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Anatomía coronaria normal.
Coronaria derecha
– 1-3 proximal/mid/distal
– 4 posterior descending
– 5 posteroatrioventricular
– 6-8 first-third posterolaterals
– 9 inferior septals
– 10 acute marginals
Coronaria izquierda
– 11 LM
– 12-14 prox/mid/distal LAD
– 15-16, 29 first-third diagnals
– 17 septals (anterior)
– 18-19,23 prox/mid/distal LCx
– 20-23 obtuse marginals
– 24-26 first-third posterolaterals
– 27 LPDA
– 28 ramus intermedius
Proyecciones
RAO-caudal: left main, prox
LAD/LCx/marginals
RAO-cranial: mid/distal LAD
(w/o overlapping diag/sept)
LAO-cranial: mid/distal LAD
in orthogonal view
LAO-caudal: LM, prox LCx
LAO-cranial: origin of RPDA
RAO-cranial: mid/distal RCA
PA/lateral: ostium LM/LIMA
Lo normal…
Dominance: the vessel that supplies the
posterior diaphragmatic portion of
interventricular septum and LV (i.e. gives
off PDA)
85% right dominant, 8% left, 7%
codominant
Most easily assessed in LAO-cranial
Coronaria izquierda: Tronco
(LM)
LM usually easily engaged
with Judkin left (JL) 4 or JL5
if dilated aortic root.
LM: arises from left aortic
sinus, ave 3-6mm in
diameter, passes behind the
RV outflow tract, 0-10mm in
length, typically bifurcates
into LAD/LCx
37% LM tripurcates into
LAD/LCx/ramus medianus;
less frequently no LM and
separate ostia of LAD/LCx
View: RAO caudal/LAO
caudal
Coronaria izquierda: DA
LAD: travels down anterior
interventricular groove
towards apex
Septal branches come off
@90° off LAD, supplies IV
septum
Diagnal branches supplies
anterolateral LV; >90% pt
have 1-3 diagnals;
View: cranial views; steep
LAO cranial (80/40) or
shallow RAO cranial needed
for origin of diagnals
Coronaria izquierda: Cx
LCx: branches off LM and
courses down left AV groove;
85% is non-dominant vessel;
divided into prox/distal LCx
Typically gives off 1-3 obtuse
marginals which supplies free
wall of LV along lateral aspect;
also gives rise to 1-2 LA Cx
branches
Distal LCx usually tapers off if
non-dominant
Views: ostium: LAO/RAO
caudal; OM: AP caudal or RAO
5-15 caudal; LPDA: LAO cranial
Coronaria derecha (RCA)
RCA: originates from right aortic
sinus, passes down to the right
AV groove towards the crux (R/L
AV groove and IV groove meet.)
1st branch: conus branch, 50%
off RCA, 50% separate ostium;
supplies RVOT; important
source of collateral to LAD. 2nd
branch: sinoatrial node branch:
off RCA 59%, off LCx 38%, dual
supply 3%. 3rd: acute
marginals supplies ant wall of
RV. 4th: PDA supplies post
wall/IV septum 5th: PL
branches
Views: LAO/RAO cranial,
typically JR4 catheter
Anatomia coronaria basica
Anatomia coronaria basica

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Anatomia coronaria basica

  • 1.
  • 2. Anatomía coronaria normal. Coronaria derecha – 1-3 proximal/mid/distal – 4 posterior descending – 5 posteroatrioventricular – 6-8 first-third posterolaterals – 9 inferior septals – 10 acute marginals Coronaria izquierda – 11 LM – 12-14 prox/mid/distal LAD – 15-16, 29 first-third diagnals – 17 septals (anterior) – 18-19,23 prox/mid/distal LCx – 20-23 obtuse marginals – 24-26 first-third posterolaterals – 27 LPDA – 28 ramus intermedius
  • 3. Proyecciones RAO-caudal: left main, prox LAD/LCx/marginals RAO-cranial: mid/distal LAD (w/o overlapping diag/sept) LAO-cranial: mid/distal LAD in orthogonal view LAO-caudal: LM, prox LCx LAO-cranial: origin of RPDA RAO-cranial: mid/distal RCA PA/lateral: ostium LM/LIMA
  • 4. Lo normal… Dominance: the vessel that supplies the posterior diaphragmatic portion of interventricular septum and LV (i.e. gives off PDA) 85% right dominant, 8% left, 7% codominant Most easily assessed in LAO-cranial
  • 5. Coronaria izquierda: Tronco (LM) LM usually easily engaged with Judkin left (JL) 4 or JL5 if dilated aortic root. LM: arises from left aortic sinus, ave 3-6mm in diameter, passes behind the RV outflow tract, 0-10mm in length, typically bifurcates into LAD/LCx 37% LM tripurcates into LAD/LCx/ramus medianus; less frequently no LM and separate ostia of LAD/LCx View: RAO caudal/LAO caudal
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  • 8. Coronaria izquierda: DA LAD: travels down anterior interventricular groove towards apex Septal branches come off @90° off LAD, supplies IV septum Diagnal branches supplies anterolateral LV; >90% pt have 1-3 diagnals; View: cranial views; steep LAO cranial (80/40) or shallow RAO cranial needed for origin of diagnals
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  • 12. Coronaria izquierda: Cx LCx: branches off LM and courses down left AV groove; 85% is non-dominant vessel; divided into prox/distal LCx Typically gives off 1-3 obtuse marginals which supplies free wall of LV along lateral aspect; also gives rise to 1-2 LA Cx branches Distal LCx usually tapers off if non-dominant Views: ostium: LAO/RAO caudal; OM: AP caudal or RAO 5-15 caudal; LPDA: LAO cranial
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  • 15. Coronaria derecha (RCA) RCA: originates from right aortic sinus, passes down to the right AV groove towards the crux (R/L AV groove and IV groove meet.) 1st branch: conus branch, 50% off RCA, 50% separate ostium; supplies RVOT; important source of collateral to LAD. 2nd branch: sinoatrial node branch: off RCA 59%, off LCx 38%, dual supply 3%. 3rd: acute marginals supplies ant wall of RV. 4th: PDA supplies post wall/IV septum 5th: PL branches Views: LAO/RAO cranial, typically JR4 catheter