Elias B. Hanna - Practical Cardiovascular Medicine

32 Chapter 34Figure 34.1 RCA course and branches. The intersection of the AV groove and t...Figure 34.2 (a)Left coronary system on LAO cranial view. (b)LV walls on cr...Figure 34.3 The top two rows show the difference in morphology between stabl...Figure 34.4 LAO view, cranial. Note the diaphragm overlapping with the heart...Figure 34.5 Shallow RAO view, cranial. Note the diaphragm overlapping with t...Figure 34.6 Illustration of the difference between caudal and cranial views.Figure 34.7 View orthogonal to a segment vs. view foreshortening a segment....Figure 34.8 Heart in an anteroposterior view. Imagine how you look at the co...Figure 34.9 RAO caudal view(25°, 25°).Figure 34.10 RAO caudal view.Distal LM bifurcation area is well seen; if no...Figure 34.11 RAO caudal view.The ribs are looking down towards the right-ha...Figure 34.12 RAO caudal view in a patient with a vertical heart.Note that, ...Figure 34.13 (a)RAO caudal with a large diagonal and a totally occluded LAD...Figure 34.14 AP caudal view.Similarly to RAO caudal view, the AP caudal vie...Figure 34.15 LAO caudal view(40°, 30°). Catheter tip is at the center of he...Figure 34.16 LAO caudal view of a vertical heart.The catheter tip ( star ) is...Figure 34.17 LAO caudal view of a horizontal heart.Note that the catheter t...Figure 34.18 (a) Vertical heart. LAO caudal is not orthogonal to the LM bifu...Figure 34.19 Shallow RAO cranial view(5°, 35°).Figure 34.20 Shallow RAO cranial view.Note the overlap of the distal LM, pr...Figure 34.21 LAO cranial view(40°, 30°). The LCx and OMs run on the border ...Figure 34.22 LAO cranial view.Note the overlap at the level of the distal L...Figure 34.23 LAO cranial view showing a dominant LCx.The distal PLBs and PD...Figure 34.24 LAO cranial view.If there is too much overlap in the proximal ...Figure 34.25 RAO caudal view. One gets the impression that the LAD is patent...Figure 34.26 LAO cranial view of the patient from Figure 34.25. What seems l...Figure 34.27 RAO cranial view(30°, 30°). The circled area is the area where...Figure 34.28 Best views for ostial left main, and best views for distal left...Figure 34.29 RCA views: LAO straight vs. LAO cranial. LAO cranial opens the ...Figure 34.30 Note how the LAO cranial opens the distal RCA branches ( arrows )...Figure 34.31 AP cranial view.Note how the distal RCA is well laid out.Figure 34.32 The true RCA has two distal bends on the LAO and AP cranial vie...Figure 34.33 (a) LAO cranial view.It may seem that the RCA continues down a...Figure 34.34 (a)LAO cranial view of the RCA. Try to identify the true RCA, ...Figure 34.35 RAO straight(30°) looks at the AV groove from the side rather ...Figure 34.36 AP cranial view properly showing the SVG-to-RCA anastomosis and...Figure 34.37 On this LAO cranial view, the grafted artery is at the left rat...Figure 34.38 AP caudal view showing sequential SVG to OM2 and OM3. In this v...Figure 34.39 RAO cranial view (diaphragm is seen over the heart shadow, ribs...Figure 34.40 (a)Occluded SVG to RCA on LAO view (catheter at the left of th...Figure 34.41 Sequential and split grafts (RAO caudal view). Graft anastomose...Figure 34.42 Left lateral view showing the LIMA-to-LAD anastomosis.Figure 34.43 Top figure:Illustration of how the RAO and LAO views “look” at...Figure 34.44 LAO straight vs. LAO cranial view. LAO cranial better opens the...Figure 34.45 Left ventriculogram on LAO straight view vs. LAO cranial view....Figure 34.46 Left ventriculogram performed in LAO straight view.Figure 34.47 (a)Illustration of how the RAO and LAO views look at the mitra...Figure 34.48 RAO view of the LV. Look how the aorta overlaps with the LA. Go...Figure 34.49 Steep RAO view shows severe MR with full delineation of the LA,...Figure 34.50 Axial cuts across the aortic cusps and the PA, showing the cour...Figure 34.51 Anomalous origin of LM as visualized on RAO aortography.Always...Figure 34.52 Anomalous RCA engaged with AL1. Two cases (1 and 2) are present...Figure 34.53 Right oblique view of the aorta, iliac and femoral arteries.No...Figure 34.54 Femoropopliteal anatomy. A right lower extremity is shown. Dash ...Figure 34.55 Axial CT scan images showing the SFA anatomy.Top: note the...Figure 34.56 OmniFlush or IMA catheter used to selectively engage the left i...Figure 34.57 External iliac occlusionextending into the common femoral arte...Figure 34.58 Totally occluded left SFA from the ostium to the popliteal leve...Figure 34.59 Totally occluded right distal SFA with collaterals mostly origi...Figure 34.60 Differentiate SFA from profunda in the case of SFA occlusion.Figure 34.61 Same patient as Figure 34.60. An almost lateral view ( left pane ...Figure 34.62 Aortic arch types I, II, and III. The distance between the top ...Figure 34.63 (a)On an LAO view , the JB1 catheter is torqued counterclockwis...Figure 34.64 Simmons catheter used to engage the innominate and carotid arte...

