This document discusses the anatomy of the coronary circulation as visualized through angiography. It begins by outlining the coronary arterial anatomy, including the typical origins and branches of the right coronary artery and left coronary artery. It then discusses variations that can occur in coronary anatomy and notes the coronary venous anatomy. It concludes by describing the angiographic views used to visualize the coronary arteries.
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
3) Echocardiography guides percutaneous ASD closure by assessing defect and rim anatomy, device sizing, and post-procedure result. Understanding echo features is key to ensuring procedure success.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
The document discusses techniques for detecting intracardiac shunts including oximetry runs, indicator dilution curves, and angiography. It provides criteria for identifying left-to-right shunts using oxygen saturation step-ups in the oximetry run. Examples are given for detecting an atrial septal defect and ventricular septal defect. The ratio of pulmonary to systemic blood flow (Qp/Qs) is discussed as a measure of shunt magnitude.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
NORMAL CORONARY ANATOMY AND ANGIOGRAPHIC VIEWS SOURCE.pptxJaydeep Malakar
The document discusses normal coronary artery anatomy and angiographic views. It describes the development of the coronary arteries from fish to mammals, coronary blood supply, anatomy including branches and territories, angiographic projections and techniques. Key points include the dual aortic origin of the right and left coronary arteries, their course in the epicardial fat and termination in myocardial capillaries, and the circle and loop theory of coronary artery distribution. Standard angiographic views of the left and right coronary arteries are shown.
The document discusses various coronary artery anomalies including anomalies of origination, course, and intrinsic anatomy. Some key points include:
- Coronary artery anomalies have a global incidence of 5.64% and incidence of sudden death is 0.6%
- Anomalous origination of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare but serious anomaly if left untreated
- Certain anomalous coronary artery courses, such as between the aorta and pulmonary artery, are associated with higher risks of sudden cardiac death
- Other anomalies discussed include single coronary arteries, coronary hypoplasia, ectasia/aneurysms, and intramural coronary arteries
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
3) Echocardiography guides percutaneous ASD closure by assessing defect and rim anatomy, device sizing, and post-procedure result. Understanding echo features is key to ensuring procedure success.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
The document discusses techniques for detecting intracardiac shunts including oximetry runs, indicator dilution curves, and angiography. It provides criteria for identifying left-to-right shunts using oxygen saturation step-ups in the oximetry run. Examples are given for detecting an atrial septal defect and ventricular septal defect. The ratio of pulmonary to systemic blood flow (Qp/Qs) is discussed as a measure of shunt magnitude.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
NORMAL CORONARY ANATOMY AND ANGIOGRAPHIC VIEWS SOURCE.pptxJaydeep Malakar
The document discusses normal coronary artery anatomy and angiographic views. It describes the development of the coronary arteries from fish to mammals, coronary blood supply, anatomy including branches and territories, angiographic projections and techniques. Key points include the dual aortic origin of the right and left coronary arteries, their course in the epicardial fat and termination in myocardial capillaries, and the circle and loop theory of coronary artery distribution. Standard angiographic views of the left and right coronary arteries are shown.
The document discusses various coronary artery anomalies including anomalies of origination, course, and intrinsic anatomy. Some key points include:
- Coronary artery anomalies have a global incidence of 5.64% and incidence of sudden death is 0.6%
- Anomalous origination of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare but serious anomaly if left untreated
- Certain anomalous coronary artery courses, such as between the aorta and pulmonary artery, are associated with higher risks of sudden cardiac death
- Other anomalies discussed include single coronary arteries, coronary hypoplasia, ectasia/aneurysms, and intramural coronary arteries
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
1) The document describes methods for quantifying mitral regurgitation (MR), including Carpentier's classification of MR types and echocardiographic parameters for assessing MR severity.
2) Proximal isovelocity surface area (PISA) uses the conservation of mass principle to calculate regurgitant volume and orifice area based on measurements of the PISA radius and aliasing velocity.
3) Several limitations of PISA are discussed, but it provides a quantitative assessment of MR with acceptable reproducibility when used appropriately.
This document discusses percutaneous pulmonary valve interventions. It begins by providing background on the history of pulmonary valve interventions, starting with open surgical techniques and moving to percutaneous approaches developed in the 1950s. It then discusses the first successful percutaneous pulmonary valve implantation in 2000. The document provides details on the anatomy of the pulmonary valve, causes of pulmonary valve disease, techniques for percutaneous balloon pulmonary valvuloplasty, indications and contraindications for percutaneous pulmonary valve interventions, and the evolution and indications for transcatheter pulmonary valve implantation.
