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Cardiology
Coronary Anatomy, Variants, and Collaterals
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 90 slides
Overview
- Scope of this topic
- Abbreviations used throughout
Normal coronary anatomy
- Origin and proximal course of the right coronary artery
- Proximal branches of the right coronary artery
- Distal right coronary artery and the cardiac crux
- Coronary dominance
- Branch of dominance
- BARI segments of the right coronary artery
- BARI segments of the dominant right coronary artery
- Course of the right coronary artery from ostium to crux
- Origin and division of the left coronary artery
- Course of the left anterior descending artery
- Branches of the left anterior descending artery
- BARI segments of the left anterior descending artery
- Dual left anterior descending artery, types I to III
- Dual left anterior descending artery, types IV to VI
- Course of the left circumflex artery
- Branches and BARI segments of the left circumflex artery
- The dominant left circumflex artery
- BARI segments of the LAD and left circumflex
Coronary collateral pathways
- Circle of Vieussens
- Angiographic pitfalls in demonstrating the conus collateral
- Conus to left anterior descending collateral
- Kugel's anastomosis
- Septal collaterals in chronic total occlusion
- Epicardial collaterals in right coronary occlusion
- Epicardial collaterals in LAD and LCx occlusion
- Collaterals to a chronically occluded right coronary artery
Anomalous coronary origin
- Definitions and prevalence of ACAOS
- Relative frequency of R-ACAOS and L-ACAOS
- Subtypes of left coronary artery from the right sinus
- Courses of a left main arising from the right sinus and their angiographic appearance
- Courses of a left main arising from the right sinus and their angiographic appearance (continued)
- Anomalous left main from the right sinus on CCTA and angiography
- Right coronary artery from the left sinus
- High-risk anatomical features in R-ACAOS
- Slit-like ostium and acute take-off angle on CCTA
- Left circumflex arising from the right sinus
- Angiographic recognition of an anomalous circumflex
- Anomalous circumflex from the right sinus and its engagement
- Single coronary artery: Lipton group I
- Single coronary artery: Lipton groups II and III
- Associations and risk of single coronary artery
- Lipton group II single coronary artery
Diagnosis of anomalous coronary origin
- Guideline recommendation for imaging an anomalous coronary
- Role of coronary CT angiography
- Comparison of CCTA and cardiac magnetic resonance
- The dot and eye method in the catheterisation laboratory
- The dot sign on aortography
- The eye sign on selective angiography
- Pitfall of the septal course on catheter localisation
- Anomalous LAD arising alone from the right sinus
- Anomalous LAD from the non-coronary sinus
Clinical aspects and management
- Evidence linking ACAOS to sudden cardiac death
- Mechanism of ischaemia in the interarterial variant
- Revised understanding of the compression mechanism
- Four factors in evaluating a patient with ACAOS
- Multimodality testing sequence for suspected ischaemia
- Intravascular ultrasound findings in an intramural segment
- Physiological thresholds used to judge significance
- 2018 ACC/AHA recommendations: class 1
- 2018 ACC/AHA recommendations: class 2a and 2b
- Surgical repair of anomalous aortic origin
- Translocation, patch ostioplasty and percutaneous options
- Surgical translocation and unroofing of anomalous coronary origin
- IVUS-guided intervention on an intramural anomalous ostium
Catheter selection for angiography and PCI
- Catheter selection for the left coronary artery
- Left coronary engagement from radial access
- Catheter selection for the right coronary artery
- Engaging a high anterior right coronary artery
- Catheters for an anomalous left coronary from the right sinus
- Catheters for R-ACAOS by ostial position
- Guide extension catheters and a deep-seating manoeuvre
- Limitations in current knowledge and technique
- Special considerations in congenital and structural procedures
- When the anomalous vessel cannot be found in the laboratory
- Summary and take-home points
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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