Coronary angiography right coronary artery: Difference between revisions
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| [[ | | [[File:RCA_LAO_30_CRA.png|none|thumb|300px|30 <sup>o</sup> LAO view with no cranial or caudal angulation of the RCA]] | ||
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===Bifurcation of the RCA=== | ===Bifurcation of the RCA=== | ||
The camera is next swung cranially to 15<sup>o</sup> to 20<sup>o</sup> and the LAO angulation is minimized to 5<sup>o</sup>-10<sup>o</sup>. This view optimizes the bifurcation of the distal RCA where the [[right posterolateral artery]] and the [[posterior descending artery]] branch. The patient should take a deep breath and hold it during the injection to optimize the view. | The camera is next swung cranially to 15<sup>o</sup> to 20<sup>o</sup> and the LAO angulation is minimized to 5<sup>o</sup>-10<sup>o</sup>. This view optimizes the bifurcation of the distal RCA where the [[right posterolateral artery]] and the [[posterior descending artery]] branch. The patient should take a deep breath and hold it during the injection to optimize the view. | ||
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| [[File:RCA_LAO_5_CRA_15.png|none|thumb|300px|30 <sup>o</sup> LAO view with no cranial or caudal angulation of the RCA]] | |||
| [[File:RCA_LAO_5_CRA_15.gif|none|thumb|300px|30 <sup>o</sup> LAO view with no cranial or caudal angulation of the RCA]] | |||
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===Mid RCA=== | ===Mid RCA=== | ||
The middle RCA is best visualized in the straight right anterior oblique (RAO) 30 <sup>o</sup>view. | The middle RCA is best visualized in the straight right anterior oblique (RAO) 30 <sup>o</sup>view. | ||
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| [[File:RCA_RAO_30_CRA.png|none|thumb|300px|30 <sup>o</sup> LAO view with no cranial or caudal angulation of the RCA]] | |||
| [[File:RCA_RAO_30_CRA.gif|none|thumb|300px|30 <sup>o</sup> LAO view with no cranial or caudal angulation of the RCA]] | |||
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==References== | ==References== | ||
Revision as of 19:42, 26 August 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The right coronary artery (RCA) is a coronary artery with a single origin near the right cusp of the aortic valve that bifurcates (branches) to supply the right ventricular free wall (the acute marginal branches) and the inferior wall of the left ventricle through the posterior descending artery and the posterolateral wall of the left ventricle via the right posterolateral branch. On coronary angiography, the RCA is easily recognizable as it appears like the letter C in the left anterior obliques (LAO) projection and appears like a letter L in the right anterior oblique (RAO) projection. There are three angiographic views of the RCA that are traditionally obtained to visualize the proximal, mid and distal segments.
How to Engage the Right Coronary Artery
The Right Coronary Artery (RCA) is engaged in the 30o left anterior oblique (LAO) position. Using the femoral arterial approach, a Judkins Right 4 (JR4) catheter is traditionally used to engage the right coronary artery. The JR4 catheter is advanced into the body to make contact with the aortic valve. Next, the operator gently pulls the catheter out of the body about 2 cm while torquing the catheter clockwise. When the catheter faces to the left on the screen, it should be in or near the ostium of the right coronary artery. Other catheters that can be used to engage the right coronary artery include that Amplatz Right (AR1), and Amplatz Left (AL2, and AL3) catheters. If the origin of the right coronary artery has an upward trajectory, an internal mammary artery catheter may engage better.
Optimal Views of the Right Coronary Artery
The following sequence of 3 traditional views is obtained as the gantry is swung from the 30o LAO position to the AP cranial position to the 30o RAO position.
Proximal RCA
The proximal RCA including the ostium is best visualized in the 30o LAO view with no cranial or caudal angulation.
Bifurcation of the RCA
The camera is next swung cranially to 15o to 20o and the LAO angulation is minimized to 5o-10o. This view optimizes the bifurcation of the distal RCA where the right posterolateral artery and the posterior descending artery branch. The patient should take a deep breath and hold it during the injection to optimize the view.
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Mid RCA
The middle RCA is best visualized in the straight right anterior oblique (RAO) 30 oview.
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