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
This document summarizes various devices used to close atrial septal defects (ASDs), including their designs, sizes, advantages, and disadvantages. The most commonly used device is the Amplatzer Septal Occluder, which has a double disc design and is self-expanding. Other devices discussed include the Gore HELEX, Lifetech/Cera, Figulla, Cardioseal/Starflex, and newer bioabsorbable options like the Biotrek. Complication rates of ASD device closure are generally low, below 10%, with embolization and arrhythmias being the most common issues. Larger trials have shown the Amplatzer to be very effective and easy
Echocardiography is a key tool for diagnosing and evaluating mitral stenosis (MS). It is essential to use an integrative approach when grading MS severity by combining Doppler, 2D imaging, and measurements, rather than relying on one alone. Echocardiography plays a major role in MS by confirming diagnosis, quantifying severity, analyzing consequences, and examining valve anatomy. Mitral valve planimetry directly measures valve area and is considered the reference standard, but additional measurements like pressure gradient and half-time are also useful. Echocardiography aids clinical decision making for patients with MS.
The document discusses atrial septal defects (ASDs), including indications for closure, procedural details, and echocardiographic assessment. Key points include:
- ASD closure is recommended in the presence of right-sided heart volume overload or symptoms. It prevents further deterioration and helps normalize heart size.
- Indications for closure include hemodynamically significant ASD, paradoxical embolism risk, and transient cyanosis. Contraindications include irreversible pulmonary hypertension.
- Echocardiography is used to assess defect size, rims, and shunt severity. Deficient rims, especially aortic and superior vena cava, increase erosion risk post-closure.
This document discusses pulmonary valve stenosis and balloon dilatation techniques. It provides background on the history and development of percutaneous pulmonary valvuloplasty. Key details include indications for the procedure, preprocedural evaluation and imaging, sedation and vascular access considerations, hemodynamic assessment, angiography, balloon catheter selection and use, and post-procedure protocol. The document serves as a reference for performing safe and effective balloon dilatation to treat pulmonary valve stenosis.
This document discusses peripheral pulmonary artery stenosis, including its description, associated conditions, classification, clinical features, diagnosis using imaging modalities like echocardiography and angiography, and treatment options like balloon angioplasty. Peripheral pulmonary artery stenosis can involve the main pulmonary artery or its branches and is present in 2-3% of congenital heart disease cases. Diagnosis relies on cardiac catheterization and angiography to determine severity and anatomy. Balloon angioplasty is an option for treating moderate or severe stenosis when surgery is difficult.
This document summarizes different devices used for closing ventricular septal defects (VSDs). It describes the common complications of VSD devices which are mostly minor, including embolization, arrhythmias, and conduction defects. Three types of Amplatzer devices are outlined - the muscular VSD device, asymmetric VSD occluder, and perimembranous VSD devices. Sizes and designs of each are provided. Results of post-myocardial infarction VSD closure show high residual leak rates. Finally, it briefly mentions some VSD devices manufactured in China including by Yatai and Lifetech, and introduces the novel NitOcclud VSD coil.
This document provides an overview of segmental analysis for congenital heart disease. It discusses the key segments that are analyzed which include thoraco-abdominal situs, pulmonary situs, atrial situs, ventricular situs and looping, connections between segments (venous, atrioventricular, ventriculoarterial), and abnormalities that can occur in each segment. The document emphasizes evaluating each segment in a systematic, sequential manner to identify abnormalities.
An overview of the normal embryological process of development of the Aortic arch and the clinically relevant anomalies of the aortic arch development. Ideal for Cardiology Fellows.
This document discusses the echocardiographic evaluation of cardiomyopathies. It defines cardiomyopathy and outlines the major classification systems. The main types discussed are dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, restrictive cardiomyopathy, and unclassified cardiomyopathy. Specific features of dilated cardiomyopathy are then reviewed in detail, including morphological features, causes, Doppler findings, and involvement of the right ventricle and left atrium. Evaluation of diastolic dysfunction and ischemic cardiomyopathy are also summarized.
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
Rotational atherectomy is described in detail including vascular access, wiring, burr selection, technique, complications and their management. Key steps include using the smallest burr possible, short ablation runs under 20 seconds, and avoiding sudden drops in rotational speed to minimize complications. Complications can include slow-flow/no-reflow, dissection, perforation and burr entrapment. Prevention focuses on optimal technique and treatment involves reversing anticoagulation, vasodilators, balloons, stents or surgery depending on the complication.
