The Essentials of Coronary Angiography: What you Need to Know · 2020. 2. 10. · UCI Cardiac Cath...
Transcript of The Essentials of Coronary Angiography: What you Need to Know · 2020. 2. 10. · UCI Cardiac Cath...
The Essentials of Coronary Angiography:
What you Need to Know
Morton J. Kern, MD, MSCAI, FACC, FAHAChief of Medicine, VA Long Beach
Professor of Medicine, UCI
020120 UCI Essentials
Cardiac Cath Lab Procedures
Diagnostic Studies
Coronary Angiography
Ventriculography
Hemodynamics
Shunt Detection
Ao and Periph. Angio
Pulmonary Angio
Coronary Hemodynamics
Endomyocardial Biopsy
Therapeutic Interventions
PCI—Balloon, Stents, Roto
Thombolysis
Coil Embolization
Pericardiocentsis, Window
Cardiomems Monitor
Structural Heart Intervention
Valves
Shunts
HCM
PVD
UCI Cardiac Cath Lab
Nomenclature for Angulations
Radial Cardiac Cath in Biplane at UCI
Concordant Angulation for Biplane Angiography
Radiographics 21:1033-1045, 2001
Better Imaging with better set up.
(also less radiation exposure)
Better Imaging with better set up. Also less panning
Better Imaging with better set up. “The best panning is no panning”
APAP
LAOLAORAO RAO
A B
C D
AP
Heart Shape
LAD RCA
LAD
CFX
CFXLM
LAD CFX
LM
LAD
CFX
LM
LAO, cranial
LAO, caudal
LCA, LAO LM
CFX
LAD
Diagonals
CFX AV continuation
Marginal branches
Septal perforators
LCA – LAO Cranial
LCA – LAO Caudal
RCALAD
CFX
LM
CFXLAD
LAD
CFX
LM
RAO, caudalRAO, cranial
LCA, RAOLM
LAD
CFX
Septals
Marginals
Diagonals
CFX continuation
LCA – RAO Cranial
LCA – RAO Caudal
Conus branchSA node branch
AV nodal branchPL branch
RV marginal branchPDA
RCA, LAO
PDA
LAO, cranialRAO
RCA – LAO
RCA, RAO
SA node branchConus branchRV marginal branch
AV nodal branch
PDAPL branch
RCA - RAO
AP LAO
RAO
Changes in Cardiac Silhouette of LV
1
3
2
1
2
3
4
54
Nomenclature of Cardiac LV Silhouette
SVG Angiography
Angiographic Problems
• Clot
• Dissection
• Aneurysm
• Fistula
Angiographic Problems
• Spasm
• Overlap
• Inadequate opacification
• CTO
• Anomalous origin
– Separate LAD/CFX orgin
– Short LM
IC NTG
Change angulations
Change coaxial seating
Check perfusion territories
Check perfusion territories
Looks for keys to anomalous course
53yo M with Unstable Angina and multiple CAD risk factors
Remember when ever you say,
“Gee, that’s a long left main….”
You should follow it with,
“I wonder if there is anomalous CFX?”
Anomalous Circumflex from RCA
Nonatherosclerotic Coronary Heart Disease, p 1243
Ischemia is not always predicable from the angiographic imaging.