Right coronary angiogram by trans radial approach. Catheter is marked by the black arrow and the proximal right coronary artery (RCA) by the green arrow. When the cathter is not tightly wedged within the coronary artery, dye refluxes back into the aorta after filling the coronary artery (blue arrow). This is the ideal situation as a catheter wedged in the coronary artery compromises the forward blood flow through the artery and can cause ischemia if kept in situ for longer periods. Wedging can be recognized by the absence of dye reflux as well as by damping or ventricularization of the catheter tip pressure tracing. Injection of contrast into a wedged catheter should be avoided as far as possible. Wedging can also occur due to an ostial lesion or spasm. The right coronary artery divides into posterior left ventricular (PLV) and posterior descending (PDA) branches. Presence of these branches indicate that the artery is dominant. Dominance does not mean that larger area of supply than the other artery. It only means that the artery crosses the crux (junction of the atrioventricular and inter ventricular grooves on the posterior surface of the heart). It is usually the dominant artery which gives a branch to the atrioventricular node (AV nodal artery).
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