CORONARY ANATOMY _ SANDEEP M CAG VIEWS.ppsxAadhi55
This document discusses the anatomy of the coronary circulation and angiographic visualization. It outlines the coronary arterial anatomy, including the right and left coronary arteries and their branches. It describes variations in coronary circulation and coronary venous anatomy. It discusses angiographic views of the coronary arteries and various angiographic projections that provide optimal views of different coronary segments. The document is intended to provide an overview of coronary arterial and venous anatomy and angiographic techniques for visualization of the coronary arteries.
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
1) The document describes methods for quantifying mitral regurgitation (MR), including Carpentier's classification of MR types and echocardiographic parameters for assessing MR severity.
2) Proximal isovelocity surface area (PISA) uses the conservation of mass principle to calculate regurgitant volume and orifice area based on measurements of the PISA radius and aliasing velocity.
3) Several limitations of PISA are discussed, but it provides a quantitative assessment of MR with acceptable reproducibility when used appropriately.
This document discusses percutaneous pulmonary valve interventions. It begins by providing background on the history of pulmonary valve interventions, starting with open surgical techniques and moving to percutaneous approaches developed in the 1950s. It then discusses the first successful percutaneous pulmonary valve implantation in 2000. The document provides details on the anatomy of the pulmonary valve, causes of pulmonary valve disease, techniques for percutaneous balloon pulmonary valvuloplasty, indications and contraindications for percutaneous pulmonary valve interventions, and the evolution and indications for transcatheter pulmonary valve implantation.
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
This document summarizes various devices used to close atrial septal defects (ASDs), including their designs, sizes, advantages, and disadvantages. The most commonly used device is the Amplatzer Septal Occluder, which has a double disc design and is self-expanding. Other devices discussed include the Gore HELEX, Lifetech/Cera, Figulla, Cardioseal/Starflex, and newer bioabsorbable options like the Biotrek. Complication rates of ASD device closure are generally low, below 10%, with embolization and arrhythmias being the most common issues. Larger trials have shown the Amplatzer to be very effective and easy
Echocardiography is a key tool for diagnosing and evaluating mitral stenosis (MS). It is essential to use an integrative approach when grading MS severity by combining Doppler, 2D imaging, and measurements, rather than relying on one alone. Echocardiography plays a major role in MS by confirming diagnosis, quantifying severity, analyzing consequences, and examining valve anatomy. Mitral valve planimetry directly measures valve area and is considered the reference standard, but additional measurements like pressure gradient and half-time are also useful. Echocardiography aids clinical decision making for patients with MS.
The document discusses atrial septal defects (ASDs), including indications for closure, procedural details, and echocardiographic assessment. Key points include:
- ASD closure is recommended in the presence of right-sided heart volume overload or symptoms. It prevents further deterioration and helps normalize heart size.
- Indications for closure include hemodynamically significant ASD, paradoxical embolism risk, and transient cyanosis. Contraindications include irreversible pulmonary hypertension.
- Echocardiography is used to assess defect size, rims, and shunt severity. Deficient rims, especially aortic and superior vena cava, increase erosion risk post-closure.
This document discusses pulmonary valve stenosis and balloon dilatation techniques. It provides background on the history and development of percutaneous pulmonary valvuloplasty. Key details include indications for the procedure, preprocedural evaluation and imaging, sedation and vascular access considerations, hemodynamic assessment, angiography, balloon catheter selection and use, and post-procedure protocol. The document serves as a reference for performing safe and effective balloon dilatation to treat pulmonary valve stenosis.
This document discusses peripheral pulmonary artery stenosis, including its description, associated conditions, classification, clinical features, diagnosis using imaging modalities like echocardiography and angiography, and treatment options like balloon angioplasty. Peripheral pulmonary artery stenosis can involve the main pulmonary artery or its branches and is present in 2-3% of congenital heart disease cases. Diagnosis relies on cardiac catheterization and angiography to determine severity and anatomy. Balloon angioplasty is an option for treating moderate or severe stenosis when surgery is difficult.
This document summarizes different devices used for closing ventricular septal defects (VSDs). It describes the common complications of VSD devices which are mostly minor, including embolization, arrhythmias, and conduction defects. Three types of Amplatzer devices are outlined - the muscular VSD device, asymmetric VSD occluder, and perimembranous VSD devices. Sizes and designs of each are provided. Results of post-myocardial infarction VSD closure show high residual leak rates. Finally, it briefly mentions some VSD devices manufactured in China including by Yatai and Lifetech, and introduces the novel NitOcclud VSD coil.
