This document discusses coronary angiography views used to visualize the coronary arteries during percutaneous coronary interventions. It begins with an introduction explaining the need for multiple angiographic views to see all artery segments clearly without overlap or foreshortening. It then provides details on the basic anatomy of the right and left coronary arteries and their branches. Several standard angiographic views used are described, including left anterior oblique, right anterior oblique, cranial and caudal angulations. The conclusion emphasizes that a series of two-dimensional images from different angles must be obtained to fully visualize the complex three-dimensional coronary artery structure.

1. Text Book Reading Divisi Cathlab
( invasif non bedah )
Presenter : dr. Rivhan Fauzan
Supervisor : Prof. dr Harris Hasan Sp.PD, Sp.JP (K)
CORONARY ANGIOGRAPHY VIEW

2. INTRODUCTION
• Angiography for percutaneous coronary interventions (PCIs) requires
establishing the precise lesion length, morphology and degree of
calcification (or thrombus), as well as the relationship to side branches and
their associated ostial involvement with CAD
• The complex and serpiginous array of vessels constituting the coronary
arterial circulation mandates the need for multiple angiographic views to
visualize all segments free of overlap and foreshortening
• The nomenclature used to define these views based on the position of the
image intensifier relative to the midline of the supine patient
• The X-ray source lies under the patient, and the image intensifier typically
lies above the patient

3. Basic Anatomy of the
Coronary Circulation

4. Right Coronary Artery
Origin
Right aortic sinus (lower origin than LCA)
Course
Down right AV groove toward crux of the heart, gives off PDA (85%) from
which septals arise, continues in LAV groove giving off posterior LV branches
(posterolaterals). PDA may originate more proximally, bifurcate early or be
small with part of “its territory” supplied by an acute marginal branch.
Supplies
25% to 35% of Left Ventricle

5. Right Coronary Artery: other branches
Conus Artery – Anterior course
usually very proximal; (~50% have a separate origin)-courses anteriorly and upward over
the RV outflow tract toward the LAD. May be an important source of collaterals.
SA Nodal Artery – Posterior course
60%) usually 2nd branch of RCA-courses obliquely backward through upper portion of
atrial septum and anteromedial wall of the RA-supplies SA node, usually RA and sometimes
LA.
Right Ventricular (Acute Marginal) Branches)
Arise from mid RCA; supply anterior RV; may be a collateral source.
AV Nodal Artery
Arises at or near crux; supplies AV node.
Posterior Descending Artery (PDA)
Supplies inferior wall, ventricular septum, posteromedial papillary muscle.

6. Left Coronary Artery System
Origin
Upper portion of left aortic sinus just below the sinotubular ridge.
Typically 0-10 mm in length. Rarely no LM (separate origins of LAD and
LCx).
Optimal Views
LAO caudal and cranial; AP-caudal, cranial or flat. Limit views

7. Left Anterior Descending (LAD)
Course
down the anterior interventricular groove-usually reaches apex. In 22%
of cases does not reach apex (short LAD).
Branches
septals and diagonals-supply lateral wall of LV, anterolateral papillary
muscle; 37% have median ramus (courses like 1st diagonal).
LAD
Supplies anterolateral, apex and septum; ~45%-55% ofleft ventricle.

8. Left Circumflex Artery or LCx
Origin
from distal LMCA.
Course
down distal left AV groove.
Branches
obtuse marginal and posterolaterals-supply posterolateral LV,
anterolateral papillary muscle. SA node artery ~ 38%.
Supplies
15%-25% of LV, unless dominant (supplies 40-50% of LV).

9. CRANIAL AND CAUDAL ANGULATION

10. LAO AND RAO ANGULATION

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13. RAO 30: mid RCA and PDA

17. CONCLUSION
• Coronary angiography provides a two-dimensional image of a three-
dimensional structure. Therefore a series of images must be obtained
to allow visualization of all segments of the coronary arteries in at
least two orthogonal projections
• These issues of overlapping segments and foreshortening are
particularly relevant at bifurcation points. Here angiographic images
should be obtained where the vessels are maximally divergent to
ensure adequate assessment
• Modification of standard views may be required to achieve an optimal
dataset.

18. THANKYOU