Thoracic pseudoaneurysms are a rare variety of aortic disorders that are potentially fatal. Traditionally, these are treated surgically. False aneurysms are usually a late complication of a previous surgical procedure. Surgical management is often complicated by poor outcomes with high morbidity and mortality. We report a patient with recurrence of an aortic pseudoaneurysm after closure with an Amplatzer (AGA Medical Corp, Plymouth, NH) septal occluder that was successfully treated with a second Amplatzer device.

Objectives The purpose of this study was to evaluate the diagnostic accuracy of electrocardiographically gated 64-multidetector row coronary computed tomographic angiography (CCTA) in individuals without known coronary artery disease (CAD).Background CCTA is a promising method for detection and exclusion of obstructive coronary artery stenosis. To date, no prospective multicenter trial has evaluated the diagnostic accuracy of 64-multidetector row CCTA in populations with intermediate prevalence of CAD.Methods We prospectively evaluated subjects with chest pain at 16 sites who were clinically referred for invasive coronary angiography (ICA). CCTAs were scored by consensus of 3 independent blinded readers. The ICAs were evaluated for coronary stenosis based on quantitative coronary angiography (QCA). No subjects were excluded for baseline coronary artery calcium score or body mass index.Results A total of 230 subjects underwent both CCTA and ICA (59.1% male; mean age: 57 +/- 10 years). On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect >= 50% or >= 70% stenosis were 95%, 83%, 64%, and 99%, respectively, and 94%, 83%, 48%, 99%, respectively. No differences in sensitivity and specificity were noted for nonobese compared with obese subjects or for heart rates <= 65 beats/min compared with <= 65 beats/min, whereas calcium scores >400 reduced specificity significantly.Conclusions In this prospective multicenter trial of chest pain patients without known CAD, 64-multidetector row CCTA possesses high diagnostic accuracy for detection of obstructive coronary stenosis at both thresholds of 50% and 70% stenosis. Importantly, the 99% negative predictive value at the patient and vessel level establishes CCTA as an effective noninvasive alternative to ICA to rule out obstructive coronary artery stenosis. (A Study of Computed Tomography [CT] for Evaluation of Coronary Artery Blockages in Typical or Atypical Chest Pain; NCT00348569) (J Am Coll Cardiol 2008; 52: 1724-32) (C) 2008 by the American College of Cardiology Foundation

A 70-year-old man with type II diabetes mellitus underwent a routine screening coronary calcium score evaluation using nonenhanced 64 multi-slice computed tomography (MSCT) (LightSpeed VCT, General Electric, Waukesha, WI). The cumulative Agatston score was low and contrast enhanced MSCT coronary angiography failed to demonstrate any significant coronary artery lesions. The contrast enhanced 64-MSCT data were reconstructed on an imaging workstation and a thorough review of the heart was performed. Despite a lack of previously identified valvular heart disease, the 64-MSCT contrast enhanced images obtained in 10% step reconstructions showed dynamic morphology of both the mitral and aortic valves, including mitral valve prolapse (Fig 1A). A subsequent transthoracic echocardiogram with Doppler flow confirmed moderate mitral valve prolapse (Fig 1B). Routine screening evaluation of the mitral valve prolapse will be performed in this asymptomatic patient. Rapid advances in MSCT speed, resolution, and slice thickness have facilitated increasingly accurate diagnostic measurement of coronary artery disease and calcium burden. However, the 64-MSCT has not yet been applied to the evaluation of structural heart disease, including valvular abnormalities. As the quality of noninvasive coronary artery imaging with MSCT continues to improve and begins to replace invasive diagnostic coronary arteriography, the opportunity exits to simultaneously evaluate patients for unsuspected structural heart disease. Early detection of structural heart disease could lead to early intervention and potentially improved patient survival. This case demonstrates that 64-MSCT cardiac imaging may have reached sufficient quality to adequately assist in the evaluation of patients with structural heart disease.