Laid-back aortogram for visualization of coronary arteries

Laid-back aortogram for visualization of coronary arteries

Laid-back aortogram is a technique described by Mandell VS et al [1] for the visualization of coronary arteries in d-transposition of great arteries in infants prior to surgery. This technique has also been used for the visualization of coronary arteriovenous fistulas in infants [2]. Balloon occlusion aortography (dye is injected proximal to the balloon which is inflated to occlude the aorta) is done through the venous route. In d-transposition, the catheter is passed from the right ventricle to the aorta. In cases without transposition, as in coronary arteriovenous fistula, the catheter is passed to the left heart via the foramen ovale.

The visualization of coronary arteries is optimized by a 40 – 45 degrees caudal tilt of the camera / image intensifier (laid-back). 1 ml/Kg of contrast is delivered in half to one second to provide best images. The caudal view is easier to interpret than standard views. The relation between the great vessels and origins of coronary arteries and the territory supplied by each artery are better visualized. The caudal view is better for the demonstration of coronary anatomy in infants with transposition of great arteries and double outlet right ventricle.

References

1. Mandell VS, Lock JE, Mayer JE, Parness IA, Kulik TJ. The “laid-back” aortogram: an improved angiographic view for demonstration of coronary arteries in transposition of the great arteries. Am J Cardiol. 1990 Jun 1;65(20):1379-83.
2. Hofbeck M, Wild F, Singer H. Improved visualisation of a coronary artery fistula by the “laid-back” aortogram. Br Heart J. 1993 Sep;70(3):272-3.