Cardiology>>>>>Ischaemic heart disease
Question 5#

Angiography of a patient who had redo coronary artery bypass grafting in 1987. He had three grafts and has a recurrence of angina.

The following RAO angiogram shows?

 

A) Aortic diverticulum
B) Right coronary graft stump
C) Left coronary system graft stump
D) LIMA graft
E) Aortic pseudoaneurysm

Correct Answer is C

Comment:

Anatomy common to angiography for graft studies. These images are a particularly good example as graft markers (radio-opaque circles) have been placed and show the graft positions relative to each other in LAO and RAO view. Right coronary artery grafts are placed above the native RCA on the aorta. The graft is best engaged in the LAO view with the catheter pointing towards the left of the field of view. In this case a stump is revealed at the point of the marker.
Left coronary system grafts (commonly diagonal, obtuse marginal, or intermediate. vein grafts to the LAD are now uncommon due to the LIMA) are placed sequentially above the native left coronary system. In the RAO view the grafts are engaged with the catheter pointing to the right of the field of view.