Modified mother-child technique for selective cannulation of complex take-off left coronary artery
Daniel E Monopoli1, Luigi Politi, Giuseppe M Sangiorgi
1Cardiology Department, Policlinico University Hospital, Modena, Italy.
Insights
A modified mother-child technique enabled successful coronary angiography in a patient with complex coronary artery anatomy. This approach overcomes challenges posed by tortuous iliac arteries and unusual coronary origins.
Area of Science:
- Interventional Cardiology
- Medical Devices
Background:
- Coronary angiography is crucial for diagnosing coronary artery disease.
- Complex coronary artery anatomy can impede selective catheterization.
Observation:
- An 85-year-old male with hypertension presented with myocardial infarction.
- Severe iliac tortuosity, aortic dilatation, and anomalous coronary origins prevented standard selective cannulation.
Findings:
- A modified mother-child technique was employed using a cut Judkins left 4 guiding catheter within a valved sheath.
- This allowed easy access to separate coronary ostia for complete left coronary angiography.
Implications:
- This technique offers a viable solution for complex coronary artery origins using standard catheters.
- It enhances the feasibility of coronary angiography in challenging anatomies.
Abstract:
An 85-year-old male patient, with long-standing hypertension, was admitted to our hospital for a late inferior myocardial infarction. An elective coronary angiogram was performed, but due to severe iliac artery tortuosity, thoracic aortic dilatation, high left coronary artery take-off, and separated origin of the left descending coronary artery and circumflex, selective cannulation with different catheter shapes was not possible. Thus, we decided to utilize a modified mother-child technique by cutting the first 10 cm from the hub of a conventional 7 F Judkins left 4 guiding catheter and inserting it into a 7 F valved sheath. Then, we introduced a conventional 6 F Amplatz Left 2 diagnostic catheter inside it. In this way, we were able to easily reach both separate ostia and to perform complete left coronary angiography. The technique we described herewith could represent a valid solution to allow utilization of standard coronary catheters with different shapes commercially available in cases of complex coronary artery origin.
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