Terminology and anatomy of angulated coronary arteriography

Abstract

Summary: Angulated views in coronary arteriographyhave been increasingly utilized because of their superiority in demonstrating lesions not well seen in standard right and left oblique projections. The iniportance of these angulated views has been repeatedly demonstrated. It is the purpose of this article to review sonie basic coronary anatomy angulation terminology, and then to desciibe the particular advantages of the angulated views in coronary arteriography . Illustrations of these particular views of both coronary systems will be provided.Key words: coronary arteriography , coronary anatomy Simplified Coronary AnatomyThe more subtle details of coronary anatomy have been completely reviewed previously (Baltaxe et al., 1975;Pujadas, 1980;Soto et al., 1976; Vlodaver rt a l . , 1976). The purpose of this introductory section is merely to provide a consistent terminology with which to understand the descriptive analyses provided later in the manuscript. Right Coronary Artery (Fig. 1) The right coronary anatomy can be most easily understood from the right anterior oblique projection. In this view, the apex of both the left and right ventricle is on the right, and the posterior aspect of the heart (and the atria occasionally delineated by an atrioventricular fat pad stripe. The anterior portion of the right ventricular free wall is somewhat anterior. Thus, the posterior descending coronary artery will run toward the apex, the muscular and.marginal branches in the same direction, and, as might be expected, the posterolateral and atrial branches to the left. The posterolateral branches will eventually turn to the right as the posterior heart is reached. This view is the most simple projection to clarify anatomic landmarks, as, in general, it corresponds to the standard right and left ventricular single-plane cineangiograms. The original of the right coronary artery from the right coronary cusp often appears foreshortened in this projection, and thus in the resultant diagram, because the origin of the right coronary artery is directly aimed at the image intensifier. Often in this nonangulated projection, there is also significant overlap of the distal right coronary artery at the acute niargin of the heart. The Left Coronary ArteryThe anatomy of the left coronary artery can be simply understood with the aid of two liberally idealized drawings. As a rule, regardless of the view, the circumflex coronary artery will be closer to the spine (exceptions occurring in more vertical hearts). In the left anterior oblique (LAO) view (Fig. 2 ) . here slightly cranially angulated to lengthen the left main coronary the anatomy of the left coronary artery is easily displayed. The left