Cardiac imaging?

[question everything]

A family member was diagnosed with Aortic Root Dilation. Probably started with a leaky valve that caused the heart to enlarge and then to the artery to keep pumping. I think. Been asymptomatic.

Anyway, the cardiologist had him on observation and now decided that it is time for a surgery. Yes, in hindsight should have been done two years ago.

Anyway, it is considered "elective" for now, and no elective surgeries until next year, hopefully starting in mid January after the New Year Eve party goers have leveled off.

The surgeon prescribed angiogram. As long as I open the heart, he said, I want to know if there is a need for bypass.

Angiogram done earlier today and the cardiologist is not satisfied. Because the aorta is so dilated, he could not see everything. (I think this is what he menat).

So he wants to do another one, this one using CAT scan. Will still require dye.

Can anyone direct me, or simply explain the difference between the two?

Thanks

[Grasswire2]

1. here

In a CT scan, x rays and computers create images that show cross-sections, or slices, of your body. Angiography involves the injection of contrast dye into a blood vessel to help visualize the status of the blood vessels


https://www.scandirectory.com/article/ct-scans/ct-scan-ct-angiography-cta-scan#:~:text=In%20a%20CT%20scan%2C%20x%20rays%20and%20computers,help%20visualize%20the%20status%20of%20the%20blood%20vessels.

[question everything]

2. Thank you. Will read this

[Grasswire2]

3. just a note...

A first open heart surgery can seem so bewildering in terms of what to expect, and how to get info and support. When my good friend faced his, five years ago, we both joined a FB group called Zipper Club, and it was really helpful. (I know that many people have left FB, but it is a good place for that kind of community discussion.)

[mitch96]

5. Correct. An Angiogram is a bit more invasive than the CT scan. With an angio a catheter is

placed in the femoral artery of the groin. The catheter is snaked up to the aorta and then iodine contrast material is injected into the aorta while pictures are taken. Last time I looked these are
2 dimensional pics.. Up down, right left.
With a CT scan the contrast is injected into a vein in the arm and timed just right so the contrast is caught right when it's at the aorta. The CT is two dimensional SLICES. So you can manipulate the images to get a three dimensional look after the scan is done.. The 2 d images are stacked one on top of the other and then soft tissue is digitally removed to view the aorta by it's self.
Think of the chest as a loaf of bread. You slice up the loaf of bread and then put the slices back together to get at the whole thing...Does that make sense?
The Angio and the CT give the MD more information. What I don't understand is why he did the easy, least invasive test last? The CT is easy, quick and relatively inexpensive.... Unless he did the angiogram and made a few bucks for him self...

The one on the left (A)is the angiogram
The candy cane looking thing is the aortic arch with the root being at the end of the candy cane where it attaches to the heart. You can see the pig tail catheter in the arch of the aorta. Yup that's what they call it... Looks like a little oinker tail..
The one on the right (B) is the rendering after the CT angiogram of just the aorta...
I did Angio/CT and MRI before I retired. Hope this helps
m

[Grasswire2]

6. Yes, a cardiologist makes a fee for an angiogram. A radiologist gets paid for doing a CT. nt

[mitch96]

7. Last I looked the Rad does not do the CT/MRI the tech does..

When the exam is finished the tech sends the images off to the Rad to read. Don't believe the TV machine showing the MD's doing the CT or MRI.. That never happens...
Some special trained radiologist called interventional Radiologist do the angiograms. An arch aortagram is a easy proceedure. Depends on the politics of the hospital who does what. At some of the places I worked the cardiologist did the aorta gram and the Rad reads it. Double dipping if you will. Other places the Rad did the aorta gram and read it also.
Who ever does it, you want the person with the most experience sticking a 18g needle in your groin and nailing it first time. From there it's pretty easy to snake it up, pop squirt and take a pic...
m

[3Hotdogs]

8. My guy wants me to do a stress test with radioactivity. What is that about?

I am resisting doing it. I explained, "You tell me what to do and I will tell you what I am willing to do."

[mitch96]

10. A Nuclear stress test, last time I looked is to see if there is any damage to the heart muscle..

The radio active material is picked up by the heart via the blood flow. If there is no blood flow to a certain part of the heart it shows up as a blank spot on the pic. They do a resting set of pic's and a set when you are "stressing" the heart. A performance evaluation of the heart at both states.. They can also take measurements to see if the heart is pumping properly and with enough volume called a ejection fraction.. Usually on a tread mill with you wired up like a old time stereo.
m
https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231

BTW I'm the same with my Doc.. He want to go charging off in all directions. Risk vs Reward..
I joke with him asking if is it that time of the month he needs to make a boat payment? or was that alimony
m

[question everything]

12. Thank you very much for the detailed explanation.

Will have to study this in more details.

[Grasswire2]

4. How is he doing symptomatically? Just curious.

It seems good that the surgery is considered elective at this point.

[question everything]

11. Would walk a mile or 2 few time a week did OK

But once was told about need for surgery, started feeling a bit woozy.

Also suffers from severe asthma and is 75 yrs old.

Hoping for the best. So far no Covid. Yes had to be tested two days ago.

[Warpy]

9. OK, first some terminology. Elective surgery is any surgery that can be scheduled.

The other kind is emergency surgery, which can't be scheduled, it has to be done right then.

Elective doesn't mean minor or unnecessary or even that the patient has a choice in the matter, it just means it can be scheduled.

The regular imaging scan with radioactive dye will show problems with blood flow. A CT scan with radio opaque dye will allow them to hone in on all the structures so that they won't be surprised by damage they didn't anticipate during surgery. A CT scan images the area slice by slice so that things that can't be visualized from the angle a plain angiogram provides can be visualized.

Cracking somebody's chest open for heart surgery is a huge deal and this surgeon is being very conscientious in making sure the process won't have to be repeated in the near future for a problem that should be taken care of now.

[question everything]

13. Thank you for the detailed explanation

Yes, it is not an emergency- thankful for that - but right now cannot even be scheduled.