Bentall procedure is performed for the repair of ascending aortic root lesions. Typically the native aortic root and aortic valve are replaced with a composite graft that comprises both ascending aortic and aortic valve grafts, to which the coronary arteries are anastomosed.
History and etymolo...
Blalock-Taussig shunt, also known as Blalock-Thomas-Taussig shunt, is a palliative procedure performed in patients with tetralogy of Fallot (prior to the ability to repair the defect) to increase the pulmonary blood flow.
Originally the shunt sacrificed the subclavian artery (with a distal lig...
Cardiac chamber enlargement can be recognised by cardiac contour changes, new or different interfaces with adjacent lung, and/or displacement of adjacent mediastinal structures. These are discussed separately:
right atrial enlargement
right ventricular enlargement
left atrial enlargement
Implantable cardiac conduction devices are a very common medical device of the thorax, with over one million implanted in the United States of America alone.
There are two major types of cardiac conduction devices: pacemakers and automatic implantable cardioverter-defibrillators (AICD/ICD), and...
The cardiac curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core cardiac knowledge.
Topics pertaining to the heart and pericardium, but excluding the mediastinum (see: chest curriculum) and great vessels (see: vascular curricul...
Cardiomegaly is a catch-all term to refer to enlargement of the heart, and should not be confused with causes of enlargement of the cardiomediastinal outline, or enlargement of the cardiac silhouette.
There are many aetiologies for cardiomegaly:
congestive heart failure
Cardiovascular (cardiac) shunts are abnormal connections between the pulmonary and systemic circulations. Most commonly they are the result of congenital heart disease.
Blood can either be shunted from the systemic circulation to pulmonary circulation (left-to-right shunt) or between...
Carotid pacemaker, also known as implantable carotid sinus stimulators, is a device that delivers activation energy through the carotid leads and the leads conduct activation energy to the carotid baroreceptors. This is sometimes offered for drug-resistant hypertension. The baroreceptors send si...
COL4A1-related disorders are a group of autosomal dominant disorders caused by a mutation in the COL4A1 gene.
The exact prevalence is unknown, but the group of disorders is considered to be under-recognised, especially asymptomatic variants 1.
The clinical ...
A coronary artery bypass graft (CABG or CAG) is placed during a surgical procedure to increase blood flow to the myocardium due to coronary stenoses, usually caused by coronary artery disease. Arteries or veins can be grafted during this procedure.
Long term outcome of coronary artery bypass gr...
A number of entities can present as cyanotic congenital heart disease. These can be divided into those with increased or decreased pulmonary vascularity (pulmonary plethora):
increased pulmonary vascularity
total anomalous pulmonary venous return (TAPVR) (types I and II)
transposition of the ...
Deductive echocardiography is a step-by-step approach in diagnosing and differentiating congenital heart disease.
position of heart
Delayed myocardial enhancement can occur in cardiac MR assessment due to a number of causes.
myocardial ischaemia: typically subendocardial and follows a vascular territory 1
nonischaemic dilated cardiomyopathy
Dextrocardia is a congenital cardiac malrotation in which the heart is situated on the right side of the body (dextroversion) with the apex pointing to the right.
Dextrocardia is believed to occur in approximately 1 in 12,000 people 2.
There are two main types of dextr...
A small cardiothoracic ratio (CTR) as defined as <42%/0.42 when assessed on a PA chest radiograph, and can be due to number of entities:
adrenal insufficiency, e.g. Addison disease
asthmatic paroxysm ...
Drug and toxin induced pulmonary hypertension is one of the causes of pulmonary arterial hypertension. It falls under group 1.3 under the Dana point classification system of pulmonary hypertension.
A wide range of difference drugs have been associated with developing pulmonary hyper...
An enlarged/dilated azygos vein may result from a number of physiological as well as pathological causes. The enlarged azygos vein may be seen as a widened right paratracheal/paraspinal stripe on a frontal chest radiograph.
Causes for dilatation
There are a number of physiological causes for e...
The differential of an enlarged pulmonary trunk/main pulmonary artery on chest radiography includes:
may appear prominent in young patients especially women
rotation of the heart
left lower lobe collapse
pulmonary arterial hyp...
Epicardial (pericardial) fat pads are normal structures that lie in the cardiophrenic, more so on the right. Unsurprisingly, they are more prominent in obese patients.
They can be affected by fat necrosis (see: epipericardial fat necrosis).
Fetal cardiac tumours refer to primary cardiac tumours that can present in the in utero population.
Fetal cardiac tumours are rare; the prevalence, reported from autopsy studies of patients of all ages, varies from 0.0017-0.28 % 2.
Known cardiac tumour types that pres...
Cardiac involvement in haemochromatosis typically occurs with primary haemochromatosis, as the organ is usually spared in the secondary form of the disease.
Cardiac involvement occurs in approximately 15-20% of the patients with haemochromatosis.
Haemopericardium refers to the presence of blood within the pericardial cavity, i.e. a sanguineous pericardial effusion. If enough blood enters the pericardial cavity, then a potentially fatal cardiac tamponade can occur.
There is a very long list of causes 1,4 but some o...
High output cardiac failure refers to a state of cardiac failure that is associated with a higher than normal cardiac output which is still not sufficient for body tissue demands.