33 Chapter 35Figure 35.1 (a)Axial cut at the level of sinuses of Valsalva. R is the righ...Figure 35.2 (a)Judkins left (JL) catheter. The size of the Judkins catheter...Figure 35.3 In the case of an elongated or enlarged aorta (elderly, hyperten...Figure 35.4 The Amplatz left (AL) catheter has a “duck” shape. AL may be use...Figure 35.5 AL sits both on the back wall of the aorta and on the aortic val...Figure 35.6 AL engaging the RCA. AL looks up if the AL curve is proportionat...Figure 35.7 The primary-to-secondary distance distinguishes Amplatz right (A...Figure 35.8 Engagement of RCA. The catheter must be positioned on the right ...Figure 35.9 The 3DRC catheter is, in a way, a JR4 that is already torqued. I...Figure 35.10 (a)Origin of the RCA in a young patient. (b)Origin of the RCA...Figure 35.11 Axial cut at the level of the sinuses of Valsalva. Instead of L...Figure 35.12 Relationship of the conus branch and RCA. If JR4 falls into the...Figure 35.13 (a)Engagement of the left coronary artery in patients with nor...Figure 35.14 In (i), the whole catheter falls down and tip points up→a longe...Figure 35.15 JL catheter engagement when it falls slightly below the left co...Figure 35.16 Catheterization of the left coronary artery with an Amplatz lef...Figure 35.17 Small-arm Amplatz catheter. Pushing it may further dive it insi...Figure 35.18 Extra-backup guides and AL guide for the left coronary artery....Figure 35.19 Small-arm AL guide catheter (AL1) is used to engage the LCx in ...Figure 35.20 Guide catheters for superior RCA takeoff and inferior RCA takeo...Figure 35.21 AL1 guide catheter engaging the RCA, and providing good backup ...Figure 35.22 Location of SVGs:Down to up: SVG-to-RCA, SVG-to-LAD or diag...Figure 35.23 LAO view is orthogonal to the marker of SVG-to-RCA , perfectly l...Figure 35.24 Shapes of various catheters.Figure 35.25 (a)A hockeystick 2 guide catheter is used to engage the SVG-to...Figure 35.26 (a)Engagement of the left subclavian artery with a JR4 cathete...Figure 35.27 Pigtail catheter advancement.This is an LAO view. Advance the ...Figure 35.28 Dealing with a situation when the pigtail bend is in the LV, bu...Figure 35.29 Various aortic root shapes, with various locations of the aorti...Figure 35.30 Engagement of a coronary artery through a radial approach.(...Figure 35.32 Right transradial engagement of the left coronary artery in a p...Figure 35.33 AL2 is used to engage the left coronary artery through a right ...Figure 35.34 Severe right subclavian/ innominate tortuosity or loop is prese...Figure 35.35 Specific radial catheters, particularly helpful for a right rad...Figure 35.36 Ikari left catheter engagement.Ikari left is, in a way, a modi...Figure 35.37 Examples of damping and ventricularization of the aortic pressu...Figure 35.38 Damping, ventricularization, and effect of side-hole catheters....Figure 35.39 (a)Catheter loop at the lateral RA wall allows advancement int...