This document provides an overview of segmental analysis for congenital heart disease. It discusses the key segments that are analyzed which include thoraco-abdominal situs, pulmonary situs, atrial situs, ventricular situs and looping, connections between segments (venous, atrioventricular, ventriculoarterial), and abnormalities that can occur in each segment. The document emphasizes evaluating each segment in a systematic, sequential manner to identify abnormalities.
An overview of the normal embryological process of development of the Aortic arch and the clinically relevant anomalies of the aortic arch development. Ideal for Cardiology Fellows.
This document discusses the echocardiographic evaluation of cardiomyopathies. It defines cardiomyopathy and outlines the major classification systems. The main types discussed are dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, restrictive cardiomyopathy, and unclassified cardiomyopathy. Specific features of dilated cardiomyopathy are then reviewed in detail, including morphological features, causes, Doppler findings, and involvement of the right ventricle and left atrium. Evaluation of diastolic dysfunction and ischemic cardiomyopathy are also summarized.
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
Rotational atherectomy is described in detail including vascular access, wiring, burr selection, technique, complications and their management. Key steps include using the smallest burr possible, short ablation runs under 20 seconds, and avoiding sudden drops in rotational speed to minimize complications. Complications can include slow-flow/no-reflow, dissection, perforation and burr entrapment. Prevention focuses on optimal technique and treatment involves reversing anticoagulation, vasodilators, balloons, stents or surgery depending on the complication.
CORONARY ANATOMY _ SANDEEP M CAG VIEWS.ppsxAadhi55
This document discusses the anatomy of the coronary circulation and angiographic visualization. It outlines the coronary arterial anatomy, including the right and left coronary arteries and their branches. It describes variations in coronary circulation and coronary venous anatomy. It discusses angiographic views of the coronary arteries and various angiographic projections that provide optimal views of different coronary segments. The document is intended to provide an overview of coronary arterial and venous anatomy and angiographic techniques for visualization of the coronary arteries.
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
The coronary arteries develop from three elements: sinusoids, an in situ endothelial network, and coronary buds on the aortic sinuses. The right coronary artery arises from the right sinus and the left coronary artery arises from the left sinus. The left main coronary artery bifurcates into the left anterior descending artery and left circumflex artery. The LAD supplies the anterior walls and septum. The LCx supplies the lateral and posterior walls. There are typically variations in the number of branches but the main coronary arteries maintain consistent vascular territories.
Cardiac CT-CCTA involves three main steps: patient preparation with beta blockade and nitroglycerine to lower heart rate, initial calcium scoring to identify atherosclerotic vessels, and coronary CTA scan using retrospective or prospective ECG gating. CCTA allows visualization of the coronary arteries and quantification of plaque type and stenosis. Normal coronary anatomy includes the left main artery bifurcating into the LAD and LCX, and the RCA originating from the right coronary cusp and dominantly supplying the posterior descending artery in most cases.
The document summarizes the anatomy of the coronary arteries and veins. It discusses the four main parts of the coronary artery system: the left main coronary artery, left anterior descending artery, left circumflex artery, and right coronary artery. It provides details on the branches and blood supply territories of each. The coronary venous system is also summarized, including the coronary sinus and anterior, great, middle, small cardiac veins. Specialized areas supplied like the SA node, AV node are highlighted. Coronary dominance and variations are also mentioned.
This document discusses various coronary artery anomalies that can be identified on CT angiography. It begins by stating that coronary anomalies occur in 1-2% of the population and can range from being clinically silent to life-threatening. The document then categorizes anomalies based on origin, course, and termination of the coronary arteries. It provides examples of each type of anomaly and highlights potentially serious variants such as anomalies with an interarterial course that increase risk of sudden cardiac death. The document aims to increase awareness of coronary anomalies and their identification on CT imaging.
This document describes the anatomy of the heart, including:
1. The layers of the pericardium and the pericardial space containing pericardial fluid.
2. The coronary arteries originating from the aortic root including the left and right coronary arteries.
3. The conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers.
4. The four chambers of the heart - right and left atria and right and left ventricles - and valves between the chambers.
This document discusses congenital coronary artery anomalies. It begins by describing the normal anatomy of coronary arteries and veins. It then defines what constitutes a normal versus abnormal coronary variation. The document categorizes coronary anomalies into four groups: those unassociated with congenital heart disease, those associated with congenital heart disease, acquired anomalies associated with congenital heart disease, and anomalies of the coronary venous circulation. It provides examples of specific anomalies that fall into each category and discusses their clinical significance. Particular emphasis is placed on anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).
1. Coronary artery anomalies can be classified as either normal coronary anatomy or anomalous coronary anatomy based on variations in origination, course, and termination.