Patients can present with a number of symptoms of varying degrees which include tachycardia,...
Cardiovascular manifestations are seen with increased frequency in the HIV/AIDS adult population, and include:
dilated cardiomyopathy (prevalence 8-30%)
endocarditis: either infective or non-bacterial thrombotic (marantic) which is associated with malignancy or HIV wasti...
Implantable loop recorders, also known as insertable cardiac monitors, are small insertable devices that continuously monitor and record cardiac rhythms. They are placed subcutaneously and used for the evaluation of patients with recurrent unexplained episodes of palpitations or syncope. They sh...
The left atrial (LA) line monitors LA pressure and is indicative of left ventricular function, preload and afterload. The LA line enters from the left superior vein and exits the far side of the chest.
The LA line is a single lumen catheter unlike the right atrial line, which is double lumen. N...
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc may also be visible
These devices ...
Milking effect phenomenon is a pathognomonic angiographic finding in myocardial bridging of coronary arteries. Systolic compression of coronary vessels with partial or complete decompression during diastole is described as milking effect. Its significance lies in:
increased risk of thrombus fo...
Mitral valve disease (MVD) principally comprise of a two main functional abnormalities, which can occur in isolation or in combination:
In addition other pathologies that affect the mitral valve include
mitral valve prolapse
mitral annular calcification
The 'moguls of the heart' refer to the bulges of the cardiomediastinal contour on frontal chest radiographs. The cardiomediastinal bulges are likened to skiing moguls (bumps of packed snow on a mountainside sculptured by turning skis). Awareness of their usual locations and aetiologies is helpfu...
Myocardial perfusion and viability assessment is important for many reasons:
to diagnose, locate and grade the severity of coronary artery disease
to identify candidates who would benefit from re-vascularization
to evaluate response of re-vascularization
Partial anomalous pulmonary venous return (PAPVR), also known as partial anomalous pulmonary venous connection (PAPVC), is a rare congenital cardiovascular condition in which some of the pulmonary veins, but not all, drain into the systemic circulation rather than in the left atrium.
Pericarditis is defined as inflammation of the pericardium. It is normally found in association with cardiac, thoracic or wider systemic pathology and it is unusual to manifest on its own.
In general, infection is the most common cause of pericarditis. Infection accounts for two-thir...
Porcelain left atrium, also known as coconut left atrium, is a term used when a large part of or the entire left atrial wall becomes calcified. It can occur as a rare consequence of endocarditis (with underlying rheumatic heart disease). It has also been described in the setting of end stage ren...
A Pott shunt is a form of palliative surgery performed in patients with tetralogy of Fallot prior to the ability to repair the defect. It consists of a shunt formed between the descending thoracic aorta and the left pulmonary artery.
This does not relieve the right ventricular outflow obstructi...
Primary benign cardiac tumours are much less common than secondary metastatic deposits. However they are more likely when a cardiac mass is seen outside of the setting of terminal metastatic disease. Tumours include 1-2:
most common in adults
accounts for ~50% of all primary be...
Primary malignant cardiac tumours are rare, and account for only ~25% of primary cardiac tumours, and only a small proportion of all malignant tumours which involve the heart: direct extension of adjacent tumours or metastatic deposits are far more common. Histologcal types include 1:
Prosthetic heart valves are common. The four valves of the heart may all be surgically replaced. However, aortic and mitral valves are the most commonly replaced.
Replacements may be tissue or metallic valves, only the latter being visualised on imaging investigations. Sometimes the annulus alo...
Pulmonary hypertension has many causes, and these can be divided in many ways. A simple and systematic approach is to proceed along the cardiopulmonary pulmonary circulation, as causes are found at each site (for a more official classification system see 2003 third world symposium on pulmonary a...
RASopathies are a class of developmental disorders caused by germline mutations in genes that encode for components or regulators of the Ras/mitogen activated protein kinase (MAPK) pathway.
As a group, RASopathies represent one of the most common malformation syndromes, with an in...
Restrictive cardiomyopathy is the least common subtype of cardiomyopathy and is characterised by a marked decrease in ventricular compliance.
Patients can present with symptoms and signs of left ventricular failure and/or right ventricular failure 9.
It is p...
Right atrial enlargement is less common, and harder to delineate on chest radiograph, than left atrial enlargement.
Enlargement of the right atrium can result from a number of conditions, including:
raised right ventricular pressures
pulmonary arterial hypertension
Right heart strain (or more precisely right ventricular strain) is a term given to denote the presence of right ventricular dysfunction usually in the absence of an underlying cardiomyopathy. It can manifest as an acute right heart syndrome.
Right heart strain can often occur as a re...
Secondary cardiac neoplasms or cardiac metastasis/es refer to a secondary malignant tumour of the heart, arising by lymphatic or haematogenous spread of a primary neoplasm 3,5.
Overall cardiac malignancy is an infrequent finding. Metastatic spread is much more common than primary ...
Troponin elevation can occur from a number causes although there is no imaging involved, it is useful for the radiologist to have a basic understanding of their causes (especially when interpreting imaging findings associated with troponin elevation). The cardiac troponin complex consists of thr...