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In the field of cardiovascular surgery, cardiac computed tomography (CT) has served an important role in association with the improvement of the spatial and temporal resolution. Because CT angiography (CTA) provides more available information than plain CT, CTA has been increasingly used to access the coronary arteries and graft patency after coronary artery bypass grafting (CABG). Recently, minimally invasive cardiac surgeries, including CABG with left mini-thoracotomy and mitral valve surgery with right mini-thoracotomy, are revived, which requires preoperative CTA to make a strategy of incision placement on the basis of anatomical relationship between the target structure of the heart and the thorax. In Japan, transcatheter aortic valve implantation (TAVI) was approved in the late 2013, and is expected to be widely performed in the future. CTA is extremely useful for TAVI patients to determine the choice of the valve size and the surgical approach. CT provides many other valuable findings to us, but if we cannot fully leverage it in the daily cardiovascular surgery, its value is decreased. We have to acquire enough skill to maximize the performance of CT in the practical clinical setting.

Diameters of coronary artery aneurysms (CAAs) complicating acute phase KD can strongly predict the long-term prognosis of coronary artery lesions (CAL). Recently, computed tomographic angiography (CTA) has been used to detect CAL, and the purpose of this study was to determine whether coronary artery diameters measurements by CTA using dual-source computed tomography (DSCT) can be used instead of coronary angiogram (CAG) measurements. Twenty-five patients (22 males and three females) with CAL due to KD, who had undergone both CTA and CAG within one year, were retrospectively evaluated between 2007 and 2013. A prospective electrocardiogram-triggered CTA was performed on a DSCT (SOMATOM Definition, Siemens Healthcare, Germany). Two pediatric cardiologists independently measured the diameters of CAAs twice in each maximum intensity projection (MIP), curved multiplaner reconstruction (MPR) and CAG. We measured 161 segments in total (segment 1-3, 5-7, 11, 13). Diagnostic accuracy was expressed as κ coefficient. A Bland-Altman analysis was also used to assess the intra-observer, inter-observer and inter-modality agreement. The diagnostic quality of CTA was excellent ( κ = 0.93). Excellent inter-observer agreement for the diameters of CAAs was obtained for MIP, MPR and CAG and for the intra-observer agreement. The inter-modality agreement was also excellent in measurements of CAA (MPR-CAG: y = 0.9 x + 0.40, r = 0.97, p < 0.0001 MIP-CAG: y = x + 0.1, r = 0.94, p < 0.0001). These values in normal coronary arteries were also obtained. We found a significant correlation between CTA and CAG in measuring the coronary arteries. We conclude that measuring coronary artery diameters by CTA is reliable and useful. [ABSTRACT FROM AUTHOR]