2. Specific anomalous coronary artery variations include anomalous location of the coronary ostium, single coronary artery, high take-off of the coronary artery from the aorta, and origins from the opposite or improper sinus.
3. Additional intrinsic anomalies involve hypoplastic arteries, myocardial bridging, coronary artery ectasia/aneurysms, and coronary arteriovenous fistulas or other terminations such as anomalous drainage into systemic arteries.
This document provides information on coronary angiography views and angiographic anatomy. It discusses the clinical divisions of the major coronary arteries and defines what constitutes significant coronary artery disease. Standard angiographic views are described for visualizing different segments of the left and right coronary arteries. Lesion classification systems and other angiogram interpretation elements like TIMI frame count are also summarized.
This document provides information on coronary angiography views and angiographic anatomy. It discusses the clinical divisions of the major coronary arteries and defines what constitutes significant coronary artery disease. Standard angiographic views are described for visualizing different segments of the left and right coronary arteries. Lesion classification systems and other angiogram interpretation elements like TIMI frame count are also summarized.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 and is used to visualize the coronary arteries and assess for stenosis. It can determine treatment options and prognosis. Complications are rare but include vascular injury and contrast reactions. Proper angiographic views are important for evaluating different coronary artery segments.
The document provides an overview of heart anatomy including:
1. It describes the general characteristics of the heart such as its location in the mediastinum behind the sternum, that it lies within a fibrous pericardial sac, and that it has four chambers and a three-layered wall.
2. It outlines the four chambers of the heart - right atrium, left atrium, right ventricle, and left ventricle - as well as the conduction system and cardiac valves.
3. It discusses the coronary arteries including the left main, left anterior descending, and left circumflex arteries, as well as the coronary veins that drain deoxygenated blood from the heart muscle
Multi detector CT can be used to evaluate coronary artery disease. It allows visualization of coronary artery anatomy and detection of anomalies. The coronary arteries normally arise from the sinuses of Valsalva and have variable branching patterns. Anomalies can involve abnormal origins, courses, or terminations of the arteries. MDCT is useful for distinguishing these anomalies from normal variants and assessing their clinical significance.
The document summarizes coronary artery anatomy. It describes the origins and branches of the right coronary artery and left coronary artery. The right coronary artery typically arises from the right coronary sinus and supplies the right ventricle. The left main coronary artery bifurcates into the left anterior descending artery and circumflex artery. It also discusses common anatomical variations such as anomalous origins, fistulas, and intrinsic abnormalities like stenosis.
Anatomy and imaging of coronary artery disease withSarbesh Tiwari
1) Coronary CT angiography (CCTA) uses computed tomography to non-invasively image the coronary arteries. It provides high quality images of the coronary arteries and their branches.
2) CCTA is performed using either electron-beam CT or multi-detector row CT (MDCT). MDCT is now more commonly used due to its wider availability and lower cost. The latest generation 64-detector MDCT allows for very high resolution imaging.
3) CCTA requires careful preparation of the patient including medication to control heart rate and dilation of the coronary arteries. The scan itself involves ECG gating to image the heart during diastasis and injection of iodinated contrast to outline the coronary
Role of ct angiography in diagnosis of coronary anomalies GhadaSheta
CT angiography plays an important role in diagnosing coronary artery anomalies. It provides detailed 3D images of the coronary arteries with high spatial and temporal resolution in a noninvasive manner. Proper patient preparation including beta blockers to lower heart rate and nitroglycerin to dilate arteries is important for optimal imaging. CT angiography can detect various types of anomalies such as anomalous coronary artery origins, fistulas, myocardial bridging, and duplication of arteries. It serves as a roadmap for cardiologists in guiding patient management.
1) MDCT provides detailed images of coronary artery anatomy and is useful for evaluating common coronary pathologies.
2) The coronary arteries normally arise from the sinuses of Valsalva and have variable branching patterns. MDCT helps distinguish benign variants from potentially dangerous anomalies.
3) Coronary artery anomalies can involve abnormal origins, courses, or terminations and in some cases may lead to ischemia or sudden cardiac death. MDCT is well-suited to characterize these anomalies.
Similar to Second Step of Coronary Angiography (20)
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8. The LEIDEN convention
• Each artery arises from respective aortic sinuses
- Right coronary sinus(anterior)
- Left coronary sinus(left posterior)
- Non-coronary sinus(right posterior)
1R2LCx
pattern
9.
10.
11. Right coronary artery
~ 9.8cm
1)Conus artery/ Infundibular/ Third coronary/ Adipose
/Arteria of Vieussens
- Separate ostium in 23% - 51%
- Circle of Vieussens
12.
