Archives of the Turkish Society of Cardiology
Reshaping the left Judkins catheter for a right coronary angiogram in the anomalous aortic origin of the right coronary: killing two birds with one left Judkins [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2012; 40(6): 513-517 | DOI: 10.5543/tkda.2012.96226

Reshaping the left Judkins catheter for a right coronary angiogram in the anomalous aortic origin of the right coronary: killing two birds with one left Judkins

Taylan Akgün1, İbrahim Halil Tanboğa2, Vecih Oduncu2, Mustafa Kurt2, Arif Oğuzhan Çimen2, Atila Bitigen2
1Camlica Erdem Hospital, Istanbul, Turkey
2Fatih Medikalpark Hospital, Istanbul, Turkey


OBJECTIVES
Selective cannulation of the right coronary artery (RCA) in the anomalous aortic origin of the RCA is technically difficult and challenging. In this study, we tested the success of RCA cannulation with a reshaped left Judkins catheter in cases of difficult selective cannulation.

STUDY DESIGN
The study population consisted of 837 consecutive patients (456 male, 381 female) that were admitted to our hospital with stable angina pectoris and acute coronary syndrome between October 1 and December 31, 2011. In cases where RCA cannulation was difficult, the 10 centimeter section of the left Judkins proximal to the secondary curve was reshaped by hand to form an inward slope. The secondary curve angle was increased to approximately 100 degrees and the primary curve angle was adjusted to 120 degrees. Then, we attempted to perform selective RCA cannulation.

RESULTS
In 49 of the 837 patients, selective RCA cannulation was unsuccessful with the right Judkins catheter. In 42 of these 49 (86%) cases, the RCA was cannulated with the reshaped left Judkins. We failed to cannulate the right coronary in two cases with downward angulation, one with upward angulation, one with high take-off origin, and one with anterior origin. A multipurpose, internal mammary artery, left Amplatz 1, and right Amplatz 1 catheter were used for cannulation in these cases, respectively. There was no angina, nor were there electrocardiographic or hemodynamic changes during the procedure.

CONCLUSION
In cases where the selective cannulation of the RCA is difficult, using a reshaped left Judkins may be a successful and cost-effective method of selective cannulation.

Keywords: Coronary angiography, coronary vessel anomalies

How to cite this article
Taylan Akgün, İbrahim Halil Tanboğa, Vecih Oduncu, Mustafa Kurt, Arif Oğuzhan Çimen, Atila Bitigen. Reshaping the left Judkins catheter for a right coronary angiogram in the anomalous aortic origin of the right coronary: killing two birds with one left Judkins. Turk Kardiyol Dern Ars. 2012; 40(6): 513-517

Corresponding Author: Taylan Akgün, Türkiye
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