MDCT Angiography Guides Cardiac Vein Procedures

ReviewAACHEN, Germany, Dec. 30 - For imaging cardiac veins to guide procedures, angiography using multi-detector computed tomography (MDCT) may be a good alternative to conventional angiography, researchers here reported.

Although the newer three-dimensional technique sometimes suffered from motion artifacts, it proved equal to traditional two-dimensional angiography by all measures and provided better visualization of small cardiac veins, said Goerg Mühlenbruch, M.D., and colleagues at the Aachen University Hospital.

Although MDCT angiography has already proved valuable in guiding procedures involving coronary arteries, no previous studies have compared MDCT and conventional angiography in procedures involving coronary veins, the authors reported in the November issue of the American Journal of Roentgenology.

The study included seven patients undergoing interventional cardiac procedures involving the coronary venous system. Two patients underwent radiofrequency ablation procedures and five had left ventricular leads implanted for biventricular pacing. All patients underwent conventional angiography and MDCT angiography.

Both techniques were able to visualize the major coronary veins, such as the coronary sinus, great cardiac, and left ventricular veins equally well in all patients. When it came to the small cardiac veins, MDCT was able to adequately visualize these in three patients, compared with two for conventional angiography.

"Especially for visualization of the small cardiac veins draining directly into the right atrium, MDCT angiography was superior to conventional angiography," the authors said.
On a visibility grade ranging from 0 (worst) to 3 (best), both techniques rated a solid 2. MDCT angiography scored a mean of 2.38, while conventional angiography scored a mean of 2.33.
"Compared with conventional angiography, MDCT angiography is less invasive and has a lower rate of complications," the authors wrote. "Besides increased acceptance of the procedure by the patient population, reduced hospital stays and cost-reduction may be expected."

They concluded, "Cardiac MDCT angiography provides additional information on cardiac function and thoracic abnormalities and may replace other invasive procedures, in some cases even catheter-based coronary angiography."