Keywords:
Pulmonary vessels, Thorax, Cardiovascular system, CT-Angiography, Catheter arteriography, CT, Diagnostic procedure, Catheters, Surgery, Embolism / Thrombosis, Haemodynamics / Flow dynamics, Hyperplasia / Hypertrophy
Authors:
A. J. Theruvath1, G. Wirth1, T. Bostel2, E. Mayer1, C. Düber1, K.-F. Kreitner1; 1Mainz/DE, 2Heidelberg/DE
Results
In contrast to DSA,
the entire pulmonary vasculature was accessible on CT angiograms.
CTA showed a tendency towards higher accuracy of displaying typical vascular changes in central and segmental pulmonary arteries of CTEPH.
Moreover,
on subsegmental level CT angiography was clearly superior to DSA (202 vs.
160 pathologic vascular segments; P=0.0003) (Table 1).
Right ventricular hypertrophy was seen in 8 of 12 patients (67 %) and the pulmonary trunk was dilated in 11 of 12 patients (92 %).
Parenchymal signs of CTEPH (mosaic perfusion pattern,
focal scars) were detected in all of our patients as well as enlarged bronchial systemic arteries indicating a systemic collateral supply.
Coronary artery disease was found in 8 of 12 patients (67%) including 2 patients with a significant coronary artery lesion (i.e.,
at least one stenosis of > 50%).
Evaluation of the interventricular septum showed pathological leftward curvature in 6 patients.
Maximum IVS bowing was observed in the early diastolic phase at 45-60% of the R-R interval.
There was a strong correlation between the IVS curvature and mean and systolic pulmonary artery pressure,
measured by RHC (r=-0,91 / r=-0,96) (Figure 2,
3).
Furthermore,
the pulmonary vascular resistance also correlated with the IVS curvature (r=-0,69).