Multisection CT Evaluation of the Reoperative Cardiac Surgery Patient

Robert C. Gilkeson, MD ; Alan H. Markowitz, MD ; Leslie Ciancibello, RT

1 From the Departments of Radiology (R.C.G., L.C.) and Cardiothoracic Surgery (A.H.M.), University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106. Presented as an education exhibit at the 2002 RSNA scientific assembly. Received February 3, 2003; revision requested March 11 and received April 2; accepted April 8.

Development of electrocardiographically (ECG) gated multisection computed tomography (CT) has had a significant, immediate impact in cardiovascular imaging. The capabilities of this new technique have become particularly important in the preoperative assessment of the cardiac surgery patient. Cardiac surgery in the 21st century has become increasingly complex because of an aging population needing multiple procedures. As patients live longer, reoperative surgery is often needed, requiring further complicated intervention. Recent research in cardiac surgery patients has linked atherosclerotic disease of the aorta to the risk of perioperative stroke. Multisection CT has been effective in evaluations of the atherosclerotic aorta, minimizing perioperative stroke risk in these often elderly patients. By using the capabilities of ECG gating, improved CT imaging of the aortic valve has helped guide the surgeon in decisions of aortic valve replacement. Injury to preexisting coronary artery grafts is associated with significant perioperative morbidity and mortality. The superior imaging features of ECG-gated CT have enabled preoperative identification of coronary grafts, preventing injury to these important structures during reoperative surgery. Assessment of normal anatomic structures is also important in preoperative planning. Proximity of the aorta, pulmonary artery, and native coronary arteries to the sternum is an important potential cause of morbidity and mortality, and it can be preoperatively assessed with multisection CT. The advancement of ECG gating has enabled accurate assessment of the coronary arteries, which is particularly important in the preoperative identification of congenital and acquired abnormalities. With continued advances, ECG-gated multisection CT will play an increasingly important role in the evaluation of patients with cardiovascular disease.