Lalita Nemani, Maddury Jyotsna, Ramachandra Barik, Venkata K

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Tools and techniques for angioplasty of anomalous origin of right coronary artery Lalita Nemani, Maddury Jyotsna, Ramachandra Barik, Venkata K. Siva Krishna Journal of Indian College of Cardiology Volume 5, Issue 3, Pages 189-197 (September 2015) DOI: 10.1016/j.jicc.2015.05.006 Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 1 Hypothetical anomalous origin of AORCA in LAO cranial 30 degrees from usual 4 sites in patients undergoing PCI is shown. Origin from right coronary sinus (RCS) are labelled as high take off (RA), low take off (RB) anterior or posterior to normal origin but not from midline of aorta (RC),.Origin from Left coronary sinus (LCS) are similarly classified as LA, LB AND LC respectively. Origin either from RCS or LCS in the midline are labelled D. Origin from noncoronary sinus (NCS) called P (posterior sinus in tricuspid aortic valve). Origin from aortic wall far above the sinotubular junction are labelled as AO. Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 2 Schematic representation of anomalous RCA types and their successful cannulation with guide catheters and access site. Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 3 (A) Diagnostic coronary angiogram illustrating the effortless hooking of AORCA (Type D) in LAO-45 and RAO-45 degree (B). Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 4 The hooking of AORCA from RCS (type-RA with down slant take off) using JR-3.5 in LAO (A) and RAO (B).Because of failure to negotiate guide wire to distal part of RCA, the guide catheter was changed to AR-1 and PCI was completed effortlessly (C and D). Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 5 The hooking of AORCA from LCS (type-LC) using AL-2 in LAO (A) and RAO-45 degree (B) respectively. Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 6 (A) The hooking of AORCA from LCS (type-LB) by using EBU-3.0 in LAO view. (B): The hooking of AORCA from LCS (type-LA) using JL-4.0 in LAO wherein the curve is further modified by pushing deep into LCS to facilitate easier cannulation. Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions

Fig. 7 Selective cannulation of AORCA from post wall of aorta using Amplatzer left guide catheter. Journal of Indian College of Cardiology 2015 5, 189-197DOI: (10.1016/j.jicc.2015.05.006) Copyright © 2015 Indian College of Cardiology Terms and Conditions