT VEINS

IMPORTANT FOR CORRECT IMAGE INTERPRETATION AND IMPORTANT FOR CORRECT IMAGE INTERPRETATION AND PATIENT CAREPATIENT CARE

Axial Anatomy of HeartAxial Anatomy of Heart

SVCSVC

ASCENDING ASCENDING AORTAAORTA

DESCENDING DESCENDING AORTAAORTA

RR-- SUPERIOR SUPERIOR PULMONARY PULMONARY VEINVEIN

LL-- SUPERIORSUPERIORPULMONARY PULMONARY VEINVEIN

MAINMAINPULMONARYPULMONARYARTERY BIFURCARTERY BIFURC’’NN


LEFT ATRIALLEFT ATRIALAPPENDAGEAPPENDAGE


LADLAD

INFLOW INFLOW LL-- SUPERIORSUPERIORPULMONARYPULMONARYVEINVEIN

PULMONARYPULMONARYVALVEVALVE

2


RVOTRVOT

LL--MAINMAIN

SVC SVC INFLOWINFLOW

INFLOWINFLOWRR-- SUPERIORSUPERIORPULMONARYPULMONARYVEINVEIN


RIGHTRIGHTATRIALATRIALAPPENDAGEAPPENDAGE

CEPHALADCEPHALADINTERATRIALINTERATRIALSEPTUMSEPTUM

LL-- MAINMAINORIGINORIGIN


RCARCA

LADLAD

LCxLCx

NONNON--CORONARYCORONARYCUSPCUSP


SASA--NODENODEBRANCHBRANCH

INFLOWINFLOWLL-- INFERIORINFERIORPULMONARYPULMONARYVEINVEIN


AORTIC VALVEAORTIC VALVE


LVOTLVOT

MITRAL VALVEMITRAL VALVE

INFLOWINFLOWRR--INFERIORINFERIORPULMONARYPULMONARYVEINVEIN

3


RCARCA LADLAD

LCxLCx


INTERATRIALINTERATRIALSEPTUMSEPTUM

ANTEROLATERALANTEROLATERALPAPILLARYPAPILLARYMUSCLEMUSCLE

RVRV

RARA

LALA

LVLV

INTERVENTRICULARINTERVENTRICULARSEPTUMSEPTUM


INFLOWINFLOW--CORONARY CORONARY SINUSSINUS

TRICUSPIDTRICUSPIDVALVEVALVEPLANEPLANE


CORONARYCORONARYSINUSSINUS

IVCIVCINFLOWINFLOW


POSTEROMEDIALPOSTEROMEDIALPAPILLARYPAPILLARYMUSCLESMUSCLES

DISTALDISTALRCARCA

SUPRAHEPATICSUPRAHEPATICIVCIVC


4


PDAPDA

Axial Anatomy of HeartAxial Anatomy of Heart--MRIMRI

IMAGING PLANES (SETIMAGING PLANES (SET--UP)UP)

LAOLAO

RAORAO

CARDIAC ANATOMYCARDIAC ANATOMY--(4D (4D MIPsMIPs))(VERTICAL LONG AXIS(VERTICAL LONG AXIS--RAO)RAO)

RAORAO

CARDIAC AND CORONARY CARDIAC AND CORONARY ARTERY ANATOMYARTERY ANATOMY--(3D(3D--MIPs)MIPs)(VERTICAL LONG AXIS(VERTICAL LONG AXIS--RAO)RAO)

CARDIAC ANATOMYCARDIAC ANATOMY--(CINE MRI)(CINE MRI)(VERTICAL LONG AXIS(VERTICAL LONG AXIS--RAO)RAO)

5

CARDIAC ANATOMYCARDIAC ANATOMY--(4D(4D--MIPs)MIPs)(HORIZONTAL LONG AXIS, 4 CHAMBER)(HORIZONTAL LONG AXIS, 4 CHAMBER)

HLAHLA

CARDIAC AND CORONARY CARDIAC AND CORONARY ARTERY ANATOMYARTERY ANATOMY--(3D(3D--MIPs)MIPs)

(HORIZONTAL LONG AXIS)(HORIZONTAL LONG AXIS)

