Basic Coronary Artery Anatomy Paul Fefer, MD. Interventional Cardiology Unit Sheba Medical Center, Tel Hashomer Courtesy of Frederick Feit, MD The Cardiovascular Research Foundation Transcatheter Cardiovascular Therapeutics Medtronic Fellows PCI Primer Medtronic Fellows PCI Primer
Medtronic Fellows PCI Primer. Basic Coronary Artery Anatomy. Paul Fefer, MD. Interventional Cardiology Unit Sheba Medical Center, Tel Hashomer Courtesy of Frederick Feit, MD. The Cardiovascular Research Foundation. Transcatheter Cardiovascular Therapeutics. Basic Coronary Artery Anatomy. - PowerPoint PPT Presentation
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Basic Coronary Artery Anatomy
Basic Coronary Artery Anatomy
Paul Fefer, MD.Interventional Cardiology Unit
Sheba Medical Center, Tel Hashomer
Courtesy of Frederick Feit, MD
Paul Fefer, MD.Interventional Cardiology Unit
Sheba Medical Center, Tel Hashomer
Courtesy of Frederick Feit, MD
The Cardiovascular Research FoundationThe Cardiovascular Research Foundation Transcatheter Cardiovascular TherapeuticsTranscatheter Cardiovascular Therapeutics
Medtronic Fellows PCI PrimerMedtronic Fellows PCI Primer
77thth Annual Interventional Cardiology Self-Assessment Course at TCT2004 Annual Interventional Cardiology Self-Assessment Course at TCT2004
Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Right Coronary ArteryRight Coronary Artery
• OriginRight aortic sinus (lower origin than LCA)
• CourseDown 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.
• Supplies25% to 35% of Left Ventricle
• OriginRight aortic sinus (lower origin than LCA)
• CourseDown 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.
• Supplies25% to 35% of Left Ventricle
Basic AnatomyBasic Anatomy
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Right Coronary ArteryRight Coronary Artery
• Conus Arteryusually 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.
• Conus Arteryusually 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 BranchesOther Branches
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Right Coronary ArteryRight Coronary Artery
• Right Ventricular (Acute Marginal) Branches)Arise from mid RCA; supply anterior RV; may be a collateral source.• AV Nodal Artery
Demonstrating Origin of Acute MarginalDemonstrating Origin of Acute Marginal
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
AP Cranial View of Distal RCAAP Cranial View of Distal RCA
PDAPDAPDAPDA
AV
Gro
ove
AV
Gro
ove
AV
Gro
ove
AV
Gro
ove
RPL 1RPL 1RPL 1RPL 1
RPL 2RPL 2RPL 2RPL 2
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Left Coronary ArteryLeft Coronary Artery
• Originupper portion of left aortic sinus just below the sinotubular ridge. Typically 0-10 mm in length. Rarely no LM (separate origins).
• Catheterization Technique“The Judkins’ 4-Left coronary catheter will find the LCA orifice unless thwarted by the operator”. Just in case-other Judkins sizes for smaller or larger aortas; Amplatz, XB type curves. Watch for “damping”; For separate ostia-separate catheters, larger for Cx, or counterclockwise rotation for LAD.
• Optimal ViewsLAO caudal and cranial; AP-caudal, cranial or flat. Limit views. May need IVUS
• Originupper portion of left aortic sinus just below the sinotubular ridge. Typically 0-10 mm in length. Rarely no LM (separate origins).
• Catheterization Technique“The Judkins’ 4-Left coronary catheter will find the LCA orifice unless thwarted by the operator”. Just in case-other Judkins sizes for smaller or larger aortas; Amplatz, XB type curves. Watch for “damping”; For separate ostia-separate catheters, larger for Cx, or counterclockwise rotation for LAD.
• Optimal ViewsLAO caudal and cranial; AP-caudal, cranial or flat. Limit views. May need IVUS
Left Main Coronary ArteryLeft Main Coronary Artery
Sternocostal Aspect
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Diaphragmatic Aspect
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Left Anterior Descending ArteryLeft Anterior Descending Artery• Course
down the anterior interventricular groove-usually reaches apex. In 22% of cases does not reach apex.
• Branchesseptals and diagonals-supply lateral wall of LV, anterolateral papillary muscle; 37% have median ramus (courses like 1st diagonal).
• LADSupplies anterolateral, apex and septum; ~45%-55% of left ventricle.
• Coursedown the anterior interventricular groove-usually reaches apex. In 22% of cases does not reach apex.
• Branchesseptals and diagonals-supply lateral wall of LV, anterolateral papillary muscle; 37% have median ramus (courses like 1st diagonal).
• LADSupplies anterolateral, apex and septum; ~45%-55% of left ventricle.
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Left Circumflex ArteryLeft Circumflex Artery• Origin
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The Coronary Arteries Are ComplementaryThe Coronary Arteries Are Complementary
• Large PDA Small LAD• Huge Cx (posterolaterals) Small RCA continuation in AV Groove• Etc, etc, etc…..
• Large PDA Small LAD• Huge Cx (posterolaterals) Small RCA continuation in AV Groove• Etc, etc, etc…..
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Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.
Wrap Around LADWrap Around LAD
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Short LAD/Large RCA with Apical ExtensionShort LAD/Large RCA with Apical Extension
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BYPASS GRAFTSBYPASS GRAFTS
• SVGLeft coronary grafts generally arise from left side of the aorta. Best cannulated with Judkins’ Right, IMA, LCB or MP.Right sided grafts-arise from right side of
the aorta-MP usually best.
• IMAdon’t forget to check subclavians.
• SVGLeft coronary grafts generally arise from left side of the aorta. Best cannulated with Judkins’ Right, IMA, LCB or MP.Right sided grafts-arise from right side of
the aorta-MP usually best.
• IMAdon’t forget to check subclavians.
All distal vessels must be accounted for; op notes and old films are extremely helpful.All distal vessels must be accounted for; op notes and old films are extremely helpful.
77thth Annual Interventional Cardiology Self-Assessment Course at TCT2004 Annual Interventional Cardiology Self-Assessment Course at TCT2004
Basic Coronary Artery AnatomyBasic Coronary Artery Anatomy: Frederick Feit, M.D. : Frederick Feit, M.D.