13. Right coronary artery
2) Atrial branches of the RCA
- < 1mm
- SA nodal artery ( Ramus crista terminalis) – 55-65%
14. Right coronary artery
3) Right ventricular branches
- Acute right marginal artery
- Ramus crista supraterminalis (Superior septal artery) –
12 -20% , males
17. Clinical division of the RCA
• Proximal - Ostium to 1st main RV branch
• Mid - 1st RV branch to acute marginal branch
• Distal - acute margin to the crux
18. Left coronary artery
LMCA
- 10-15mm(upto 30mm) length & 3-6mm(upto 10mm
diameter)
- Trifurcates in 1/3rd : Ramus intermedius/ median artery/ left
diagonal artery/straight LV artery
- Rare variations – absent LMCA/ pentafurcation
19. Left anterior descending artery
- ~ 14.7 cm ; Type I (22%) , Type II & Type III
- 2-9 diagonal branches
- 90deg bend after turning around P. conus as it gives off 2nd
diagonal branch
- Right ventricular branches( left conal/pre-infundibular A)
- ~ 10 septal perforating branches (40-80mm X 0.5-1.2mm)
anchors the LAD
20. LAD(contd)
- 1st proximal septal A is prominent (His Bundle and LBB)
- Myocardial bridging – 0.5-1.6% overall (28% in children)
- Rarely dual LADs
21. Clinical division of the LAD
• Proximal - Ostium to 1st major septal perforator
• Mid - 1st perforator to D2 (90 degree angle)
• Distal - D2 to end
22. Left circumflex artery
- ~9.3 cm long ; 1.5 -5mm
- Left atrial branches
- Kugel’s artery (Arteria anastomotica auricularis magna)
- LV branches are called the Obtuse marginal arteries
23.
24. Clinical division of the LCX
• Proximal - Ostium to 1st major obtuse marginal branch
• Mid - OM1 to OM2
• Distal - OM2 to end
25. Coronary segment classification
system
• CASS investigators – 27 segments
• BARI – 29 segments ( ramus intermedius and
3rd diagonal branch)
- Obstructive CAD : > 50% stenosis
26. “Dominance”
• A misnomer
• giving rise to PDA, at least 1 PLV & AV nodal A
(BARI classification)
- 85% right dominant
- 8% left dominant
- 7% co-dominant
(70%/ 10%/ 20% – Hurst’s THE HEART)
• Left dominance is 25-30% in Bi-AoV
Gensini GG. Coronary Arteriography. Mount Kisco,NY: Futura Publishing Co; 1975:260–274.
27. Nodal blood supply
• Studies on nodal blood supply principally by
James (1961) and Hutchinson( 1978)
- James : SA node - RCA 55% & LCA 45%
AV node- RCA 90% & LCA 10%
- Hutchinson : SA node - 65% & 35%
AV node- 80% & 20%
AV node may have dual supply in 2% cases
28. Arterial anastomoses
• Seen at the intracoronary/inter-coronary levels in
abundance– significant in development in
collaterals in CAD
• Most abundant at the septum
• Intracoronary : 1-2cm X 20- 250 micm
• Inter-coronary: 2-3 cm X 20-350 micm
29. Coronary artery variations
• 2 coronary artery system is a recent evolutionary
acquisition
• Fish and amphibia – 1 coronary artery
• Birds – ~ 40% have single coronary arteries.
• 1-5% of those undergoing CAG
Angelini P – Coronary artery anomalies – current clinical issues. Definition, classifications, incidence, clinical relevance and treatment guidelines.
Tex Heart Inst J 2002;29:271-278
30. Coronary artery variations
• Definition of a coronary artery is not based on its origin
and proximal course, but by focusing on its intermediate
and distal segments/ its dependent microvascular bed.
Angelini P – Coronary artery anomalies – current clinical issues. Definition, classifications, incidence, clinical relevance and treatment guidelines. Tex Heart Inst
J 2002;29:271-278
31. • ? Coronary artery Variation vs Anomalies
• A broad spectrum of variations of which some
may cause adverse effects
• Most of the coronary variations may have no
clinical implications as can be proven by
myocardial perfusion studies.
• The regional distribution of a coronary artery,
rather than its absolute origin and
characteristics.
32. A puzzling issue…..
• Proximal course of the LAD may be very
different
• LCx may run over atrial or ventricular surface.