CARDIAC ANATOMYCARDIAC ANATOMY--(CINE MRI)(CINE MRI)(HORIZONTAL LONG AXIS)(HORIZONTAL LONG AXIS)

CARDIAC ANATOMYCARDIAC ANATOMY--(CINE MRI)(CINE MRI)(HORIZONTAL LONG AXIS)(HORIZONTAL LONG AXIS)

CARDIAC ANATOMYCARDIAC ANATOMY--(4D(4D--MIPs)MIPs)(SHORT AXIS(SHORT AXIS--LAO)LAO)

LAOLAO

CARDIAC AND CORONARY CARDIAC AND CORONARY ARTERY ANATOMYARTERY ANATOMY--(3D(3D--MIPs)MIPs)

(SHORT AXIS(SHORT AXIS--LAO)LAO)

6

CARDIAC ANATOMYCARDIAC ANATOMY--(CINE MRI)(CINE MRI)(SHORT AXIS(SHORT AXIS--LAO)LAO)

1717--MYOCARDIAL SEGMENT MODELMYOCARDIAL SEGMENT MODEL

Above schematic is for RCA dominance.Above schematic is for RCA dominance.Note: With left dominance, Note: With left dominance, LCxLCx supplies the inferior septum and inferior supplies the inferior septum and inferior

distributionsdistributions

BASEBASE

MIDDLEMIDDLE

APEXAPEX

CARDIAC ANATOMYCARDIAC ANATOMY--(CINE MRI)(CINE MRI)(INLET(INLET--OUTLET, 3OUTLET, 3--CHAMBER, CHAMBER, ““PARASTERNAL LONG AXISPARASTERNAL LONG AXIS””))

ADDITIONAL VIEWSADDITIONAL VIEWS--(CINE MRI)(CINE MRI)

LVOT RVOT AORTIC ROOTLVOT RVOT AORTIC ROOTDirect coronalDirect coronal Oblique coronalOblique coronal Oblique axialOblique axial

CORONARY DOMINANCECORONARY DOMINANCE

Determined by blood supply to inferior Determined by blood supply to inferior wallwallPDA, PLB and AVPDA, PLB and AV--node branches help node branches help define dominancedefine dominance

7

RIGHT DOMINANCE (80RIGHT DOMINANCE (80--85%)85%)

RCA gives rise to PDA, PLB and AVRCA gives rise to PDA, PLB and AV--node node branchesbranchesPDAPDA supplies inferior septumsupplies inferior septumPLBPLB supplies inferior wallsupplies inferior wall

DOMINANT RCA ANATOMYDOMINANT RCA ANATOMY--ANTERIOR SCHEMATICANTERIOR SCHEMATIC

DOMINANT RCA ANATOMYDOMINANT RCA ANATOMY RCA ANATOMYRCA ANATOMY

RCA proximalRCA proximal –– From From ostiumostiumto one half the distance to the to one half the distance to the acute margin of the heart.acute margin of the heart.RCA middleRCA middle–– RCA from above RCA from above segment to the acute margin segment to the acute margin of heart.of heart.RCA distalRCA distal -- From the acute From the acute margin to the origin of the margin to the origin of the PDA.PDA.Report of the AdReport of the Ad--Hoc Committee for Hoc Committee for Grading of Coronary Artery Disease, Grading of Coronary Artery Disease, Council on Cardiovascular Surgery. Council on Cardiovascular Surgery. Circulation 1975; 51:5Circulation 1975; 51:5--40.40.

CONUS BRANCH VARIATIONSCONUS BRANCH VARIATIONS

50%50%

50%50%

ConusConus BranchBranchSupplies RVOTSupplies RVOT

CONUS BRANCH FROM LADCONUS BRANCH FROM LAD

8

SASA--NODE BRANCH VARIATIONSNODE BRANCH VARIATIONS

55%55%

45%45%

FROMFROMRCARCA

FROMFROMLCxLCx

RV (ACUTE) MARGINAL BRANCHESRV (ACUTE) MARGINAL BRANCHESSUPPLY ANTERIOR RVSUPPLY ANTERIOR RV

PDA and PLB VARIATIONPDA and PLB VARIATION--RCA DOMINANCERCA DOMINANCE

SINGLE PDASINGLE PDAand PLBand PLB

DUAL PDADUAL PDAand PLBand PLB

HIGH PDAHIGH PDATAKETAKE--OFFOFF

AVAV--NODE BRANCH NODE BRANCH --RIGHT DOMINANCERIGHT DOMINANCE

Usually distal to PDAUsually distal to PDAPDAPDA

LEFT DOMINANCE (15LEFT DOMINANCE (15--20%)20%)

