7. 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
Basic Anatomy
8. Right Coronary Artery
Conus Artery
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
(~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.
Other Branches
9. Right Coronary Artery
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.
PDA
Supplies inferior wall, ventricular
septum, posteromedial papillary muscle.
Other Branches
10. Right Coronary Artery
LAO (30) Cranial(30)
particularly for distal bifurcation (AP
Cranial may be better).
RAO
main shaft; cranial enhances distal
vessels and very proximal; caudal may
help with Shepherd’s crook.
Lateral
bifurcations with RV branches-distal
bifurcation, particularly with cranial.
Optimal View(s)
11. Left Coronary Artery
Origin
upper portion of left aortic sinus just below the
sinotubular ridge. Typically 0-10 mm in length. Rarely
no LM (separate origins).
Optimal Views
LAO caudal and cranial; AP-caudal, cranial or flat.
Left Main Coronary Artery
12. Left Anterior Descending Artery
Course
down the anterior interventricular groove-usually
reaches apex. In 22% of cases does not reach apex.
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%
of left ventricle.
13. Left Circumflex Artery
Origin
from distal LMCA.
Course
down distal left AV groove.
Branches
obtuse marginal, posterolaterals-supply posterolateral
LV, anterolateral papillary muscle. SA node artery-
38%.
Supplies
15%-25% of LV, unless dominant (supplies 40-50% of
LV).
14. Left Coronary Artery
AP (30)Caudal
LMCA, proximal LAD, Cx, distal LAD. Poor for mid
LAD- RAO may be useful.
AP (40)Cranial
LMCA, LAD, diagonals, septals, distal Cx-may need
RAO to separate LAD and Cx.
(45)LAO (35) Cranial
LMCA, LAD, diagonals, septals, and distal Cx.
(45)LAO (30) Caudal
LMCA, Cx,and prox LAD.
Optimal Views
15. Standard Angiographic Views
LAO-Caudal view: 400
to 600
LAO and 100
to 300
caudal
Best for visualizing left main, proximal LAD and proximal LCx
RAO-Caudal view: 100
to 200
RAO and 150
to 200
caudal
Best for visualizing left main bifurcation, proximal LAD and the
proximal to mid LCx
Shallow RAO-Cranial view: 00
to 100
RAO and 250
to 400
cranial
Best for visualizing mid and distal LAD and the distal LCx (LPDA
and LPL)
Separates out the septals from the diagonals
LAO-Cranial view: 300
to 600
LAO and 150
to 300
cranial
Best for visualizing mid and distal LAD, and the distal LCx in a left
dominant system
Separates out the septals from the diagonals
Left Coronary Artery
16. Standard Angiographic Views
PA projection: 00
lateral and 00
cranio-caudal
Best for visualizing ostium of the left main
PA-Caudal view: 00
lateral and 200
to 300
caudal
Best for visualizing distal left main bifurcation as well as the
proximal LAD and the proximal to mid LCx
PA-Cranial view: 00
lateral and 300
cranial
Best for visualizing proximal and mid LAD
Left lateral view:
Best for visualizing proximal LCx, proximal and distal LAD
Also good for visualizing LIMA to LAD anastomotic site
Left Coronary Artery (other views)
17. Standard Angiographic Views
LAO 30: 300
LAO
Best for visualizing ostial and proximal RCA
RAO 30: 300
RAO
Best for visualizing mid RCA and PDA
PA Cranial: PA and 300
cranial
Best for visualizing distal RCA bifurcation and the PDA
Right Coronary Artery
18. Standard Angiographic Views
An easy way to identify the tomographic views is to use the anatomic
landmarks - catheter in the descending aorta, spine and the diaphragm.
The rough rules are:
RAO vs. LAO- If the spine and the catheter are to the right of the
image, it is LAO and vice versa. If central, it is likely a PA view
Cranial vs. caudal - If diaphragm shadow can be seen on the image,
it is likely cranial view, if not, it is caudal
Catheter and
spine to the
LEFT
RAO view
No diaphragm
shadow
Caudal view
Catheter at
the
CENTER
PA view
No diaphragm
shadow
Caudal
view
Spine to
the
RIGHTLAO view
Diaphragm
shadow
Cranial view
19. Standard Angiographic Views
Left Coronary Artery
RAO 20 Caudal 20
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
RAO 20 Caudal 20
Knowledge of the orientation of the artery
for a given view can help identify the
probable path of the artery in the setting of
complete occlusion
Distal LAD
fills by
collaterals
LAD
Best for visualization of
LM bifurcation and
proximal LAD and LCx
20. Standard Angiographic Views
Left Coronary Artery
LAO 50 Cranial 30
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
PA 0 Cranial 30
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
Best for visualization of LM
proximal and mid LAD
Best for visualization of proximal and
mid LAD and splaying of the septals
from the diagonals. Also ideal for
visualization of distal LCx
21. Standard Angiographic Views
Left Coronary Artery
PA0 Caudal 30
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
LAO 50 Caudal 30
OM
LM
LAD
Diagonal
Distal
LAD
LCx
OM
‘Spider’ view
Best for visualization of LM
bifurcation and proximal
LAD and LCx
Best for visualization of LM
bifurcation, proximal LAD and LCx
and OM
22. Standard Angiographic Views
Right Coronary Artery
LAO 30
Proximal
RCA
PDA
Distal
RCA
Mid
RCA
RAO 30
Mid
RCA
PDA/
PLV
PA 0 Cranial 30
Proximal
RCA
PDADistal
RCA
Mid
RCA
Best for visualization of
ostial and proximal RCA
Best for visualization of mid
RCA and PDA
Best for visualization of distal
RCA and its bifurcation
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