angiographic views_30_12_13.pdf

8/11/2019 Angiographic views_30_12_13.pdf

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Angiographic

Views&

AnatomyDr. Mohammad Gouda

Lecturer of Cardiology


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1. Anterior descending and posterior

descending coronary arteries lie in the

plane of IVS2. RCA& LCX lie in the plane of AV valves

3. In the 60 LAO projection, one is looking

down the plane of IVS, with the plane of Avalves seen en face

4. In 30RAO projection, one is looking down

the plane of AV valves, with plane of IVS

seen en face


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General Roles


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1. LCX goes with intensifier and LAD goes in the

opposite direction. In other words, moving the

intensifier leftward to LAO will project LCX to the

left on the XR picture and LAD to the right

2. Cranial angulation will elevate LCX up and pull

LAD down. It is the reverse with caudal

angulation. The same rule is applied to thediaphragm and the spine.

3. In order to straighten a tortuous coronary segment,

the image intensifier should be moved to an angle

with more or less 90opposite to the present one


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Left System

Practically


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WHERE IS THE LAD?????

HOW TO KNOW IT????

SO,

Is LAD is to Rt or Lt to LCX?

If LAD is to Rt to LCXthis is PA Or

LAO If LAD is to Lt to LCXthis is PA Or

RAO

Where is the spine, LM on line or curved, anglebw (LAD-LCX)?

Cranial Or caudalDiaphragm, Px Or Distal bed well visualized??


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???


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LAO views By placing the left hand

fingers over the clenchedright fist, the index fingerbecomes LAD and runs overthe knuckles, which

represent the anterior IVgroove

The middle finger is spread,lying on the finger joints,

and represents LCX The thumb runs horizontal

to the wrist joint and

represents the initial courseof RCA


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LAO

cranial and

caudal angulations

In cranial angulation a

downward tilt of LAO view

exaggerating the left main

segment but keeping the

relationship between LAD and

CFX almost the same

Caudal angulation: views

coronaries from underneath

tipping the LAO view upward

and producing a branching

appearance some call the

spider view


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RAO projections RAO, position of the fingers

(LAD/CFX) changes orientation suchthat the LAD is now on the left, and

the CFX is in the middle or morerightward than in the LAO view

RAO with caudal angulation tips theCFX downward, separating it morefrom the LAD.

RAO with cranial angulation, the CFXis tipped upward, foreshortened, andoverlapped with the LAD. Cranialviews are best used to see the LADand diagonals, while caudal views are

best to see the CFX and LM segments


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Take a breath.


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LAO-caudal

viewSpiderview

1

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? ?

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2- LCA lateral view


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LAO-cranialview

demonstratesmid and

distal LAD

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RAO caudal view,

LCX is well

elongated and sofully

exposed.


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RAO-caudal view assesses

LCx and Oms

RAO-caudal projection

(0 to 10 RAO and 15 to20 caudal) our initial

view of choice in studying

unstable patients, because

it provides an excellent

view of the left main

bifurcation, proximal

LAD, and proximal to

middle LCX

RAO caudal view, LCX is well

elongated and so fully

exposed.


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LAO cranial view


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RAO caudal view


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RCA


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L-Shaped

RCA.Shape

C-shaped

RAO LAO PA Lateral

RCA Ostium & midportion of the RCAwith separation of

the RCA and its RV

branches

RV Marginal branch & Spine

DemonstratesRCA and

origin of PDAand PL

branches

Mid RCA +Px, Mid &

Distaltermination of

PDA.

Termination ofRCA, includingthe bifurcationof RCA andPDA (crux)and PL

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RAO view of RCA. In this view,

the guide is truly coaxial, so the tip

of the guide will be seen headon as

a circle.

RAO view of RCA anomaly with the ostium in the

anterior position. In this view, if the guide is truly

coaxial, then the tip of the guide should be seen

head-on as a circle. As the location of the ostium in

this case is abnormal, so the tip of the guide pointsto the left.


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LAO view of RCA. In this view, RCA islike a letter C. To focus on the ostialsegment, a caudal angulation is needed.A cranial angulation would help tovisualize the bifurcation, origin, andcourse of PDA. ?


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