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Hybrid Cardiac Single Photon Emission Computed Tomography/Computed Tomography Imaging With Myocardial Perfusion Single Photon Hybrid Cardiac Single Photon Emission Computed Tomography/Computed Tomography Imaging With Myocardial Perfusion Single Photon Emission Computed Tomography and Multidetector Computed Tomography Coronary Angiography for the Assessment of Unstable Angina Pectoris After Coronary Artery Bypass Grafting by Eduard Ghersin, Zohar Keidar, Shmuel Rispler, Diana Litmanovich, Rachel Bar. Shalom, Ariel Roguin, Adrian Soil, Ora Israel, and Ahuva Engel Circulation Volume 114(6): e 237 -e 239 August 8, 2006 Copyright © American Heart Association, Inc. All rights reserved.

Figure 1. Focused image of a volume-rendered CT angiogram demonstrates 3 out of 5 Figure 1. Focused image of a volume-rendered CT angiogram demonstrates 3 out of 5 bypass grafts, including saphenous vein grafts to the first marginal (white dotted arrow), ramus intermedius (white arrowhead), and first diagonal (black arrowhead) coronary arterial segments, respectively. Eduard Ghersin et al. Circulation. 2006; 114: e 237 -e 239 Copyright © American Heart Association, Inc. All rights reserved.

Figure 2. A and B, Corresponding curved planar reformations in 2 different projections of Figure 2. A and B, Corresponding curved planar reformations in 2 different projections of the saphenous vein graft to the first diagonal artery demonstrate severe irregular stenosis (solid white arrow) proximal to a patent stent (black arrow). Eduard Ghersin et al. Circulation. 2006; 114: e 237 -e 239 Copyright © American Heart Association, Inc. All rights reserved.

Figure 3. Cardiac perfusion SPECT study at stress (first and third rows) and rest Figure 3. Cardiac perfusion SPECT study at stress (first and third rows) and rest (second and forth rows) shows reversible perfusion defect in the anterolateral wall (arrows) consistent with myocardial ischemia. Eduard Ghersin et al. Circulation. 2006; 114: e 237 -e 239 Copyright © American Heart Association, Inc. All rights reserved.

Figure 4. Combined data of myocardial perfusion (represented on the left ventricle epicardial surface Figure 4. Combined data of myocardial perfusion (represented on the left ventricle epicardial surface extracted from the SPECT study) and the native left coronary tree. Eduard Ghersin et al. Circulation. 2006; 114: e 237 -e 239 Copyright © American Heart Association, Inc. All rights reserved.

Figure 5. Selective invasive angiography of the saphenous vein graft to the first diagonal Figure 5. Selective invasive angiography of the saphenous vein graft to the first diagonal artery confirms severe stenosis of the graft (arrow) proximal to a patent coronary stent (dotted arrow). Eduard Ghersin et al. Circulation. 2006; 114: e 237 -e 239 Copyright © American Heart Association, Inc. All rights reserved.