• An RCA that terminates in the AV groove well
before the crux may not always be an
obstruction: 7 – 10% (Grossman)
• Double ostia from the RCS
• All 3 arteries from a single sinus
• One single artery……………..and so on……
33. • The most common coronary variation (Cleveland
Clinic-1,26,000 patients) was separate ostia for LAD &
LCX – 0.41% and 2nd commonest was LCX from
RCS / RCA – 0.37%
• However, in another series of 1950 angiograms
coronary anomalies were seen in 5.6% cases and
split RCA (1.2%) was the commonest.
Angelina P. Coronary artery anomalies. Philadelphia, Lippincott Williams & Wilkins, 1999.
34. • Level of variables
1) Ostium 2) Size 3) Proximal course
4) Mid-course 5) Intra-myocardial ramifications
6) Termination
• MSCT with retrospective ECG gating is now
considered the gold standard for characterization of
coronary anomalies.
• Prompt a search for underlying CHDs
1) Shi H, Aschoff AJ, Brambs HJ. Multislice CT imaging of anomalous coronary arteries. Eur Radiol. 2004;14:2172-2182.
2) Memisoglu E, Hobikoglu G, Tepe MS. Congenital coronary anomalies in adults: Comparison of anatomic course
visualized by catheter angiography and electron beam CT. Catheter Cardiovasc Interv. 2005;66:34-42.
35. Abnormal position of ostia
• Coronary orifice below the cuspal margin:
- 10% RCS
- 15% LCS
• Coronaries above the sinotubular jn ~ 6% - leads to difficult
cannulation, esp RCA with a high anterior ostium.
36. Abnormal number of coronary arteries
• Single coronary artery - 0.024%, usually benign
D/d- 2 separate ostia from same sinus, atresia..
Course is important – in 25% a major branch crosses
the infundibulum.
• 3 coronaries -
1) Separate origin of conus artery from RCS (36- 50%)
2) Absent LMCA with separate ostia for LAD & LCX
• 4 coronaries - case reports
• Dual LAD- 0.13 -1% (Morettin ,1976)
37. Absent LMCA
• ~0.4%
- 1 ostia at the LCS/ 2 ostia in LCS/ 1 ostia in LCS & other RCS
- Increased incidence of Left dominance
- 6% incidence of bridging
- Not usually associated with CHDs
- Similar incidence of atherosclerosis
- Difficulty in selective cannulation
Topaz et al. Absent left main coronary artery: angiographic findings in 83 patients with separate ostia of the
left anterior descending and circumflex arteries at the left aortic sinus.
Am Heart J.1991 Aug;122(2):447-52.
38. Shepherd’s-crook RCA
• ~5%
• Acute superiorly angled take-off of the RCA
from the aorta.
• Difficult RCA lesion angioplasty
Ethan Halpern. Cardiac CT . Functional anatomy.
39. Dual LAD (Duplication)
• ~0.13 - 1% of normal hearts
• Proximal LAD (LAD proper) bifurcates early into a
short and long LAD
-Type I : Short LAD in AIVS, Long LAD on prox AIVS, LV side, distal AIVS
-Type II : Short LAD in AIVS, Long LAD on prox AIVS, RV side, distal AIVS
-Type III: Short LAD in AIVS, Long LAD intra-myocardially in septum
-Type IV: Very short LAD proper and short LAD, Long LAD from RCA
Spindola-Franco H et al. Dual left anterior descending coronary artery: angiographic description of Important variants
and surgical implications. Am Heart J 1983:105;445–55.
40. Coronary artery Ectasia
• 1 - 5% in angiographic series, more in males
• 20- 30 % are congenital
• Dialatation of a segment to at least 1.5times of the
adjacent normal coronary artery.
41. Coronary venous anatomy
• Targeted drug delivery
• Retrograde cardioplegia administration
• Potential conduit to bypass cor. artery stenosis
• Stem cell delivery to the infarcted region
• Access to LA & LV myocardium for arrythmia mapping
& ablation
• LV epicardial pacing in CRT
45. Segmental venous classification
• Thus 9 LV venous segments are derived which when added with the
conventional classification gives the best comprehensive information to place
the epicardial LV leads for CRT purposes
48. Coronary Angiographic Views
• Cardiac Cath 1st by Werner Forssman in 1929
• 1st contrast angiography by Chavez in 1947
• CART 1st performed by F. Mason Sones in 1958
• a high-resolution image-intensifier television system with digital
cineangiographic capabilities.