PDA and PLBPDA and PLB arise from arise from LCxLCx and supply and supply inferior wall and inferior septum inferior wall and inferior septum AVAV--Node branch usually distal to PDANode branch usually distal to PDA

LAO SCHEMATICLAO SCHEMATIC--DOMINANT LEFT CORONARY DOMINANT LEFT CORONARY

ANATOMYANATOMY

9

DOMINANT DOMINANT LCxLCx ANATOMYANATOMY

AVGA= AVAVGA= AV--groove artery of groove artery of LCxLCx


DOMINANT DOMINANT LCxLCx ANATOMYANATOMY--Dual PDADual PDA COCO--DOMINANCE (5%)DOMINANCE (5%)

PDA ARISES FROM RCAPDA ARISES FROM RCA PLB ARISES FROM PLB ARISES FROM LCxLCx

LAO SCHEMATICLAO SCHEMATIC--DOMINANT LEFT CORONARY DOMINANT LEFT CORONARY

ANATOMYANATOMYLEFT MAIN BIFURCATIONLEFT MAIN BIFURCATION

LMLM--55--10 mm10 mm

10

LEFT MAIN TRIFURCATIONLEFT MAIN TRIFURCATION--RAMUS INTERMEDIUS BRANCH RAMUS INTERMEDIUS BRANCH

VARIATIONVARIATION

MOST COMMON LCA VARIATIONMOST COMMON LCA VARIATION

RAMUS INTERMEDIUS BRANCH RAMUS INTERMEDIUS BRANCH VARIATIONVARIATION

RI DISTRIBUTIONRI DISTRIBUTION--AS DIAGONAL ORAS DIAGONAL OROBTUSE MARGINALOBTUSE MARGINAL

Single RISingle RI

Dual RIDual RI

LAD ANATOMYLAD ANATOMYLAD proximalLAD proximal –– Proximal to and including Proximal to and including origin of the first major origin of the first major septalseptal perforator.perforator.LAD middleLAD middle –– Distal to origin of first major Distal to origin of first major septalseptal perforator and extending to point perforator and extending to point where the LAD forms an angle (RAO where the LAD forms an angle (RAO view). This is often, but not always, close view). This is often, but not always, close to the origin of the second diagonal. If this to the origin of the second diagonal. If this angle or diagonal is not identifiable, this angle or diagonal is not identifiable, this segment ends one half the distance from segment ends one half the distance from the first major the first major septalseptal perforator to the perforator to the apex.apex.LAD apicalLAD apical –– Beginning at the end of the Beginning at the end of the previous segment and extending to or previous segment and extending to or beyond the apex.beyond the apex.

Report of the AdReport of the Ad--Hoc Committee for Grading of Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Coronary Artery Disease, Council on Cardiovascular Surgery. Circulation 1975; 51:5Surgery. Circulation 1975; 51:5--40.40.

RAORAO

LAD ANATOMYLAD ANATOMY

SEPTAL PERFORATOR BRANCH SEPTAL PERFORATOR BRANCH VARIATIONVARIATION

NUMBERED IN SEQUENCENUMBERED IN SEQUENCES1, S2, S3S1, S2, S3……....

SUPPLY VENTRICULAR SUPPLY VENTRICULAR SEPTUMSEPTUM

DIAGONAL BRANCH ANATOMYDIAGONAL BRANCH ANATOMY

NUMBERED IN SEQUENCENUMBERED IN SEQUENCED1, D2, D3D1, D2, D3……....

