Jae-Hwan Lee Cardiovascular Center, Chungnam National University Hospital, Daejeon, Korea Jae Jae - - Hwan Lee Hwan Lee Cardiovascular Center, Chungnam National University Hospital, Daejeon, Korea Interpretation of Coronary Angiogram Interpretation of Coronary Angiogram
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Jae-Hwan Lee
Cardiovascular Center,Chungnam National University Hospital,
Daejeon, Korea
JaeJae--Hwan LeeHwan Lee
Cardiovascular Center,Chungnam National University Hospital,
Daejeon, Korea
Interpretation ofCoronary Angiogram
Interpretation ofCoronary Angiogram
Interpretation of Coronary Angiogram 2
Coronary AnatomyCoronary AnatomyCoronary Anatomy
Sternocostal surface
Branch to SA node
(SVC branch)
Anterior
RA branch
of RCA
Right coronary artery
(RCA)
RV branch
Left main coronary artery
(LMCA)
Left circumflex artery
(LCx)
Left anterior
descending
(LAD) artery
Diagonal artery
(Dx)
Anterior cardiac vein
Small cardiac vein
Great cardiac vein
Obtuse marginal (OM)
Interpretation of Coronary Angiogram 3
Coronary AnatomyCoronary AnatomyCoronary Anatomy
Right coronary artery
Posterior descending
artery
RV branch
Diaphragmatic surface
Small cardiac vein
SA node
Branch to SA node
(SVC branch)
Great cardiac vein
Oblique vein of LA
(Marshall)
Coronary sinus
Left circumflex artery
Obtuse marginal
(OM) branch
Posterior veinof LV
Middle cardiac vein
PL branch
Interpretation of Coronary Angiogram 4
Atrioventricular and Interventricular Planes
Interpretation of Coronary Angiogram 5
Conusbranch
RV branch
PL
PDA
Right Coronary ArteryRight Coronary ArteryRight Coronary Artery
SA nodalartery
Interpretation of Coronary Angiogram 6
Right Coronary ArteryRight Coronary ArteryRight Coronary Artery
Basic AnatomyBasic Anatomy
• Origin
- Right aortic sinus (lower origin than LCA)
• Course
- Right-dominant system (85%)
Down right AV groove toward crux of the heart,
gives off PDA from which septals arise, continues
in left AV groove giving off PL branches.
• Supplies to LV
- 25-35% of LV
• Origin
- Right aortic sinus (lower origin than LCA)
• Course
- Right-dominant system (85%)
Down right AV groove toward crux of the heart,
gives off PDA from which septals arise, continues
in left AV groove giving off PL branches.
• Supplies to LV
- 25-35% of LV
Interpretation of Coronary Angiogram 7
Right Coronary ArteryRight Coronary ArteryRight Coronary Artery
Other BranchesOther Branches• Conus Artery
- Usually very proximal
- ~50% have a separate origin
- Courses anteriorly and upward over the RVOT
- May be an important source of collaterals
• SA Nodal Artery
- Usually 2nd branch of RCA
- Courses obliquely backward through upper portion
of atrial septum and anteromedial wall of the RA
- Supplies SA node, RA and sometimes LA
• Conus Artery
- Usually very proximal
- ~50% have a separate origin
- Courses anteriorly and upward over the RVOT
- May be an important source of collaterals
• SA Nodal Artery
- Usually 2nd branch of RCA
- Courses obliquely backward through upper portion
of atrial septum and anteromedial wall of the RA
- Supplies SA node, RA and sometimes LA
Interpretation of Coronary Angiogram 8
Right Coronary ArteryRight Coronary ArteryRight Coronary Artery
Other BranchesOther Branches
• 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
• Posterolateral Artery (PL)
- From crux to left AV groove � Meet LCx 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
• Posterior Descending Artery (PDA)
- Supplies inferior wall, ventricular septum,
posteromedial papillary muscle
• Posterolateral Artery (PL)
- From crux to left AV groove � Meet LCx artery
Interpretation of Coronary Angiogram 9
LMCA
LAD
LCx
OM1
OM2Se
ptal
Diagonal
Left Coronary ArteryLeft Coronary ArteryLeft Coronary Artery
Interpretation of Coronary Angiogram 10
Left Coronary ArteryLeft Coronary ArteryLeft Coronary ArteryLeft Main Coronary ArteryLeft Main Coronary Artery
• Origin
- Upper portion of the left aortic sinus just below the
sinotubular ridge.
- Typically about 10 mm in length
• Optimal Views
- Caudal views might be the best to evaluate LMCA and
both LAD and LCx ostia
- Shallow LAO cranial view for ostial evaluation
- Sometimes, RAO cranial will be helpful for ostial LAD
evaluation
• Origin
- Upper portion of the left aortic sinus just below the
sinotubular ridge.
- Typically about 10 mm in length
• Optimal Views
- Caudal views might be the best to evaluate LMCA and
both LAD and LCx ostia
- Shallow LAO cranial view for ostial evaluation
- Sometimes, RAO cranial will be helpful for ostial LAD
evaluation
Interpretation of Coronary Angiogram 11
Left Coronary ArteryLeft Coronary ArteryLeft Coronary Artery
LAD ArteryLAD Artery• Course
- Down the anterior interventricular groove
- Usually reaches apex; 22% does not reach apex
- Some have twin LADs (one for entire septal and the
other for surface LAD)
• Branches
- Septals; root-like, intramyocardial, less movement
- Diagonals; supply lateral LV, anterolateral papillary m.
- 1/3 have ramus intermedius (RI)
• LV Supplies
- 45~55% of LV; anterolateral, apex, and septum
• Course
- Down the anterior interventricular groove
- Usually reaches apex; 22% does not reach apex
- Some have twin LADs (one for entire septal and the
other for surface LAD)
• Branches
- Septals; root-like, intramyocardial, less movement
- Diagonals; supply lateral LV, anterolateral papillary m.
- 1/3 have ramus intermedius (RI)
• LV Supplies
- 45~55% of LV; anterolateral, apex, and septum
Interpretation of Coronary Angiogram 12
Left Coronary ArteryLeft Coronary ArteryLeft Coronary Artery
LCx ArteryLCx Artery• Course
- Down distal left AV groove
- Left-dominant system (8%)
� supply PL, PDA and AV nodal arteries
- Balanced system (7%)
� PDA from RCA, PL from LCx
• Branches
- Obtuse marginal; lateral free wall of LV
• LV Supplies
- 15~25% of LV
- 40~50% in dominant LCx system
• Course
- Down distal left AV groove
- Left-dominant system (8%)
� supply PL, PDA and AV nodal arteries
- Balanced system (7%)
� PDA from RCA, PL from LCx
• Branches
- Obtuse marginal; lateral free wall of LV
• LV Supplies
- 15~25% of LV
- 40~50% in dominant LCx system
Interpretation of Coronary Angiogram 13
Left Coronary AngiogramLeft Coronary AngiogramLeft Coronary Angiogram
Interpretation of Coronary Angiogram 14
Right Coronary AngiogramRight Coronary AngiogramRight Coronary Angiogram