6/20/2010

Cath: Angiographic Projections

According to site of injection:

Site

Projection
Anatomy of interest
RV
PA/Lat
PA,20°­/Lat
Pulmonary Valve
Sitting up view
TOF, Pulm. Atresia
PA
PA/Lat
Peripheral PAs
Sitting up view
TOF
RAO30° / LAO60°
Central PAs
LV
Long Axial Oblique
RAO30°/ LAO60°
Hepatoclavicular
AVC, Tri. Atresia
Asc. Ao.
(Ao. Root)
Long axial Oblique
RAO30° / LAO60°
30-40°¯ ± 10-15°LAO (Laid-back or Down-the-barrel view)
Coronaries in TGA
Desc. Ao.
PA/Lat
PDA
PA/Lat
RAO ± ­angulation helps in some PDAs.
RUPV
(For Sec. ASD)
Hepatoclavicular view
Named projections:

Sitting up view: 30-40°­ / Lateral

Central PAs in TOF, Pulm. Atresia
Pulmonary sling
Vascular ring (Double aortic arch)
Hepatoclavicular view (4 Chamber view)*
Lat camera only (LAO 40°/­40°)
PA camera is not part of this view. Can be used as determined by the operator.
Complete and Partial AVC
Tricuspid atresia
Straddling TV or MV
Single ventricle
Inlet VSD
Secundum ASD (Injection in RUPV)

Long axial oblique view (L.Ax.Obl.)*

(RAO 20°,¯10° / LAO 70°,­ 20°)
Ventricular septal defects:
Membranous
Malalignment (TOF)
Sub pulmonary
Muscular
Apical (L.Ax.Obl.)
Anterior (RAO)
Mid-Posterior (L.Ax.Obl.)
Subaortic stenosis
Subpulmonary stenosis in TGA
Secundum ASD (injection in RUPV) - Hepatoclavicular view is more preferred.
(*Hepatoclavicular view and L.Ax.Obl view are called axial views, since they ‘line up’ in the long axis of the heart.)

Laid-back view: (35 degree caudal in PA view)
For demonstration of coronary arteries in d-TGA
See posting in "Anatomy: Coronary anatomy in TOF, d-TGA, ..."

Sleeping bat view: (35 degree caudal in PA or RAO or LAO view)
For demonstration of distal Sano shunt junction with branch PAs.
See posting "sleeping bat view" in this blog.
LPA origin: (LAO 15 degree, cranial 20 degree on PA camera & Straight lateral)
Dr. Rao uses this. He says, Bergeron described it.

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