Three-Dimensional Visualization of Recurrent Coarctation of the Aorta by Electron-Beam Tomography and MRI
The patient was a 12-year-old boy who was born with a coarctation of the thoracic aorta. He underwent a Gore-Tex patch angioplasty of the coarctation at 13 days of age. Subsequent restenosis led to subclavian flap angioplasty at age 7 months. He presented now with upper extremity hypertension and decreased femoral pulses.
Attempted visualization of the aortic isthmus by cross-sectional echocardiography was inadequate. The family was initially reluctant to consent to a cardiac catheterization. After 3-dimensional (3D) reconstruction of electron-beam tomography (EBT) and MRI (Figures 1⇓ and 2⇓), the pathological condition was more fully appreciated. The patient then underwent cardiac catheterization, angiography (Figure 3⇓), and balloon angioplasty of the recurrent coarctation.
Parameters for the EBT images were image thickness 1.5 mm, spacing 1.5 mm, scan duration 0.1 second, 40 slices, and 3 mL/kg of contrast delivered by injection into the right antecubital vein. The scan was performed with breath-holding, and the scans were triggered to late diastole (80% of the R-R interval) for every heartbeat. The EBT shaded-surface displays were created with MagicView software (Siemens Medical Systems) on a Sun workstation; the chest wall was subtracted from the source images before the display. The MRI shaded-surface displays were created from a 3D fast spoiled-gradient-recalled acquisition in steady state data set obtained during a bolus infusion of gadolinium.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 1999 by American Heart Association