Transthoracic echocardiographic imaging of coronary arteries: tips, traps, and pitfalls

Abstract

The aim of this paper is to highlight coronary investigation by transthoracic Doppler evaluation. This application has recently been introduced into clinical practice and has received enthusiastic feedback in terms of coronary flow reserve evaluation on left anterior coronary artery disease diagnosis. Such diagnosis represents the most important clinical application but has in itself some limitations regarding anatomical and technological knowledge. The purpose of this paper is to offer a didactic approach on how to investigate the different segments of left anterior and posterior descending coronary arteries by transthoracic ultrasound using different anatomical key structures as markers. We will conclude by underlining that, nowadays, innovative technology allows complete evaluation of both major coronary arteries in many patients in a resting condition as well as during pharmacology stress-tests, but we often do not know it.

Figure 1

shows Transthoracic positioning of probe in order to highlight the two major coronary arteries while.

Figure 2

represents an artist's drawing illustrating transducer beam orientations to the left anterior descending coronary artery (LAD) and to posterior descending coronary arteries with the corresponding echocardiographic images of the mid-distal tract of LAD Pulse-wave flow and posterior descending coronary artery (PDCA).

Figure 3

shows anatomical finding of proximal tract of Left anterior descending coronary artery (reference key are Aorta, Pulmonary artery and left atrial appendage).

Figure 4

highlights the ultrasound findings of proximal left anterior highlighted with color-Doppler and.

Figure 5

shows the pulse Doppler envelope of proximal tract of the left descending coronary artery.

Figure 6

represents the anatomical findings of Intermediate tract of Left anterior descending coronary artery (reference keys are: the anterior interventricular Sulcus and Septal Branches).

Figure 7

shows the ultrasound findings of proximal left anterior highlighted with color-Doppler.

Figure 8

shows the Pulse Doppler envelope of mid tract of left descending coronary artery.

Figure 9

shows the anatomical finding of distal tract of Left anterior descending coronary art (the reference keys are: distal tract of the anterior interventricular Sulcus and Septal Branches).

Figure 10

represents the Ultrasound findings of distal left anterior highlighted with color-Doppler.

Figure 11

shows the Pulse Doppler envelope of distal tract of left descending coronary artery.

Figure 12

shows the anatomical findings of distal tract of Left posterior descending coronary artery (reference keys are: distal tract of the posterior interventricular Sulcus and Septal Branches).

Figure 13

highlights the Ultrasound findings of distal left posterior descending coronary artery highlighted with Color-Doppler.

Figure 14

shows the Pulse Doppler envelope of the distal tract of left posterior coronary artery.

Figure 15

shows an example of the distal tract of left descending coronary artery highlights by 3-Dimensional Color Doppler evaluation.