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