SUPPLY ANTERIORSUPPLY ANTERIORWALLWALL

11

LCX ANATOMYLCX ANATOMY

LCxLCx proximalproximal –– From itFrom it’’s s origin off LCA to and origin off LCA to and including origin of including origin of obtuse marginal.obtuse marginal.LCxLCx distaldistal –– The The LCxLCxdistal to the origin of the distal to the origin of the obtuse marginal and obtuse marginal and running along or close to running along or close to left (posterior) AV left (posterior) AV groove.groove.Report of the AdReport of the Ad--Hoc Committee for Hoc Committee for Grading of Coronary Artery Disease, Grading of Coronary Artery Disease, Council on Cardiovascular Surgery. Council on Cardiovascular Surgery. Circulation 1975; 51:5Circulation 1975; 51:5--40.40.

NONNON--DOMINANT DOMINANT LCxLCx ANATOMYANATOMY

AXIALAXIAL--ANTERIORANTERIOR LAOLAO


OBTUSE MARGINAL BRANCHES OBTUSE MARGINAL BRANCHES NUMBERED IN SEQUENCE : OM1, OM2, OM3NUMBERED IN SEQUENCE : OM1, OM2, OM3……....

SUPPLY LATERAL WALLSUPPLY LATERAL WALL

Cardiac VeinsCardiac Veins

Cardiac VeinsCardiac Veins PDA and MIDDLE CARDIAC VEINPDA and MIDDLE CARDIAC VEIN

12

SMALL CARDIAC VEINSMALL CARDIAC VEIN ANTERIOR INTERVENTRICULAR ANTERIOR INTERVENTRICULAR VEIN AND GREAT CARDIAC VEINVEIN AND GREAT CARDIAC VEIN

CAUDALCAUDAL--TOTO--CRANIALCRANIALACQUISITIONACQUISITIONTRIPLE R/O PROTOCOLTRIPLE R/O PROTOCOL

STANDARD CRANIALSTANDARD CRANIAL--TOTO--CAUDALCAUDALACQUISITIONACQUISITION

GCVGCVGCVGCV

AIVAIVAIVAIV AIVAIV

CORONARY SINUS ANATOMYCORONARY SINUS ANATOMY

DOMINANTDOMINANTLCxLCx

NONNON--DOMINANTDOMINANTLCxLCx

What is an Anomaly?What is an Anomaly?NormaNormal –– the anatomy seen in >99% of the anatomy seen in >99% of the populationthe population66

Variant –– unusual anatomy seen in >1% unusual anatomy seen in >1% of the populationof the population

AnomalyAnomaly –– unusual and uncommon unusual and uncommon anatomy seen in <1% of the populationanatomy seen in <1% of the population

Coronary Artery AnomaliesCoronary Artery AnomaliesAnomalies of Origin

High takeoffMultiple ostiaSingle coronary arteryAnomalous origin of the coronary artery from the

pulmonary artery*Origin of coronary artery from the opposite or

noncoronary sinus with an anomalous course (either retroaortic, interarterial,* prepulmonic, septal (subpulmonic).

Anomalies of CourseMyocardial bridging*Duplication of arteries

Anomalies of terminationCoronary artery fistulas*Coronary arcadeExtracardiac termination

*-Potentially hemodynamically significant or malignant abnormalities

Anomalies of Course Anomalies of Course –– Myocardial Myocardial BridgingBridging

Myocardial bridgingMyocardial bridging -- When a coronary When a coronary artery runs artery runs intramurallyintramurally within the within the myocardium instead of myocardium instead of epicardiallyepicardially..

Encased segment called tunneled artery.Encased segment called tunneled artery.

SuperficialSuperficial bridge (75%) (no deviation into bridge (75%) (no deviation into myocardium) myocardium)

DeepDeep Bridge (25%) (Dips, Bridge (25%) (Dips, ieie UU--shaped, into shaped, into myocardium)myocardium)

13

SUPERFICIAL AND DEEP SUPERFICIAL AND DEEP MYOCARDIAL BRIDGEMYOCARDIAL BRIDGE

SungSung--Min Min KoKo IntInt J J CardiovascCardiovasc ImIm, 2007, 2007

SuperficialSuperficial

DeepDeep

DEEP MYOCARDIAL BRIDGEDEEP MYOCARDIAL BRIDGE

Anomalies of Course Anomalies of Course –– Myocardial Myocardial BridgingBridging

Usually asymptomatic with good prognosis. Has Usually asymptomatic with good prognosis. Has been associated with arrhythmia, unstable angina, been associated with arrhythmia, unstable angina, myocardial infarction and sudden death.myocardial infarction and sudden death.

