PMC5093871_01
A 78-year-old male with history of aortic valve replacement presented with dyspnea on exertion. Three dimensional reconstructed image of computed tomographic of the aorta shows giant aortic root of 10.2 cm labeled as ascending aortic aneurysm.
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F1
Subsequently, CT angiogram of the chest showed massively dilated ascending aorta with maximum diameter of 10.2 cm [Figure 1]. Amplatz left 3 (AL3) 7F (French) guide catheter (90 cm) was initially used, and nonselective injection of contrast was done to see the coronary ostium [Figure 2 and Video 1].
A 78-year-old male with history of aortic valve replacement and giant aortic root. Coronary angiogram in left anterior oblique cranial view showing left main ostium (downward pointing arrow) through nonselective contrast injection by (leftward pointing arrow) 7 French Amplatz left 3 catheter.
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F2
Amplatz left 3 (AL3) 7F (French) guide catheter (90 cm) was initially used, and nonselective injection of contrast was done to see the coronary ostium [Figure 2 and Video 1]. After that, a 5F multipurpose (MP) catheter (110 cm) was telescoped through 7F AL3 guide catheter to engage the ostium of the left main coronary artery [Figure 3 and Video 2].
A 78-year-old male with history of aortic valve replacement and giant aortic root. Coronary angiogram in left anterior oblique cranial view showing proper engagement of left main ostium with 5 French multipurpose catheter telescoped through 7 French Amplatz left 3 catheter. Left main is clearly seen branching into left anterior descending and left circumflex arteries.
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F3
After that, a 5F multipurpose (MP) catheter (110 cm) was telescoped through 7F AL3 guide catheter to engage the ostium of the left main coronary artery [Figure 3 and Video 2].