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8 mm proximal RCA aneurysm. Abbreviation: RCA, right coronary artery. 1182 Chap03 5/14/07 36 6:07 PM Page 36 CARDIOVASCULAR MULTIDETECTOR CT ANGIOGRAPHY FISTULAS CLINICAL CASE 19 A 58-year-old female with CAD and prior bypass surgery presented for evaluation of dyspnea. Invasive angiography showed patent LIMA to mid-LAD, SVG to RCA, and occluded SVG to OM. There was also suggestion of extracardiac communication of contrast during RCA injection (Fig. 50). She was referred for CTA for further definition.
There was also suggestion of extracardiac communication of contrast during RCA injection (Fig. 50). She was referred for CTA for further definition. CTA confirmed two of three grafts patent and also visualized a fistulous communication between the RCA and the right pulmonary artery (Fig. 51). CMR showed normal myocardial perfusion in all segments at rest and with vasodilator stress, and no significant net left-to-right shunt with Qp:Qs ϭ 1:1. 50 Appearance of contrast in a vessel traveling away from the heart (arrow) with injection of contrast into the RCA.
30). Role of CTA: The advantage of CTA in this case in comparison to traditional catheter-based angiography is the ability to delineate the anastomosis of the grafts to the native coronaries with tissue and lumen detail without multiple catheter manipulations and contrast injections to identify occluded grafts. Lacking a target for repeat revascularization in the setting of fixed perfusion abnormalities, this patient was managed medically without requiring invasive angiography. 28 Patent LIMA conduit to the left anterior descending coronary artery.