Clinical cardiac CT: anatomy and function

447 Pages·2011·38.01 MB·English

by  Halpern

MediaCenter.thieme.com
plus e-content online
E1FM01.qxd 10/12/10 10:17 AM Page i
Clinical Cardiac CT
Anatomy and Function
Second Edition
E1FM01.qxd 10/12/10 10:17 AM Page iii
Clinical Cardiac CT
Anatomy and Function
Second Edition
Ethan J. Halpern, MD
Professor and Vice Chairman of Radiology
Director, Cardiac CT
Thomas Jefferson University
Philadelphia, Pennsylvania
Thieme
New York .Stuttgart
E1FM01.qxd 10/12/10 10:17 AM Page ii
E1FM01.qxd 10/12/10 10:17 AM Page iv
Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
Executive Editor: Timothy Y. Hiscock
Managing Editor: J. Owen Zurhellen IV
Editorial Assistant: Judith Tomat
Editorial Director, Clinical Reference: Michael Wachinger
Production Editor: Kenneth L. Chumbley, Publication Services
International Production Director: Andreas Schabert
Vice President, International Marketing and Sales: Cornelia Schulze
Chief Financial Officer: James W. Mitos
President: Brian D. Scanlan
Compositor: Thomson Digital
Printer: Leo Paper Group
Library of Congress Cataloging-in-Publication Data
Halpern, Ethan J.
Clinical cardiac CT : anatomy and function / Ethan J. Halpern. –2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60406-375-2
1. Heart–Tomography. I. Title.
[DNLM: 1. Coronary Disease–radiography. 2. Heart–anatomy & histology.
3. Tomography, X-Ray Computed–methods. WG 300]
RC683.5.T66H35 2011
616.1'20757–dc22
2010036129
Copyright ©2011 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use,
exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and
liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating,
preparation of microfilms, and electronic data processing and storage.
Important note:Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in
treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be
reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication.
However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowl-
edge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants
that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions
or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with
other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan
to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the
recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with
new or infrequently used drugs.
Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary
names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation
as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
Printed in China
5 4 3 2 1
ISBN 978-1-60406-375-2
E1FM01.qxd 10/12/10 10:17 AM Page v
Dedicated to my dear wife Sarah. You are my best friend, my partner in all endeavors, and
always selflessly devoted to our family. Once again, I could not possibly have completed
the second edition of this textbook without your love and support. I love you always.
Ethan J. Halpern
E1FM01.qxd 10/12/10 10:17 AM Page vi
E1FM01.qxd 10/12/10 10:17 AM Page vii
Contents
Media Center Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
David C. Levin
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
1 Key Issues in Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ethan J. Halpern
2 Technique, Protocols, Instrumentation, and Radiation Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Ethan J. Halpern
3 Normal Coronary Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Ethan J. Halpern and David C. Levin
4 Coronary Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Ethan J. Halpern and David C. Levin
5 Calcium Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Ethan J. Halpern and David M. Shipon
6 Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Jonathan Gomberg and Ethan J. Halpern
7 Coronary Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
David L. Fischman and Aaron M. Giltner
8 Bypass Grafts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Linda J. Bogar, Stephanie Fuller, and James T. Diehl
9 Cardiac Morphology and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Ethan J. Halpern and Alyson N. Owen
10 Valve Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Ethan J. Halpern and Donna R. Zwas
vii
E1FM01.qxd 10/12/10 10:17 AM Page viii
viii Contents
11 Ablation in the Left Atrium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Behzad B. Pavri and Ethan J. Halpern
12 Cardiac Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Panayotis Fasseas and Daniel J. McCormick
13 Thoracic Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
Scott C. Silvestry, James T. Diehl, and Ethan J. Halpern
14 Congenital Heart Disease in the Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
Robert A. Quaife, C. Douglas Borg, Nicolas Hilpipre, and David Wang
15 Triple Rule-Out CT Angiography for Evaluation of Acute Chest Pain
and Suspected Acute Coronary Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Ethan J. Halpern
16 Innovations in Cardiac CT: Slice Wars, Dual Energy, Myocardial Perfusion,
and Targeted Contrast Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Jacob Sosna, Galit Aviram, and Ethan J. Halpern
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
E1FM01.qxd 10/12/10 10:17 AM Page ix
Media Center Information
◆ 3 Normal Coronary Circulation Cine 9.3 Normal left and right ventricular function
with enlarged right heart.
Cine 3.1 Normal right dominant coronary
circulation. Cine 9.4 Normal left ventricular function with a
dilated, hypokinetic right ventricle.
Cine 3.2 Normal right dominant coronary
circulation. Cine 9.5 Low normal left ventricular function with
paradoxical motion of the interventricular septum.
Cine 3.3 Normal right dominant coronary
circulation. Cine 9.6 Dynamic left ventricular function.
Cine 3.4 Normal left dominant coronary-circulation. Cine 9.7 Low normal left ventricular function.
Cine 3.5 Weakly left dominant coronary circulation. Global left ventricular dysfunction
Cine 3.6 Co-dominant (balanced) coronary Cine 9.8 Mild global hypokinesis.
circulation.
Cine 9.9 Mild-moderate global hypokinesis.
◆ 8 Coronary Bypass Graft Anatomy Cine 9.10 Mild-moderate global hypokinesis.
Cine 9.11 Mild-moderate global hypokinesis with
Cine 8.1 LIMA bypass to LAD.
dilated left ventricle.
Cine 8.2 LIMA bypass to LAD, diagonal branch
Cine 9.12 Severe global hypokinesis.
and distal RCA.
Cine 9.13 Severe global hypokinesis related to
Cine 8.3 RIMA bypass to LAD and LIMA bypass to
ischemic cardiomyopathy.
obtuse marginal of LCX.
Segmental left ventricular dysfunction
Cine 8.4 Radial artery, LIMA and RIMA bypass grafts.
Cine 9.14 Mid-septal infarct.
Cine 8.5 LIMA and two vein grafts.
Cine 9.15 Mid-distal anteroseptal infarct.
Cine 8.6 Vein grafts to LAD and PDA with LIMA
graft to a diagonal artery.
Cine 9.16 Anteroseptal infarct.
Cine 9.17 Anteroseptal infarct.
◆ 9 Normal Left Ventricular Function
Cine 9.18 Normal LV function with septal
Cine 9.1 Normal left and right ventricular function. contraction abnormality.
Cine 9.2 Normal left and right ventricular function. Cine 9.19 Distal septal and apical Infarct.
ix