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References
Grossman’s Textbook of Cardiac Catheterization
Kern’s Handbook of Interventional Catheterization
Hurst’s The He...
Coronary Anatomy
Main coronary trunks lie in one of two orthogonal planes
Anterior descending and posterior descending cor...
Clinical division of RCA
Proximal - Ostium to 1st main RV branch
Mid - 1st RV branch to acute marginal branch
Distal - acu...
Clinical division of LAD
Proximal - Ostium to 1st major septal perforator
Mid - 1st perforator to D2 (90 degree angle)
Dis...
Clinical division of the LCX
Proximal - Ostium to 1st major obtuse marginal
branch
Mid - OM1 to OM2
Distal - OM2 to end
Normal calibre of major coronaries
LMCA: 4.5 ± 0.5 mm
LAD: 3.7 ± 0.4 mm
LCX : 3.5 ± 0.5 mm ( 4.2 mm if dominant)
RCA: 3.9 ...
LCA ostium ~ 4mm
RCA ostium~ 3.2mm
Coronary Anatomy
Right-Dominant Circulation-85%
RCA
conus branch (supplies RVOT)
AM(supply free wall of RV)
AV nodal arter...
Left-Dominant Circulation- 8%,
PD,PLV & AV nodal all supplied by terminal portion of
LCX
Balanced-Dominant Circulation- 7%...
Coronary Segment Classification
Right coronary
1, prox 2, mid 3, distal 4,PD 5, posteroatrioventricular 6,
1st PL 7, 2nd PL 8, 3rd PL 9, inferior septals;...
Angiographic Views-Nomenclature
AP position Image intensifier is directly over patient with beam
traveling perpendicularly...
AP caudal or shallow RAO
LMCA -entire length
Prox LAD & LCX
(branches overlapped)
After LM segment, slight
RAO or LAO angu...
LAO-cranial view
LMCA (slightly foreshortened)
LAD-Septal & diagonal are
separated clearly
LCX/OM:
foreshortened/ overlapp...
RAO-caudal
LMCA bifurcation
Origin & course of
LCX/OM, RI & prox LAD
seen clearly
One of the best for
visualization of LCX...
RAO-cranial
Used for origins of
diagonals along mid
/distal LAD
Diagonals bifurcations
well visualized
Diagonals projected...
LAO-caudal (“spider” view)
LMCA (foreshortened) &
LMCA bifurcation
Prox & mid LCX with
origins of OM
Lateral view
Best view to show mid &
distal LAD
LAD/LCX well separated
Diagonals usually
overlapped
RI course well visuali...
LAO-cranial
Origin of RCA
Entire length of mid
RCA
PDA bifurcation (crux)
Cranial angulation tilts
PDA down to see vessel
...
RAO view
Shows mid RCA & length
of PDA / PL
Septals coursing upward
from PDA, supplying
occluded LAD artery via
collateral...
AP cranial
Shows origin of RCA
Mid segment
foreshortened
Best view for PD/PL of
dominant RCA system
and size of collateral...
Lateral view
Shows RCA origin
(especially in pt with
more anteriorly oriented
orifices) and mid RCA
PDA and PL are
foresho...
Saphenous vein graft views
1. RCA graft—LAO cranial, RAO, and AP cranial
2. LAD graft (or internal mammary artery)—lateral...
Routine Angio views
Left Coronary Artery For Concentration on Vessel Segment
Straight AP or 5 -10 deg RAO with caudal Left...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY E...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY E...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ER...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ER...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ER...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY E...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ER...
Optimal angiographic views for coronary segments
Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ER...
Thank you
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
Coronary angiograpgy basic n special views
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Coronary angiograpgy basic n special views

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Will be useful for understanding coronary angiography

Publicado en: Salud y medicina
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Coronary angiograpgy basic n special views

