Koroner Arter Çıkış Anomalilerinin Tespitinde 16-Dedektör Bilgisayarlı Tomografinin Önemi

Coronary artery origination anomalies are detected during catheter angiography and can rarely be a cause of patient's complaint. In this study, we aimed to investigate the role of ECG-gated 16-detector computed tomography in the detection of coronary artery origination anomalies. Ninehundred and fifty adult patients from January 2005 to June 2006 were evaluated retro spec tively. Coronary CT angiography studies had been routinely performed by 16-detector CT scanners with ECG gating. Detector collimation was 16x1 mm, and reconstruction interval 0.5mm. Patients with pre-scan heart rates greater than 75 beats/min were given oral or intravenous beta-blocker. CT scans were obtained with breath hold after intravenous 120 ml iodinated contrast material was given. The coronary CT angiograms were evaluated by thoracic radiologist on Vitrae workstation using axial, multi planar reformation, and three dimensional images. Fourteen coronary artery anomalies were detected in 950 consecutive coronary CT a ng io gra p h ie s (1.47%). Identified anomalies were as fallows: origin of right coronary artery (RCA) from left sinus of Valsalva =2, hypoplasia of RCA =2, second left anterior descending artery (LAD) from RCA = 1, origin of circumflex artery (CxA) from right sinus of Valsalva =4, origin of LAD and CxA from 2 different ostia in the left sinus of Valsalva =5. 16-detector CTA can non invasively demonstrate accurate depiction of the origin and course of coronary artery anomalies. It is important to detect coronary artery anomalies because they can be compressed by cardiac chambers and great vessels during their aberrant courses. In addition, coronary CT angiography can be helpful to guide bypass surgery and catheter angiography in these patients. Koroner arter cikis anomalileri genellikle kateter anjiyografi sirasinda saptanir ve nadir olarak hastadaki sikayetlerin kaynagi olabilir. Bu calismada koroner arter cikis anomalilerinin tespitinde 16-dedektorlu bilgisayarli tomografik anjiyografinin (BTA) rolunu ve koroner arter cikis anomalisi sikligini arastirmayi amacladik. Ocak 2005-Haziran 2006 tarihleri arasinda toplam 950 hastanin koroner BTA' lari retros-pektif olarak degerlendirildi. Koroner BTA tetkikleri rutin olarak EKG tetikleme ozellikli 16 -dedektorlu BT cihazi ile yapildi. Dedektor kolimasyonu 16x1 mm, rekonstruksiyon intervali 0.5mm idi. Tetkik oncesi kalp hizlari dakikada 75'in uzerinde olan hastalara oral veya intra-venoz beta bloker tatbik edildi. Kesitler 120 ml non iyonik iyotlu kontrast maddenin intra-venoz yoldan verilmesi ardindan nefes tutmali olarak elde edildi. Goruntuler radyoloji uzma-ninca, Vitrae calisma istasyonunda aksiyel, multiplanar reformat ve uc boyutlu imajlarda degerlendirildi. Dokuzyuzelli koroner BTA tetkikinde 14 koroner arter cikis anomalisi saptandi (%1.47). Tespit edilen anomaliler ve sayilari su sekildeydi: sol sinus valsalva cikisli sag koroner arter =2, sag koroner arter hipoplazisi =2, sag koroner arter cikisli ikinci sol anterior desendan ar-ter=1, sag sinus valsalva cikisli sirkumfleks arter=4, sol sinus valsalva'dan sirkumfleks ve sol anterior desendan arterin ayri ayri cikisi =5. 16-dedektorlu BTA non invaziv olarak koroner arter cikis anomalilerini dogru bir sekilde ortaya koyar ve onlarin seyirlerini goruntuleyebilir. Anormal seyir sirasinda kalp ana vaskuler yapilar tarafindan basiya maruz kalabileceklerinden saptanmalari klinik acidan onemlidir. Ayrica koroner BTA bu hastalarda by pass cerrahisi ve kateter anjiyografiye yol gosterebilir