Incidence ranges from 0.5Incidence ranges from 0.5--2.5% in angiographic 2.5% in angiographic studies to 15studies to 15--85% in pathologic series and thus, may 85% in pathologic series and thus, may be considered an anatomic variant rather than a true be considered an anatomic variant rather than a true anomaly.anomaly.

5.7% incidence on CTA 5.7% incidence on CTA (Sung(Sung--Min Min KoKo, et.al. , et.al. IntInt J J CardiovascCardiovasc ImImOct. 2007)Oct. 2007)

Additional Facts Additional Facts –– Myocardial BridgingMyocardial Bridging

When symptoms occur they often donWhen symptoms occur they often don’’t t manifest until the third decade of life.manifest until the third decade of life.

MB predisposes artery to atherosclerosis MB predisposes artery to atherosclerosis proximal to bridge.proximal to bridge.

Large multicenter studies needed for Large multicenter studies needed for incidence and link between MB and chest incidence and link between MB and chest pain.pain.

Anomalies of OriginAnomalies of Origin

A coronary artery that arises from the opposite or A coronary artery that arises from the opposite or noncoronary cusp can take any one of four common noncoronary cusp can take any one of four common courses:courses:

1. interarterial (between aorta and pulmonary artery)1. interarterial (between aorta and pulmonary artery)2. 2. retroaorticretroaortic3. 3. prepulmonicprepulmonic4. septal (4. septal (subpulmonicsubpulmonic))

The course taken by the anomalous artery is The course taken by the anomalous artery is critically important as the critically important as the retroaorticretroaortic, , prepulmonicprepulmonicand septal courses are considered benign while the and septal courses are considered benign while the interarterial course can be associated with sudden interarterial course can be associated with sudden cardiac death.cardiac death.

ANOMALOUS RCAANOMALOUS RCA--INTERARTERIAL COURSEINTERARTERIAL COURSE

14

Left Main Arising from Right Coronary Left Main Arising from Right Coronary Cusp with Interarterial CourseCusp with Interarterial Course

Rt.

Non Lt.

Rt.

Lt.

Ant.

Rt.

Non Lt.

Rt.Rt.

Non Lt.

Rt.

Lt.

Ant.

Axial MIP and Volume rendered images show the Left main Coronary artery originating from the right coronary cuspand coursing between the aorta and pulmonary artery. Theschematic diagram depicts a similar situation.

PA

Ao


A second case demonstrating an anomalous origin of the left main coronary artery from the right coronary cusp with interarterial course. MIP images in various projections display the anomaly, however, the sagittal MIP image on the right confirmsthe interarterial course

Ao

PA


Anterior 3D Volume rendered images demonstrate the left main coronary artery arising from the right coronary cusp with interarterial course. The image on the right has had the pulmonary artery digitally removed by changing the window.

ANOMALOUS LM ORIGINANOMALOUS LM ORIGIN--SeptalSeptal ((SubpulmonicSubpulmonic) Course) Course

FROM RIGHT CORONARY CUSPFROM RIGHT CORONARY CUSPCOURSECOURSE--BETWEEN RVOT AND AORTIC ROOTBETWEEN RVOT AND AORTIC ROOT

Left Main Arising from Right Coronary Left Main Arising from Right Coronary Cusp with Septal CourseCusp with Septal Course

The anomalous left main can be seendescending inferiorly. This septal or subpulmonic course has not been associated with sudden death.

LM

SINGLE CORONARY ARTERYSINGLE CORONARY ARTERYLADLAD--VENTRAL TO RVOTVENTRAL TO RVOT--PrepulmonicPrepulmonic

LCxLCx--POSTERIOR TO AORTIC ROOTPOSTERIOR TO AORTIC ROOT--RetroaorticRetroaortic

15

Anomalous Left Coronary Artery Anomalous Left Coronary Artery Originating From the Pulmonary Originating From the Pulmonary

ArteryArtery

Left main coronary artery is seen originating from the posterior pulmonary artery. Note the large size of both the left main, LAD and the right coronary artery.

