Coronary Angiography and Clinical

Author: Li Zhanquan
Publisher:
Publish Date: 2002-08-03
Features: ...Chapter 1 Coronary Artery Anatomy and Variations...Chapter 2 Pathological Anatomy of Coronary Atherosclerosis...Chapter 3 Physiology and Pathophysiology of Coronary Circulation...Chapter 4 Historical Development of Coronary Angiography...Chapter 5 Construction of Modern Catheterization Laboratories...Chapter 6 Indications and Contraindications of Coronary Angiography...Chapter 7 Preoperative Preparation for Coronary Angiography...Chapter 8 Operation of Coronary Angiography...Chapter 9 Radiological Imaging of Coronary Arteries...Chapter 10 Interpretation of Coronary Angiography Results...Chapter 11 Left Ventricular Angiography...Chapter 12 Collateral Circulation of Coronary Arteries...Chapter 13 Easily Misdiagnosed Coronary Angiography Results...Chapter 14 Recording Methods for Coronary Angiography Results...Chapter 15 Complications and Management of Coronary Angiography...Chapter 16 Coronary Angiography in Special Cases...Chapter 17 Drug Testing During Coronary Angiography...Chapter 18 Postoperative Management of Coronary Angiography...Chapter 19 Diagnosis of Special Coronary Artery Diseases Using Coronary Angiography...Chapter 20 Limitations of Coronary Angiography...Chapter 21 Objective Evaluation of Normal Chest Pain Patients Undergoing Coronary Angiography...Chapter 22 Training Requirements for Cardiac Catheterization...Chapter 23 Comparison of Common Non-invasive Methods for Coronary Heart Disease with Coronary Angiography Results...Chapter 24 Several Issues Regarding Contrast Media...Chapter 25 Cardiac Catheterization Work Routine and Radiation Protection System...Chapter 26 Preface Introduction Coronary angiography, as the "gold standard" for diagnosing coronary heart disease, has been clinically applied for over forty years. Since Gruentzig performed the world's first percutaneous transluminal coronary angioplasty (PTCA) in 1977, coronary angiography has been stronger vitality. In recent years, with the popularization and promotion of interventional cardiology techniques, the application of coronary angiography in China has also become increasingly widespread. According to rough statistics, about 8,000 coronary angiographies and 20,000 coronary angiography procedures were performed in China in 1999. Many units have just started this work, and many doctors and professionals need to learn and master the basic theories and skills of coronary angiography. Many doctors are facing knowledge updates. It is necessary to publish a comprehensive and systematic monograph on coronary angiography. The monograph "Coronary Angiography and Clinical Practice" edited by Dr. Li Zhanquan of the People's Hospital of Liaoning Province was born under such circumstances. The authors of this book are young cardiologists actively engaged in clinical practice who have accumulated rich experience in coronary angiography. Based on the problems frequently encountered in clinical practice and teaching over the years, they collected a large number of domestic and international literature on coronary angiography in recent years and introduced in-depth and accessible knowledge about the radiological anatomy of coronary arteries, the basic operation of coronary angiography, indications, complications, and management, as well as related knowledge. The content of this book is comprehensive, systematic, novel, practical, illustrated with images, closely clinical practice, and is suitable for both beginners and grassroots medical staff. It also provides valuable reference materials for doctors in cardiology, cardiovascular surgery, radiology, electrocardiography, and echocardiography. The content of the book is detailed, with strong scientific and practical value. To refine the vast body of knowledge into a concise form is indeed rare. It is believed that after the publication of this book, it will play a role in promoting the popularization and development of interventional diagnosis and treatment of coronary heart disease in China. Academician of the Chinese Academy of Engineering, Dean of Fuwai Hospital, Beijing, February 1, 2000 Preface Since 1958, when Sones performed coronary angiography by inserting a specially designed catheter with a curved tip through the brachial artery, retrograde into the left and right coronary ostia, to 1967, when Judkins and Amplatz successively adopted the trans-femoral artery puncture approach to insert pre-formed catheters for coronary angiography, making the method widely used in clinical practice, selective coronary angiography has become the "gold standard" for modern coronary heart disease diagnosis. Over the following decades, due to the continuous improvement of catheter and guide wire quality, the constant refinement and improvement of