CT CORONARY ANGIOGRAM FOR RAMUS INTERMEDIUS

1. CARDIAC CASE SERIES RAMUS INTERMEDIUS An over view MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

2. Trifurcation of the left main coronary artery.................................. The left main coronary artery instead of bifurcating into two , sometimes trifurcates into three vessels.(LAD, LCX, Ramus) The real incidence of trifurcations could vary between 10% to 30%.

3. What course ramusintermedius takes ? It generally goes in the angle between the LAD and the LCX.It may either behave like a large OM or a diagonal branch.It supplies the lateral free wall of the LV .The peculiarity of this vessel is it does not run in a anatomical groove .It simply slides over the free surface of LV.Rarely, a very abnormal course of ramus, criss cross the aorta and pulmonary artery .

4. What is the significance of ramus for an interventional cardiologist ? PCI in ramus is a rare opportunity for a cardiologist .If the ramus is involved adjacent LAD and LCX is also likely to be involved .So it would logically be a multivessel , complex angioplasty.Isolatedramus lesion could be tackled easily.Another issue here could be ,since this vessel is not within any anatomical groove stent deployment would have a poor support and prone for mobilisation and migration .

5. RAMUS DOES NOT MOVE IN THE GROOVE LEFT MAIN LAD RAMUS INTERMEDIUS LCX

6. RAMUS INTERMEDIUS

7. Base image -Ramusintermedius originating from the left main RAMUS INTERMEDIUS

8. Some facts about coronary circulation...... The right atrioventriculo groove carries the right coronary artery(RCA) . Left circumflex artery (LCX) traverses the left atrio ventricular groovegroove The most inconstant branch is the posterior descending artery (PDA) which runs in the posterior interventricular groove.PDA can arise from either RCA, LCX or both or even from LAD.The major branches of LAD are called diagonal and septal while the branches of LCX are called obtuse marginal(OM).There can be two to three diagonal and OMs. Left and Rtcoronary arteries carry about 250ml of blood per minute . Atleast one artery follows all the grooves of the heart . In the left side , left main coronary artery (LM) originates in the left coronary sinus (Size varying between 1mm -20mm) and usually bifurcates into LAD and LCX. The left anterior descending artery (LAD) runs in anterior interventricular groove while ,