Coronary Computed Tomography Angiography

Coronary computed tomographic angiography (cCTA) as a noninvasive approach underlies a rapid technological development with an impressive improvement of spatial and temporal resolution of the images. Therefore, it has become an accurate and cost-effective method to detect or exclude obstructive coronary artery disease (CAD) in patients with low to medium cardiovascular risk profile, as recommended by the ESC/AHA/ACC guidelines. The results show an excellent sensitivity, but still with a lack of specificity compared with invasive measurement. Several novel techniques like myocardial perfusion, plaque characterization or CT-based measurement of the fractional flow reserve have been developed to improve the positive predictive value and create more accurate results in detecting hemodynamically relevant stenoses. Moreover, during the last decade, the need to reduce radiation dose has become a central issue in clinical use, while the current generation of CT scanners has drastically lowered radiation dose. In conclusion, cCTA has become a promising alternative to invasive cardiac catheterization with still existing limitations. Thus, an appropriate patient selection is mandatory to utilize the advantages of this technique

Hepatic and Renal Failure after Anterior Myocardial Infarction Induced Apical Ventricular Septal Defect

We report the case of a 68-year-old man suffering from incremental hepatic and renal failure one month after anterior myocardial infarction. Cardiac MRI showed a pronounced apical post-AMI aneurysm, a moderate to severe mitral and tricuspid regurgitation as well as a hemodynamically highly significant 12 mm apical ventricular septal defect with a left-to-right ventricular shunt of almost 63% as the underlying cause. Heart X-ray revealed a severe LAD in-stent restenosis. CAPD catheter drainage of hydroperitoneum due to congestive liver and renal failure was provided in combination with intensified CAPD hemodialysis. Heart surgery was performed where the apical aneurysm was excised, the mitral valve was reconstructed, the IVSD was closed and the subtotally in-stent occluded LAD was bypassed. Post-surgery, the ascites were significantly reduced, and CAPD hemodialysis therapy could be terminated since the renal function gradually improved (MDRD = 25 mL/min). To our knowledge, for the first time we report successful CAPD catheter drainage of hydroperitoneum in combination with CAPD hemodialysis