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Imaging the post-operative thoracic aorta: normal anatomy and pitfalls

Departments of ¹Radiology and ²Cardiothoracic Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK

View larger version (12K): [in a new window]   Figure 1. (a) Aortic root replacement with re-implantation of coronary arteries. (b) Repair of ascending aorta. IA, innominate artery; RCA, right coronary artery; LCA, left coronary artery; AV, aortic value.

View larger version (180K): [in a new window]   Figure 2. ECG-gated oblique sagittal MRI following repair of a Type A dissection. The dilated residual aortic root is seen (arrow) as well as the false lumen of a residual Type B dissection (arrowheads).

View larger version (81K): [in a new window]   Figure 3. MRI after Type A dissection repair and aortic valve replacement. (a) Oblique sagittal T1 weighted image shows the perigraft wrap (arrowheads) and a chronic Type B dissection (arrow). (b) Gradient echo sequence demonstrates signal void created by the sternal wires and valve prosthesis (arrowheads).

View larger version (79K): [in a new window]   Figure 4. ECG-gated T1 weighted axial (a) and oblique sagittal (b) MRI. The perigraft wrap (arrows) is demonstrated as soft tissue intensity posterior to the ascending aorta.

View larger version (159K): [in a new window]   Figure 5. Contrast enhanced axial CT following omental translocation (arrows). Residual air is seen in the sternotomy wound (arrowhead).

View larger version (22K): [in a new window]   Figure 6. Total arch replacement with Stage 1 elephant trunk. The single patch incorporating the head and upper limb vessels is demonstrated.

View larger version (9K): [in a new window]   Figure 7. Hemi-arch replacement.

View larger version (134K): [in a new window]   Figure 8. Contrast enhanced CT showing anastomotic pseudoaneurysms (arrow) arising from distal aortic arch.

View larger version (183K): [in a new window]   Figure 9. ECG-gated oblique sagittal MRI demonstrates persistent Type B dissection (arrow). There is signal void in both the true and false lumina.

View larger version (50K): [in a new window]   Figure 10. Stage 1 elephant trunk procedure. The distal free-lying segment of graft is seen dangling in the proximal aneurysmal descending aorta. The head and upper limb vessels have been incorporated into the arch as a single patch.

View larger version (160K): [in a new window]   Figure 11. ECG-gated T1 weighted oblique coronal MRI ("black blood" image) demonstrates appearances following elephant trunk repair. The distal graft segment is in the lumen of the distal native aortic arch.

View larger version (97K): [in a new window]   Figure 12. Contrast enhanced axial CT demonstrates the elephant trunk repair and residual aneurysm of the descending aorta. The distal graft lies free in the lumen of the proximal descending aorta. Adjacent thrombus is seen as low attenuation material against the wall of the native vessel (arrow).

View larger version (18K): [in a new window]   Figure 13. Thoracoabdominal aneurysm repair demonstrating anastomosis of the coeliac axis and superior mesenteric arteries as a single patch. The lower intercostal arteries have been incorporated into the graft in a similar fashion.

View larger version (138K): [in a new window]   Figure 14. T1 weighted axial MRI through the upper abdominal aorta. The false aneurysm can be seen as an area of mixed signal intensity anteromedial to the abdominal aorta (arrow).

View larger version (121K): [in a new window]   Figure 15. Contrast enhanced axial CT demonstrates an inclusion graft and a thrombosed perigraft space (arrow) at the site of the descending thoracic aorta.

View larger version (171K): [in a new window]   Figure 16. Oblique sagittal gradient echo MRI. Coarctation repair. The site of anastomosis of the interposition graft is indicated (arrows).

View larger version (78K): [in a new window]   Figure 17. (a) Oblique sagittal gradient echo MRI and (b) chest radiograph of bypass graft for coarctation repair. The graft (arrows) passes posteriorly towards the spine (high signal intensity) from the proximal descending aorta (a).

View larger version (65K): [in a new window]   Figure 18. (a) Contrast enhanced axial CT and (b) three-dimensional maximum intensity projection image. The enhancing extra-anatomical conduit is anterior to the left pulmonary artery (arrows). Aneurysmal native descending thoracic aorta (arrowheads).