  1. 1. References Grossman’s Textbook of Cardiac Catheterization Kern’s Handbook of Interventional Catheterization Hurst’s The Heart 13th Edition Braunwalds Heart Disease 9th edition Grey’s Anatomy Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976
  2. 2. Coronary Anatomy Main coronary trunks lie in one of two orthogonal planes Anterior descending and posterior descending coronary arteries lie in plane of IVS Right and circumflex coronary trunks lie in plane of AV valves 60 LAO projection is looking down plane of IVS, with plane of AV valves seen en face 30°RAO projection, one is looking down plane of AV valves, with plane of IVS seen en face Major segments and branches: BARI modification of CASS nomenclature
  3. 3. Clinical division of RCA Proximal - Ostium to 1st main RV branch Mid - 1st RV branch to acute marginal branch Distal - acute margin to crux
  4. 4. Clinical division of LAD Proximal - Ostium to 1st major septal perforator Mid - 1st perforator to D2 (90 degree angle) Distal - D2 to end
  5. 5. Clinical division of the LCX Proximal - Ostium to 1st major obtuse marginal branch Mid - OM1 to OM2 Distal - OM2 to end
  6. 6. Normal calibre of major coronaries LMCA: 4.5 ± 0.5 mm LAD: 3.7 ± 0.4 mm LCX : 3.5 ± 0.5 mm ( 4.2 mm if dominant) RCA: 3.9 ± 0.6 mm ( 2.8 mm if non-dominant)
  7. 7. LCA ostium ~ 4mm RCA ostium~ 3.2mm
  8. 8. Coronary Anatomy Right-Dominant Circulation-85% RCA conus branch (supplies RVOT) AM(supply free wall of RV) AV nodal artery, PDA-PLV (supplies inf part of IVS)
  9. 9. Left-Dominant Circulation- 8%, PD,PLV & AV nodal all supplied by terminal portion of LCX Balanced-Dominant Circulation- 7% RCA- PD LCX- all PLV
  10. 10. Coronary Segment Classification
  11. 11. Right coronary 1, prox 2, mid 3, distal 4,PD 5, posteroatrioventricular 6, 1st PL 7, 2nd PL 8, 3rd PL 9, inferior septals; 10, AM Left coronary 11, LM 12, prox LAD 13, mid LAD 14, distal LAD 15, 1st diag (a, br of 1st diag) 16, 2nd diagonal,;17, septals (anterior septals); 18, prox LCX 19, mid LCX 19a, distal LCX 20, 21, and 22, 1st, 2nd, 3rd OM 23, left atrioventricular; 24, 25, and 26, 1st, 2nd, 3rd, PL (in left- or balanced-dominant system); 27, left PD (in left- dominant system); 28, ramus (ramus intermedius); 29, 3rd Diag
  12. 12. Angiographic Views-Nomenclature AP position Image intensifier is directly over patient with beam traveling perpendicularly back to front (i.e., from posterior to anterior) to patient lying flat on x-ray table RAO position Image intensifier is on right side of patient. A, anterior; O, oblique LAO position Image intensifier is on left side of patient Lt Lateral position Image intensifier rotated 90 deg parallel to floor Cranial Image intensifier is tilted toward head of patient Caudal Image intensifier is tilted toward feet of patient
  13. 13. AP caudal or shallow RAO LMCA -entire length Prox LAD & LCX (branches overlapped) After LM segment, slight RAO or LAO angulation may be necessary to clear density of vertebrae /catheter shaft
  14. 14. LAO-cranial view LMCA (slightly foreshortened) LAD-Septal & diagonal are separated clearly LCX/OM: foreshortened/ overlapped PD/PL of left-dominant circulation are displayed clearly Deep inspiration helpful Cranial angulation permits view of LAD/LCX bifurcation LAO-cranial angulation that is too steep or inspiration that is too shallow produces considerable overlapping with diaphragm and liver, degrading the image
  15. 15. RAO-caudal LMCA bifurcation Origin & course of LCX/OM, RI & prox LAD seen clearly One of the best for visualization of LCX LAD beyond proximal segment obscured Apical LAD displayed clearly
  16. 16. RAO-cranial Used for origins of diagonals along mid /distal LAD Diagonals bifurcations well visualized Diagonals projected upward Prox LAD/LCX usually overlapped
  17. 17. LAO-caudal (“spider” view) LMCA (foreshortened) & LMCA bifurcation Prox & mid LCX with origins of OM
  18. 18. Lateral view Best view to show mid & distal LAD LAD/LCX well separated Diagonals usually overlapped RI course well visualized It best shows insertions of bypass grafts into mid LAD
  19. 19. LAO-cranial Origin of RCA Entire length of mid RCA PDA bifurcation (crux) Cranial angulation tilts PDA down to see vessel contour / reduce foreshortening Deep inspiration is necessary to clear diaphragm
  20. 20. RAO view Shows mid RCA & length of PDA / PL Septals coursing upward from PDA, supplying occluded LAD artery via collaterals, may be clearly identified PL are overlapped, may need addition of cranial view
  21. 21. AP cranial Shows origin of RCA Mid segment foreshortened Best view for PD/PL of dominant RCA system and size of collateralized LAD
  22. 22. Lateral view Shows RCA origin (especially in pt with more anteriorly oriented orifices) and mid RCA PDA and PL are foreshortened
  23. 23. Saphenous vein graft views 1. RCA graft—LAO cranial, RAO, and AP cranial 2. LAD graft (or internal mammary artery)—lateral, RAO cranial, LAO cranial, and AP (lateral view is especially useful to visualize anastomosis to LAD) 3. CFX (and obtuse marginal branches) grafts—LAO caudal and RAO caudal 4. Diagonal graft—LAO cranial and RAO cranial
  24. 24. Routine Angio views Left Coronary Artery For Concentration on Vessel Segment Straight AP or 5 -10 deg RAO with caudal Left main 30- 45 deg LAO & 20 -30 deg cranial LAD-circumflex bifurcation 30- 40 deg RAO & 20 - 30 deg caudal Circumflex + marginal branches 5 - 30 deg RAO & 20 - 45 deg cranial LAD + diagonals 50 - 60 deg LAO & 10 - 20 deg caudal (spider view) LAD-circumflex bifurcation, circumflex, marginals Lateral (optional) Bypass conduits to LAD Right Coronary Artery For Concentration on Vessel Segment 30 - 45 deg LAO & 15 - 20 deg cranial Proximal, mid, PDA 30 - 45 deg RAO Proximal, mid, PDA Lateral (optional)
  25. 25. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  26. 26. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  27. 27. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  28. 28. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  29. 29. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  30. 30. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  31. 31. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  32. 32. Optimal angiographic views for coronary segments Carlo Di Mario, Nilesh Sutaria.CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976.
  33. 33. Thank you

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