Angiography
The angiographic evaluation of LMD should be performed expeditiously minimizing repeat injections. Multiple dye injections in similar views can lead to death in the catheterization laboratory. The interventionist should be alert for alterations in the pressure tracing, including pressure damping and/or ventricularization. Certain views are useful, including the antero-posterior (AP) caudal view for bifurcation disease and the cranial right anterior oblique (RAO) view for ostial LMD (Figures 1A and 1B).
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Figure 1A.
Left coronary angiogram in anteroposterior view; the left main stenosis is not visualized.
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Figure 1B.
Left coronary angiogram in cranial right anterior oblique view, clearly showing the severe ostial left main disease.