European Heart Journal Advance Access originally published online on October 24, 2007
European Heart Journal 2008 29(5):617; doi:10.1093/eurheartj/ehm437
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Cabrol shunt for iatrogenic aortic dissection: evaluation with cardiac 64-slice CT
1 Department of Radiology
2 Department of Cardiology, Cardiac CT/MRI Program, St Vincent's University Hospital, Dublin 4, Ireland
* Corresponding author. Tel: +353 87 2987313, Fax: +353 1 2694513, Email: j.dodd{at}st-vincents.ie
A 63-year-old man was admitted with intractable angina and underwent elective coronary angiography. He had a history of percutaneous coronary intervention to the left circumflex artery five years previously. Coronary angiography revealed 90% stenosis of the proximal right coronary artery (RCA) (Panel A) and a 3 mm Cypher stent was placed across the lesion. The procedure was complicated by a RCA dissection with retrograde extension to the ostium and subsequently into the ascending aortic wall (Panel B). The patient was referred for urgent surgical repair. Extensive bleeding was encountered at surgery, and the false lumen of the aortic dissection was decompressed with a Cabrol shunt, whereby a dacron graft was intereposed between the lower part of the false lumen and the right atrium.
Six weeks later a 64-slice cardiac CT was performed to non-invasively evaluate patency of the graft. It confirmed a persistent aortic dissection and a patent false lumen (Panel C). It also clearly depicted a widely patent Cabrol shunt, both at the proximal anastomoses with the false lumen and the distal anastomoses with the right atrium (Panel D). A multiphasic reconstruction cine loop throughout the cardiac cycle demonstrated a contrast shunt into the right atrium during ventricular systole (Supplementary data). The patient remains well at 6-month clinical follow-up.
The Cabrol shunt was first described in 1978 as a method for decompressing the false lumen of an aortic dissection complicated by excessive peri/postoperative haemorrhage. The shunt commonly closes during the first postoperative week although a small minority may remain open for longer periods of time. In recent years cardiac CT has become established as a highly accurate non-invasive method for evaluating coronary artery bypass grafts. We adapted it to evaluate the patency of the Cabrol shunt. It clearly demonstrated the proximal and distal graft anastomoses and the contrast shunt sign confirmed graft patency (Supplementary data). Such findings illustrate the increasing versatility of cardiac CT in providing accurate non-invasive evaluation of surgical grafts and shunts.
Panel A. Coronary angiogram demonstrated a 90% stenosis (arrow) in the proximal right coronary artery.
Panel B. Following percutaneous coronary intervention a coronary dissection extended into the wall of the ascending aorta (arrows). A Cabrol shunt was inserted for intractable bleeding at surgery (see Panel D).
Panel C. Cardiac CT performed six weeks later to evaluate the dissection confirms chronic aortic dissection with contrast in the false (straight arrow) and true lumens (hollow arrow).
Panel D. Cardiac CT coronal oblique image demonstrates the Cabrol shunt extending from the false lumen of the ascending aorta (straight arrow) to the right atrium (open arrow). Distally a contrast shunt (curved arrow) confirms the site of distal anastomoses and shunt patency.
Supplemental data: Multiphasic cardiac CT cine loop throughout the cardiac cycle demonstrates the Cabrol graft with a contrast shunt into the right atrium during ventricular systole.
Supplementary material is available at European Heart Journal online.
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