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By Rikin Trivedi

Atherosclerosis represents the major explanation for mortality and morbidity on this planet. of the commonest, serious, illnesses which could happen, acute myocardial infarction and stroke, have their pathogenesis within the atherosclerosis which can impact the coronary arteries in addition to the carotid/intra-cranial vessels. for that reason, some time past there has been an intensive learn in determining pre-clinical atherosclerotic ailments so that it will plan the right kind therapeutical technique ahead of the pathological occasions happen. within the final two decades imaging thoughts and specifically Computed Tomography and Magnetic Resonance had a big development of their power. within the box of the Computed Tomography the advent of the multi-detector-row expertise and extra lately using twin power and multi-spectral imaging presents a stupendous point of anatomic element. The MR because of using power magnetic box and intensely complex sequences can snapshot human vessels in a short time whereas supplying a great distinction solution. ​

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The scan has to cover the chest from the diaphragm up to the aortic arch, in order to cover the heart and the great thoracic vessels. In certain cases, the scan has to cover also the epiarotic vessels (in particular in patients with arterial coronary artery bypass graft (CABG), see below). 4 mg sublingual (spray or tablet) to dilate the coronary arteries [14]. The next step is the contrast medium infusion: Generally a 50–60 ml contrast medium bolus is administered, with a biphasic (contrast medium bolus followed by a 50 ml saline solution bolus to wash the right chambers and better evaluate RCA) or triphasic technique (contrast medium bolus followed by a mixture of contrast medium and saline solution to evaluate right chamber, and followed then by a bolus of saline solution) [5], with a flow of 5–6 ml/s.

In symptomatic patients the most important clinical manifestation is the right ventricular enlargement with pulmonary hypertension [49]; others can be arrhythmias, myocardial ischemia or infarction and heart failure. Most of adult patients are asymptomatic [49], whereas an important left-to-right shunt will manifest clinically easier in young patients. 52 M. Porcu et al. Table 9 Report data for coronary artery fistulas Number Location Origin (LCA; RCA) and termination (cardiac chamber, pulmonary vein or artery, cardiac sinus or superior cava vein) Dimensions General conditions of the rest of the circle, including ectasia, aneurisms or thrombosis Evaluation of the heart: dimensions of the cardiac chambers, thickness of myocardium, pulmonary hypertension signs CTA Findings and Report CTA can reveal the presence of enlarged fistulas, evaluating the possible presence of ectasia or focal aneurysms of the coronary circle, with or without thrombosis [49].

D. • G. D. • I. D. • C. D. M. D. ), di Cagliari, Cagliari 09100, Italy M. D. s. S. , Fellow AIMBE. AtheroPoint LLC, Roseville, CA, USA © Springer Science+Business Media New York 2015 R. Trivedi et al. 1007/978-1-4899-7618-5_2 29 30 M. Porcu et al. Intracoronary ultrasonography (ICU) is a complementary examination that allows the evaluation of plaque morphology and the assessment of the coronary walls. These fundamental tools have the disadvantages of being invasive (in fact they are based on the selective catheterisation of the coronary arteries through an arterial access, which generally is the brachial or the femoral artery) and not without intraoperative and postoperative complications, such as plaque rupture followed by thrombosis in situ and ischemia, death and infections.

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