The clinical activity of the Cardiovascular Computed Tomography (CT) Unit is aimed at responding to any of the clinical needs of the Monzino Cardiology Centre and/or cardiology, cardiac surgery and vascular surgery in Italy, by performing CT examinations.
The Unit relies on the professional contribution of a team of 8 doctors, 4 cardiologists and 4 radiologists, 8 radiology technicians and 8 nurses.
CT enables the study of the circulation in the coronary arteries, implanted stents and aorto-coronary by-passes, as well as the circulation in the cardiac veins, the left atrium and the pulmonary veins, the aortic valve annulus, cardiac and paracardiac masses, the thoracic and abdominal aorta, supra-aortic trunks, the arterial system of the lower limbs and the pulmonary arterial circulation.
In 2015, 5,600 cardiovascular examinations were performed, of which 2,800 were dedicated to the study of the heart and the coronary circulation and the same number were performed to study the various other vascular districts.
From 3 March, 2015, a new device, the "Revolution CT", has been operational in the Monzino Cardiovascular CT Unit. This device enables examinations to be performed in all patients, regardless of their heart rhythm and clinical situation. The new equipment provides extraordinary spatial and temporal resolution, allowing the acquisition of images of the whole heart in a single beat, thus drastically reducing exposure to ionizing radiation and contrast medium, and ensuring greater comfort for the patient.
Approximately 9,500 examinations have been performed since the installation of the "Revolution CT", about half of which were dedicated to the study of the heart and the coronary circulation. Among the latter examinations, about 500 were done to plan interventional procedures (interventional cardiology or electrophysiology) and another 200 included not only an evaluation of the coronary anatomy, but also functional studies using CT-perfusion or fractional flow reserve-CT, which provides an estimate of the functional severity of a possible coronary stenosis. Monzino was the first centre in Italy and among the first in the world to introduce this technology into clinical practice.
The research activity of the Cardiac Imaging Area is deeply integrated with the daily clinical work and includes echocardiography, computed tomography and magnetic resonance.
Regarding recent research projects, our main efforts are focused on:
- new methods in transthoracic and transesophageal 3D-echocardiography demonstrating advantages of 3D vs 2D-echocardiography in the evaluation of right ventricular function, mitral valve prolapse, intraoperative monitoring of cardiac surgery, left atrial function;
- feasibility and accuracy of non-invasive evaluation of coronary arteries, stents and bypass grafting through cardiac computed tomography;
- new technical advances in radiation dose reduction in cardiac computed tomography maintaining a high accuracy in native and stented coronary arteries evaluation;
- cardiac CT and prognosis;
- new bioengineering approaches to cardiac imaging computation, mainly in the field of 3D-echocardiography;
- collaboration with other Units within the framework of a disease-specific multidisciplinary team in the evaluation of patients undergoing electrophysiological approaches, cardiac failure therapies, PCI procedures, cardiac surgery (including percutaneous/transapical aortic valve implantation, mitral clip, left atrial appendage closure).
- A recent field of scientific interest is the new real-time 3D-echocardiographic imaging. In particular, our attention is focused on the quantification of novel 3D left ventricular shape indices, able to overcome the limitations relevant to prior 2D indices, to better follow ventricular remodelling after surgery and to study the coupling between left ventricular function and morphology.
Recently, MRI has been integrated in our area and, even though the Unit start-up allowed us only a 2 year experience (with more than 1000 cases per year), has allowed new approaches such as the analysis of the tricuspid valve by an innovative method of acquisition and reconstruction of images of the tricuspid annulus and right ventricle. Interestingly, tricuspid annulus is relatively easily evaluated through this novel MRI method and an accurate dynamic reconstruction has been shown to be feasible.