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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Ostial right coronary chronic total occlusion: Transesophageal echocardiographic guidance for retrograde aortic

Frank E Corrigan1, Dimitrios Karmpaliotis1, Habib Samady1

  • 1Division of Cardiology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 26, 2017
PubMed

Insights

Retrograde intervention for right coronary artery chronic total occlusion (CTO) can be risky. Transesophageal echocardiography (TEE) successfully guided guidewire passage into the aorta, enhancing safety for ostial CTO interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Antegrade approaches for ostial right coronary artery (RCA) chronic total occlusion (CTO) are limited.
  • Retrograde approaches are often necessary but carry risks of guidewire misplacement near the RCA ostium.

Observation:

  • Transesophageal echocardiography (TEE) was utilized to visualize and guide guidewire manipulation during a retrograde intervention for ostial RCA CTO.
  • This imaging modality provided real-time anatomical context for safe guidewire advancement.

Findings:

  • TEE successfully facilitated the retrograde passage of a guidewire into the aorta from the ostium of the RCA.
  • This represents the first documented use of TEE for this specific interventional scenario.

Implications:

  • Transesophageal echocardiography guidance offers a potentially safer method for retrograde interventions in complex ostial RCA CTO cases.
  • TEE may become a valuable tool to mitigate risks associated with aggressive guidewire techniques in challenging coronary interventions.

Keywords:
CTOTTE/TEEimagingpercutaneous coronary interventionstenting technique

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