Right Coronary Angiography

The most commonly used catheter for Right Coronary Angiography is the Judkins Right 4 cm curve (JR4) catheter.

To engage thd RCA, the JR4 is advanced into the right coronary cusp and rotated 45 to 90 degrees clockwise as the tip is pulled back.

The best view to visualize the catheter cannulating the RCA is in the left anterior oblique (LAO) 30 to 50 degrees.

Once the catheter is in the ostium of the RCA, IMPORTANT! observe the monitor for pressure dampening associated with ostial stenosis or conus branch cannulation. If no dampening pressure is observed, then coronary injections can be administered. There are usually three views taken of the right coronary. Refer to the angles below:

  1. LAO 30 - This is usually the first view of the RCA and gives a good view of the proximal and mid segments as they continue into the Posterior descending artery. Having the patient take in deep breath can help clear the diaphragm from the view. The RCA looks like a "C" in this angle.
  2. AP Cranial - This angle allows for visualization of the ostial segment of the RCA as well as the Posterior Lateral and Posterior descending branches.
  3. RAO 30 - This view displays the mid segment of the RCA and the distal length of the Posterior descending. The RCA looks like a "L" in this view.

References

  • Baim, D.S. (2005) Grossman's Cardiac Catheterization, Angiography, and Intervention. (7th ed.). Philadelphia,Pa: Lippincott, Williams & Wilkins.
  • Kern, M. et al (2003) The Cardiac Catheterization Handbook (4th ed.). Philadelphia, Pa: Mosby.

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