- Radiograph tube below and Image intensifier above
(Flouroscopic imaging system with C-arm)
- Physiologic monitoring system, sterile supplies, resuscitation
equipment, Contrast injector (3-8ml/sec) and contrast media
49. • Information from a CAG:
CAG helps visualization of the major epicardial arteries up
to their 2nd and 3rd order branches
- Coronary anatomy
- Characteristics and distribution of coronary stenosis
- Distal vessel size
- Intracoronary thrombus
- Index of coronary flow
- Mass of myocardium served
- Collateral vasculature
Optimal injection rate: 7ml (2.1ml/s) for LCA and 4.8ml (1.7ml/s) for RCA
51. Interpretation of the significance of a
lumenogram
• Multiple projections from different angles, preferably
orthogonal
• Knowledge of the 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)
• IVUS
• Functional studies : FFR
52. Mistakes in CAG interpretation
• Inadequate number of projections used
• Improper/inadequate contrast injection
• Super-selective injection
• Catheter induced vasospasm
• Coronary artery variations
• Myocardial bridges
• Total ostial occlusions
• Wire induced spasm (ACCORDION EFFECT)
53.
54. • LAO and RAO views help furnish the true PA and
lateral views of the heart
D/A s - foreshortening
- superimposition
• Cranial view: Image-intensifier tilted towards head
• Caudal view: Image-intensifier tilted towards the feet
-however the optimal angiographic view varies with
coronary anatomy, body habitus and location of lesion
Angiographic projections
57. 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.
60. 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.
64. 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.
66. 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.
68. 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.
71. 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.
74. 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.
76. 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.
78. 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.
There is no single magical projection that can be
applied uniformly to all patients for visualizing
a particular coronary atery
80. References
• Hurst’s The Heart 13th Edition
• Braunwalds Heart Disease 9th edition
• Grey’s Anatomy
• Kern’s Handbook of Interventional Catheterization
• Kjell C Nikus. Coronary angiography.
• Grossman’s Textbook of Cardiac Catheterization
• Carlo Di Mario, Nilesh Sutaria. CORONARY ANGIOGRAPHY IN THE ANGIOPLASTY
ERA: PROJECTIONS WITH A MEANING Heart 2005;91:968–976
• David M Fiss. Normal coronary anatomy and anatomic variations. Applied
Radiology, Jan 2007.
• Horia Muresian. Coronary arterial anomalies and variations. MAEDICA. A journal
of clinical Medicine,1(1), 2006.
• Singh et al. The coronary venous anatomy. A segmental approach to aid CRT
2005, 46(1), 68-74.
• Shilpa Bhimali et al. A STUDY OF VARIATIONS IN CORONARY ARTERIAL SYSTEM IN
CADAVERIC HUMAN HEART. World Journal of Science and Technology 2011, 1(5):
30-35 ISSN: 2231 – 2587.
The highly variable existence of the conventional veins calls for segmental classification (ant, lat, post, base, mid and apex -9 segments of the LV) of coronay veins for better epicardial localization of veins for interventional electrophiography purposes.
Lateral LV wall venous branches can be profiled by individualizing the different radiological views- considering the anterior IV vein and middle cardiac vein as reference points.
Before venogram for better characterisation of coronary vein variations. However additional 60ml contrast and 9-11mSv exposure.
Xray generator, Xray tube , Image intensifier and detector, digital angio imaging.
A higher angulation increases the radiation scatter.
Fluoroscopy has only 1/5th rad exposure of cine angiography
NCRPM guideline: not >3 rem per 3months.. Advised safe limit is 100mrem/week for cath lab personnel.
Skin and thyroid- 15rem/year, gonads, eyes, bonemarrow- 5rem/yr
Cxray= 3 -5 mRoentgen ( 1 R = 1 rad for skin, 1R= 4rad for bone due to more absorption)
R= radiation exposure, Rad = radiation absorptioon)
Rem= radiation equivalent dose in man. 1 rem= 1rad.
1SV= 1J/kg=1Gy
1gy=100rad
1Sv= 100rem
1mrem=10micSv
Accordion effect: A mechanical alteration in the geometry and curvature of the vessel due to straightening and shortening of the artery due to wire advancement.
When the LMCA, LAD, LCX have an initial leftward course the long axis of these arterial segments are projected away frm the image intensifier and prevent optimal visualisation in the RAO view.
Some overlap with LCX can be overcome by more 60 degree LAO tilt.
However when the proximal LCA is superiorly directed it is not an optimal view- use LAO caudal
Enhanced by maximal expiration as the heart becomes more horizontal
According to Grossman: For LCA – RAO caudal and LAO caudal for LMCA and proc LAD in orthogonal & RAO cranial and LAO cranial for mid and distal LAD in orthogonal
For RCA: LAO for proximal RCA and RAO cranial for distal, PDA, PLV and Lateral view for mid