2006 Charles T. Dotter Memorial Lecture—Cardiac Surgery: Pre- & Post-Operative Insights From MR & CT
Advancements in MR and CT imaging of the cardiovascular system have permitted unique insights into the appearance and behavior of the cardiac chambers, myocardium, coronary arteries, pericardium, and proximal great vessels in disease states directly involving or indirectly affecting (eg, such as due to valve disease) these structures. However, the impact of the 3D anatomic, functional, tissue-characterizing, or flow-quantification capabilities of these two noninvasive tomographic imaging modalities specifically on pre–cardiac surgery planning and/or post–cardiac surgery monitoring has not often been addressed. With concurrent advances in catheter-based therapy, there has been significant reduction in the volume of traditional cardiac surgical procedures such as coronary artery bypass grafting. Because of the life-saving nature of these surgical alternatives, traditional surgeries, and medical therapies, older patients with complicated medical histories, including prior interventions, leading to highly patient-specific cardiac conditions, are more and more commonly cardiac surgery candidates. Thus, there is increasing need for highly specialized and individualized imaging in order for cardiac surgeons to understand the specific details of such patients’ current cardiac anatomic and physiological abnormalities in the context of their past disease course and history of therapy to plan future surgical treatments. Cardiac surgical procedures performed at major heart centers that benefit from insights provided by cardiac MR and CT include ventricular restoration of the dilated dysfunctional left ventricle, myocardial revascularization of the chronically ischemic left ventricle, septal myectomy for hypertrophic obstructive cardiomyopathy, pericardiectomy for constrictive or adhesive pericardial disease, cardiac mass resection, and aortic root and/or valve replacement.