Imaging of all three coronary arteries by transthoracic echocardiography. an illustrated guide

Abstract

BackgroundImprovements in ultrasound technology has enabled direct, transthoracic visualization of long portions of coronary arteries : the left anterior descending (LAD), circumflex (Cx) and right coronary artery (RCA). Transthoracic measurements of coronary flow velocity were proved to be highly reproducible and correlated with invasive measurements. While clinical applications of transthoracic echocardiography (TTE) of principal coronary arteries are still very limited they will likely grow. The echocardiographers may therefore be interested to know the ultrasonic views, technique of examination and be aware where to look for coronary arteries and how to optimize the images.MethodsA step-by-step approach to direct, transthoracic visualization of the LAD, Cx and RCA is presented. The technique of examination is discussed, correlations with basic coronary angiography views and heart anatomy are shown and extensively illustrated with photographs and movie-pictures. Hints concerning optimization of ultrasound images are presented and artifacts of imaging are discussed.ConclusionsDirect, transthoracic examination of the LAD, Cx and RCA in adults is possible and may become a useful adjunct to other methods of coronary artery examination but studies are needed to establish its role.

Prognostic value of non-invasive assessment of left anterior descending coronary artery blood flow during exercise test in patients with previous myocardial infarction

“…После записи стандартных ЭхоКГ-изображений про-водился поиск передней межжелудочковой борозды по предложенным ранее методикам [13,14]. По умолчанию использовали заводские настройки вкладки Coronary.…”

Transthoracic Echocardiography in the Assessment of Coronary Arteries

“…As veins are larger, located closer to the right ventricle than arteries and demonstrate a three-phase predominantly systolic flow with very high respiratory variations, it is not very difficult to differentiate between the vessels. Krzanowski et al, 2003 andFoster, 2004, observed that a strong signal confusing coronary artery flow may Fig. 6.…”

“…The diagonal and marginal branches have no connections with either the LMCA or distal LAD or both. The distinction between various vessels seen at the lateral and inferior walls of the ventricle can be challenging (Krzanowski et al, 2003). As first and second OMB is lying parallel and close to the PDA, they may be taken for the PDA.…”

“…5A, B). It is more typical for the occluded main artery in which case the branches enlarge and take over its function (Krzanowski et al, 2003). To avoid this mistake, the LAD should be searched in the anterior interventricular groove along its entire extension with the end points in the LMCA and distal LAD.…”

Coronary Flow: From Pathophysiology to Clinical Noninvasive Evaluation

“…Dipyridamole is a stressor drug particularly suitable for this use. A skilled operator can exploit another chance, assessing not only the anterior descending, but also the posterior descending and the circumflex arteries 31 . Performing the TTE-CFR assessment requires a skilled operator because of hyperventilation too: from 5 to 10 seconds after the administration of the pharmacological stressor the maximal hyperemia is observable and a significant hyperventilation occurs, making difficult to focus the ultrasonic beam on the assessed coronary artery.…”