cardiac angiography: coronary anatomy, anomalies and the ... · cardiac angiography: coronary...

Cardiac angiography: coronary anatomy, anomalies and the ventricular angiogram

Morton J. Kern, MD

Chief of Cardiology LBVAH Professor of Medicine

University California Irvine Orange, California

CTA Angiography

AP AP

LAO LAO RAO RAO

A B

C D

AP

Heart Shape

AP LAO

RAO

1

3

2

1

2

3

4

5 4

LAO, cran RAO

LAD RCA

LAD

CFX

CFX LM

LAO, cran

LAD CFX

LM

LAD

CFX

LM

LAO, cranial LAO, caudal

LAO, caudal LAO, cranial

RCA LAD

CFX

LM

CFX LAD

LAD

CFX

LM

RAO, caudal RAO, cranial

RAO, caudal RAO, cranial RAO, caudal RAO, cranial

PDA

LAO, cranial RAO

Right coronary artery

LAO, cranial RAO

Diastole Systole

Coronary Angiography “Gee, that’s a long left main….”

Anomalous Circumflex from RCA

Nonatherosclerotic Coronary Heart Disease, p 1243

The Anomalous LM: angiographic

identification by the “Dot and Eye” Method Course Dot Eye LAD

length

Septals

from

LM

Septal -- + up

cfx

Low

er

LM

Short +

Anterior -- +up

LM

Low

er

CFX

Short No

Retroaortic +pos -- Normal No

Interarterial +ant -- Normal no Serota, et al. Am J Cardiol 1990; 65:891-898

RCA from LSV

Anomalous Coronary Arteries

• CTA best modality to identify ACAs

• Angiography difficult and confusing but often first line of dx.

• Critical decisions can be facilitated with IVUS/FFR.