From Big Medical Encyclopedia

CORONARY ANGIOGRAPHY (Latin coronarius coronal + Greek grapho to write, represent; synonym: coronary angiography, arteriography of coronary vessels of heart) — a radiological method of intravital studying of coronal arteries of heart by their contrasting. It was for the first time carried out in an experiment in 1933 Mr. P. Rousthon. Di Guglielmo (G. Di Guglielmo, 1952) described a picture of normal coronary arteries and the main symptoms of atherosclerosis of coronal vessels in the koronarografichesky image. Arnyulf (G. Arnulf, 1952) suggested to contrast coronary vessels by means of an aortografiya during an atsetilkholinovy cardiac standstill, Nordenstr (V. of Nordenstrom, 1965) — to use for this purpose an aortografiya in the conditions of the increased intra bronchial pressure.

In clinical practice To. it is carried out most often or way of the semi-selection coronary angiography on S. Paulin, at a cut the simultaneous image left and right coronary arteries, or the way of selective administration of contrast medium directly in each coronary artery offered by Souns, Shayri, Amplatts and Dzhadkins turns out (F. Sones, E. Shirey, To. Amplatz, M. Judkins). Purpose K. — identification and research of character, localization, degree and extent of defeat of coronary arteries, and also assessment of a collateral blood-groove. Special significance is attached To. as to a method of exact presurgical diagnosis for establishment of indications and the choice of ways of revascularization of a myocardium at hron, coronary heart disease.

Indications and contraindications

Indications for carrying out To. are hron, the coronary heart disease which is especially proceeding without typical electrocardiographic changes, postinfarction aneurism of heart in case of its alleged operational treatment, congenital anomalies of coronary arteries. Due to the development of surgical treatment of coronary heart disease To. use for specification of existence of stenoses and occlusions of coronary vessels, their localization and extent, a condition of a vascular bed distalny occlusions. Emergency To. it is possible to carry out at an acute myocardial infarction and in a preinfarctive state for the solution of a question of urgent revascularization.

To. it is contraindicated at acute diseases and severe damages of the liver and kidneys expressed to a cardiopulmonary decompensation, ventricular tachycardia, total cross block, intolerance of drugs of iodine.

The technique

most meets the Modern requirements the selection To. It can be carried out by Souns's method by a section of the right humeral artery and introduction under local anesthesia to the ascending aorta of a special catheter, the end to-rogo is established in the mouth of the corresponding coronary artery then pour in a contrast agent. To. by Dzhadkins's method carry out by transdermal catheterization of a femoral artery. Catheters 100 cm long specially model separately for the right and left coronary arteries. The ends of each catheter create so that they corresponded to the direction of the mouth of coronary arteries. Catheters make of a polyethylene X-ray contrast tube, outer diameter a cut is equal to 2,4 mm, internal — 1,2 mm. Under control of the screen the catheter is carried out to the ascending aorta and as well as in Souns's technique, established in the mouth of the coronary artery which is subject to a research. At To. triyodirovanny water-soluble radiopaque substances apply 75 — 76%. On each injection use 6 — 8 ml of the substance entered with a speed of 3 — 4 ml/sec.

Documentation of the x-ray image can be carried out by means of high-speed X-ray cinematography (64 — 78 shots in 1 sec.) or a serial two-planned X-ray analysis in direct and side projections with a speed of 3 — 6 shots of 1 sec. during 4 sec. It is reasonable to use both of these methods since they supplement each other. Throughout all research carry out electrocardiographic control and define the ABP. At administration of contrast medium on an ECG symptoms of short-term ischemia of a myocardium can be observed; bradycardia and decrease in the ABP serve as a contraindication for continuation of a research.

Fig. 1. The angiogram of the right coronary artery (it is specified by an arrow) normal (and — a direct projection; — a side projection).
Fig. 2. The angiogram of the left coronary artery is normal (and — a direct projection; — a side projection); 1 — a front interventricular branch; 2 — the bending-around branch; 3 — a trunk of the left coronary artery.

The X-ray cinematography and serial X-ray analysis allow to judge dynamics of passing of substance on coronary vessels, their anatomo-topographical relationship (fig. 1 and 2) and the nature of defeat up to branches 3 — the 4th order.

The analysis

In the analysis koronarogramm it is necessary to consider type of blood supply. So, at 60% of people the right coronary artery participating in blood supply of the right auricle, interatrial partition, back wall of a right ventricle, back department of an interventricular partition, partially back wall of a left ventricle and atrioventricular node is prevailing; in 15% of cases — the left coronary artery providing blood supply of the left auricle and its ear, front and back wall of a left ventricle and interventricular partition. At 25% of people the uniform type of blood supply is noted.

Fig. 3. The angiogram of the right coronary artery at its stenosis (narrowing is specified by an arrow); left side projection.

Atherosclerotic changes of coronal arteries are shown in the form of a stenosis of various degree, full obstruction of arteries, diffusion defeat of a coronary bed. The Koronarografichesky picture of an organic stricture is characterized by narrowing of a gleam of an artery, irregularity of contrasting and an illegibility of its contours (fig. 3). As a rule, atherosclerotic changes are expressed in 2 — 3 and more branches. More often the stenosing and occlusal defeats are observed in the right coronary artery. At assessment koronarogramm the importance should be attached to a condition of the arteries located distalny the struck segment. At the selection To. it is possible to determine collateral current on intra coronary (by the course of one artery) and intercoronary (between different branches) to an anastomosis.

The limited stenosis of coronary arteries should be differentiated with the coronary spasm which arose in time To. For a spasm typically concentric narrowing of a vessel with accurate equal contours on the limited site. Giving investigated nitroglycerine and repeated To. allow to differentiate a spasm of a vessel and an organic stricture.

The complications arising at To., can be caused by traumatization of a peripheral artery at catheterization, a thromboembolism and toxic effect of radiopaque substances.

Likhtlen (P. Lichtlen, 1970) gave summary statistics of complications at To. (on materials more than 3300 researches). Serious complications are noted almost in 2% of researches. The myocardial infarctions which developed in time To concern to them. or directly after it, and fibrillation of ventricles. The over-all mortality at the same time made 0,1%.

See also Arteriography .

Bibliography: Petrosyan Yu. S. and 3ingerman L. S. Coronary angiography, M., 1974, bibliogr.; Rabkin I. X., Abugov A. M. and M and t of e in about with about in A. L. Angiografiya and arterioskennirovany hearts and lungs, M., 1976; The Guide to an angiography, under the editorship of. And. X. Rabkina, page 58, M., 1977; A m r 1 t z K. Technics of coronary arteriography, Circulation, v. 27, p. 101, 1963; Coronary angiography and angina pectoris, ed. by P. R. Lichtlen, Stuttgart, 1976; J u d k i n s M. P. Selective coronary arteriography, Radiology, v. 89, p. 815, 1967; S ones F.

M. a. S h i-r e at E. K. Cine coronary arteriography, Mod. Cone, cardiov. Dis., v. 31, p. 735, 1962.

And. X. Rabkin.