Anomalous Left Coronary Artery Anomalous Left Coronary Artery Originating From the Pulmonary Originating From the Pulmonary

ArteryArtery

SAME CASE AS PREVIOUS SLIDE: ALCAPA with large right coronary artery. The RCA is hypertrophied as it is providing collateral flow to the left coronary bed. Note the intramyocardial collateral vessels on the MIP image on the right.

Anomalous Pulmonary Artery Anomalous Pulmonary Artery Origin of Either the RCA or LCAOrigin of Either the RCA or LCA

Also known as ALCAPA or BlandAlso known as ALCAPA or Bland--WhiteWhite--Garland syndrome.Garland syndrome.

A rare congenital defect that represents A rare congenital defect that represents only 0.25only 0.25--0.5% of all congenital cardiac 0.5% of all congenital cardiac defects.defects.

Usually an isolated defect, but can be Usually an isolated defect, but can be associated with other anomalies such as associated with other anomalies such as ASD, VSD and aortic coarctation in ASD, VSD and aortic coarctation in approximately 5% of cases.approximately 5% of cases.

Anomalous Pulmonary Artery Anomalous Pulmonary Artery Origin of Either the RCA or LCAOrigin of Either the RCA or LCA

Symptoms usually present at 1Symptoms usually present at 1--2 months of 2 months of age when LCA pressures rise and PA age when LCA pressures rise and PA pressures decrease causing left to right pressures decrease causing left to right shunting.shunting.

Without treatment, approximately 90% of Without treatment, approximately 90% of infants will die in the first year of life.infants will die in the first year of life.

Survival beyond infancy occurs when there Survival beyond infancy occurs when there are abundant intercoronary collaterals or the are abundant intercoronary collaterals or the LCA supplies relatively less area of the LCA supplies relatively less area of the myocardium.myocardium.

Anomalies of Termination Anomalies of Termination ––Coronary Artery FistulaCoronary Artery Fistula

Usually congenital and accounts for 0.2Usually congenital and accounts for 0.2--0.4% 0.4% of congenital cardiac anomalies.of congenital cardiac anomalies.

Most are clinically and Most are clinically and hemodynamicallyhemodynamicallyinsignificant and are found incidentally.insignificant and are found incidentally.

Approximately 60% of coronary artery Approximately 60% of coronary artery fistulas originate from the right coronary fistulas originate from the right coronary artery.artery.

Anomalies of Termination Anomalies of Termination ––Coronary Artery FistulaCoronary Artery Fistula

Coronary artery can communicate with Coronary artery can communicate with either a chamber of the heart (coronary-cameral fistula) or a segment of the systemic or pulmonary circulation (coronary arteriovenous fistula).

Stealing of blood to the low pressure systemic circulation leaves myocardium at risk for ischemia.

In response, the coronary dilates and may progress to frank aneurysm which can ulcerate, thrombose or rupture.

16

Anomalies of Termination Anomalies of Termination ––Coronary Arteriovenous FistulaCoronary Arteriovenous Fistula

A complex fistula is seen between the left main coronary artery and the pulmonaryartery. Note the tortuous vessels and the contrast spill into the PA (arrows).

Ao


Another example of a complex coronary artery fistula, this one associated with a coronary artery aneurysm (arrows). The fistula is from the LAD and continues beyond the aneurysm as a serpiginous vessel over the main pulmonary artery.


SAME CASE AS PRVIOUS SLIDE:Complex coronary artery fistula from the LAD to the pulmonary artery with aneurysm (arrows).

(Coronary Anatomy(Coronary Anatomy--Swine Model)Swine Model)SELECTIVE CTA AORTIC ROOT CTA XSELECTIVE CTA AORTIC ROOT CTA X--RAY ANGIO EXRAY ANGIO EX--VIVOVIVO

CONCLUSIONCONCLUSION

MULTIDETECTOR CTAMULTIDETECTOR CTA

High Temporal and Spatial ResolutionHigh Temporal and Spatial Resolution2D2D--MPR, 3D and 4DMPR, 3D and 4D--MIP and VR MIP and VR TechniquesTechniquesDetailed Depiction of Cardiac and Coronary Detailed Depiction of Cardiac and Coronary Anatomy Anatomy

THE ENDTHE ENDTHANK YOUTHANK YOU

kbiskbis@@beaumontbeaumont..eduedu

cardiac and coronary artery anatomy no disclosures

Documents