X-ray cardiovascular imaging equipment, the development and application of new non-ionic contrast agents, and the standardization of angiographic procedures, the safety of coronary angiography has been greatly enhanced. China first introduced this new technology in 1973 at Zhongshan Hospital affiliated to Shanghai Medical University and Fuwai Hospital in Beijing. It is now widely used in many hospitals across the country. In the 1980s, the rise of interventional cardiology, represented by percutaneous transluminal coronary angioplasty (PTCA), opened a new chapter in the treatment of coronary heart disease. Coronary angiography has become a basic skill that cardiovascular physicians must master. However, most monographs on coronary heart disease in China are primarily clinical in nature, with less emphasis on interventional diagnosis and treatment, especially monographs on the basic and clinical aspects of coronary angiography are even rarer. Therefore, the idea of compiling a specialized monograph that systematically introduces coronary artery anatomy, physiology, pathology, and basic techniques and clinical applications of coronary angiography was born. Based on references to authoritative domestic and international works and domestic and international literature from 1990 to 1998, the authors organized many young scholars with rich practical experience to compile this book in conjunction with clinical practice, China's conditions and experience. The book systematically introduces coronary angiography from anatomical, physiological, pathological anatomical, radiological anatomical, pathophysiological, and clinical aspects of coronary heart disease, and combines clinical situations to introduce coronary angiography, accompanied by hundreds of images for explanation, aiming to deepen readers' understanding of coronary artery lesions and promote the improvement of coronary angiography techniques. This book is suitable for cardiovascular surgeons and cardiologists in general hospitals, as well as units that have just started coronary angiography work. As the first monograph in China on coronary angiography in this field, it covers many theoretical and practical issues of coronary angiography at home and abroad. Although the book has some shortcomings, they do not obscure its academic value. It is important to remember the teachers who have nurtured, guided, and encouraged us for many years. We dedicate this book to our teachers and the older generation of famous cardiovascular disease experts. Li Zhanquan Excerpt Chapter 1 Coronary Artery Anatomy and Variations Normal coronary artery anatomy is obviously not sufficient for clinical cardiovascular doctors working in cardiac catheterization, as described in standard textbooks. To correctly understand and interpret coronary angiography results, it is essential to fully master detailed knowledge about coronary artery anatomy, abnormalities, and variations, as well as their radiological manifestations. This chapter focuses on the former, with the latter discussed in detail in Part 9. The coronary arteries we commonly refer to are the vessels distributed under the epicardium and within the myocardium, transporting blood to the capillary bed. They can be divided into two groups: one distributed under the epicardium and outside the myocardial wall, and the other distributed inside the myocardial wall. The former consists of larger vessels that can be fully demonstrated by coronary angiography, while the latter consists of smaller, densely distributed vessels, with coronary angiography only able to demonstrate vessels with a diameter greater than 0.5 mm, while others cannot be visualized. The normal human coronary arteries mainly consist of two major branches: the left coronary artery and the right coronary artery, with all other vessels branching from these two to supply the heart surface and myocardium. They are described as follows: 1.1 Left Coronary Artery (Left Coronary Artery, LCA) 92% of left coronary arteries open in the left aortic sinus posterior to the left aortic cusp, with the remaining 8% opening outside the sinus. When the left aortic sinus is divided into three equal parts vertically, approximately 88% of left coronary arteries open in the middle one-third, with the openings being horizontal ellipsoids, slightly higher than the right coronary artery openings (2–4 mm higher), with diameters mostly between 0.41–0.5 cm (average 0.48 cm), but can vary between 0.2–0.75 cm. The distance from the left coronary artery opening to the sinus base is between 8–26 mm, with 68.5% located between 14–18 mm. The left coronary artery supplies the left ventricle, left atrium, anterior wall of the right ventricle, and the anterior two-thirds to three-quarters of the interventricular septum. See Figure 1-A1, Figure 1-A.