Is CT Coronary Angiography Necessary for Aortic Dissection Patients?

Is it necessary to pay out of pocket for a CT coronary angiography in cases of aortic dissection?

Dear Doctor,
My father experienced sudden chest pain while sleeping at the beginning of November and was taken to a nearby hospital for examination.
The diagnosis was Type B aortic dissection.
The hospital indicated that they lacked sufficient equipment and recommended transferring him to Hospital A for emergency care.
We then took a private ambulance to Hospital A, where he was admitted for further examination.
Two days later, the hospital informed us that due to his advanced age (80 years), they suggested we pay out of pocket for a CT 640 coronary angiography at a health management center (as the hospital only had a 64-slice CT).
After the examination, his chest pain persisted, and he experienced recurrent fevers.
Before the report was available, we rushed him to the emergency department of Hospital B.
The doctors at Hospital B reviewed the relevant X-rays and deemed the situation urgent, arranging for surgery the next day to perform a bypass and stenting.
Consequently, the previously ordered out-of-pocket CT 640 coronary angiography report was rendered unnecessary.

Subsequently, friends and family questioned how Hospital A, which claims to be a cardiac authority, could require us to go to an external health management center for examination.
I have a few questions for you:
1.
Was the CT 640 coronary angiography necessary? (I only wish to understand and will not file a complaint against Hospital A.)
2.
After the surgery, my father has been experiencing recurrent fevers and low albumin levels.
We have purchased albumin out of pocket to help restore his strength (the ventilator has not yet been removed), and his left side has shown delayed responses (the doctor indicated this is due to an acute stroke, which is a surgical risk).
Given his lack of strength and having been bedridden for a month, he is not as strong or alert as before.
Are there any other better methods to help him recover more quickly?
Thank you for your patience in reading this.

Mr. Huang, 40~49 year old female. Ask Date: 2011/12/05

Dr. Lin Jixiong reply Cardiology

Hello, the CT64 coronary angiography is indeed clinically valuable for understanding whether there is a blockage in the coronary arteries and the severity of such blockages.
However, it seems that this examination is not covered by health insurance, so it would need to be paid for out-of-pocket.
For assessing aortic dissection, a standard CT scanner is sufficient for evaluation, and this type of examination should be covered by health insurance.
Based on the description, it is possible that the hospital found an aortic dissection during the examination and also suspected coronary artery blockage.
However, considering the higher risks associated with catheterization for patients with aortic dissection, it was recommended to perform coronary CT angiography to determine the location and severity of the coronary artery blockage, which would assist the cardiac surgeon in performing coronary artery bypass surgery.
As for postoperative recovery, there are no specific methods; patient care and patience are essential.
Sincerely, Dr.
Lin Chi-Hsiung, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2011/12/05

More Info

In the context of aortic dissection, the necessity of performing a CT coronary angiography (CTCA) can be a nuanced decision that depends on several clinical factors. Aortic dissection is a serious condition where the inner layer of the aorta tears, leading to a separation of the layers of the aorta. This can compromise blood flow and lead to life-threatening complications, including organ ischemia and rupture.
1. Is CT Coronary Angiography Necessary?
In cases of aortic dissection, particularly type B dissections, the primary concern is to assess the aorta and any potential complications. While CTCA can provide valuable information about the coronary arteries, it is not always necessary unless there is a specific concern about coronary artery involvement. In your father's case, the focus should have been on managing the aortic dissection and ensuring that the aorta was stable. If there was a suspicion of coronary artery involvement due to symptoms or other findings, then a CTCA could be warranted. However, if the primary issue was the aorta, a standard CT scan of the chest would typically suffice to evaluate the aorta and any complications.

2. Post-Surgery Complications and Recovery
Your father's postoperative complications, including recurrent fever and low albumin levels, are concerning. These symptoms can indicate several issues, including infection, fluid imbalance, or poor nutritional status. The fact that he is on a ventilator and has shown signs of a stroke adds complexity to his recovery.
To address his recovery, here are some considerations:
- Nutritional Support: Ensuring adequate nutrition is crucial for recovery, especially if he is unable to eat normally. This may involve enteral feeding (tube feeding) or parenteral nutrition (IV nutrition) if he cannot tolerate oral intake.

- Physical Therapy: Once stable, engaging in physical therapy can help improve strength and mobility. This should be tailored to his condition and capabilities.

- Monitoring and Management of Complications: Continuous monitoring for signs of infection, managing fluid status, and addressing any neurological deficits will be essential.

- Multidisciplinary Approach: Involving a team of specialists, including cardiologists, neurologists, and nutritionists, can provide comprehensive care tailored to his needs.

In summary, while CTCA can be useful in certain scenarios, its necessity in the context of aortic dissection should be carefully evaluated based on the clinical situation. Postoperative care is critical, and addressing complications promptly can significantly impact recovery. It is essential to maintain open communication with the healthcare team to ensure that your father's needs are met and that he receives the best possible care during this challenging time.

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