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Dr. William Crowder and Allison Dugas

Allison Dugas didn’t resemble someone with a heart defect.

At age 27, Dugas was in great physical condition and regularly worked out at the gym. As a registered diagnostic cardiac sonographer at St. Dominic’s Mississippi Heart Institute who performs tests on patients with heart problems, she knows the benefits of eating a healthy diet and not smoking.

However, at the last minute, Dugas volunteered to test the new 64-slice CT scanner at the Jackson Heart Clinic. When Dr. William Crowder of the Jackson Heart Clinic uncovered an atrial septal defect (ASD) during testing, he called it “nothing short of a miracle.”

The testing took place in late June, when Dugas agreed to let Crowder scan her heart prior to using the equipment on regular patients. During the test, Crowder found that Dugas’ heart was not only enlarged, but also contained a hole or ASD. Since she assists Crowder with closure of ASDs on other patients, she suspected from looking at the image of her heart on the screen that she had a similar problem.

“These days, most ASDs are discovered when patients are in infancy or early childhood,” Crowder noted. “It was really ironic that my intracardiac echocardiagram tech, who helps me image during most of my ASD closures, ended up having one herself.”

In some children, ASDs cause no symptoms, which may account for the fact that Dugas’ condition went undetected, Crowder said. Left untreated, an ASD may cause problems in adulthood, including hypertension, congestive heart failure, atrial arrhythmias and an increased risk of stroke.

“Heart problems should be fixed as soon as possible so that the patient can avoid long-term health problems,” Crowder said. “It’s fortunate that we found Allison’s problem now before she decided to have children or got any older, both of which can place a strain on the heart.”

Depending on the size, many ASDs can be closed in the Cardiac Cath Lab at St. Dominic’s Mississippi Heart Institute by the placement of an Amplatzer® Septal Occluder, Crowder pointed out. The Amplatzer®, named for Dr. Kurt Amplatz, is one of the most promising non-surgical devices for ASDs. Instead of putting the patient through the trauma of open heart surgery, the use of the Amplatzer means they can now receive treatment through an interventional cardiac catheterization.

The brief, minimally-invasive procedure involves entering a vein in the leg with a small needle so that a catheter can be guided into the heart and major vessels of the heart and lungs. The catheter then deploys the Amplatzer device to cover the ASD by attaching to the atrial septum.

“What’s truly amazing is that a Band-aid is all that’s needed on the leg after the procedure is over,” said Crowder. “Closing the hole with this device is complication-free in the majority of cases. Other benefits are that the heart does not have to be stopped, there are no scars, and very little down-time. In Allison’s case, we performed the procedure on Thursday and she was back at work at St. Dominic’s on Monday.”

Cardiac computed tomography (CT) angiography, also known as coronary CT angiography, is an x-ray examination that allows physicians to non-invasively determine whether fatty or calcium deposits have built up in the coronary arteries. Because these arteries supply blood to the heart muscle, areas of buildup, called plaque, can cause a heart attack/stroke.

Cardiac CT is a proven imaging system for the detection and characterization of cardiovascular disease. The introduction of the 64-slice CT scanner—with 128- and 256-slice systems on the horizon—has increased the interest in utilizing the technology to perform coronary angiography, a procedure that until recently required invasive cardiac catheterization. Multislice CT, combined with the advent of subsecond rotation, provides both high resolution and high speed, allowing high quality images of the coronary arteries.

Cardiac CT angiography uses a fan-shaped, thin x-ray beam that passes through the body at several angles to allow for cross-sectional images. The corresponding x-ray transmission measurements are collected by a detector array, digitized into pixels, and rendered into a three-dimensional image for viewing on a computer monitor.

Today, 64-slice CT scanners provide improved temporal resolution, which should lead to lower motion artifacts and possibly higher diagnostic rates.

PHOTO CUTLINE: Dr. William Crowder and Allison Dugas

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