Table 1 Normal coronary artery assessment

Parasternal long axis

(2D)

Ostium of RCA

RCA ostium may be appreciated arising from the right sinus

Note: High take-off may also be appreciated as a normal variant

Parasternal short axis

(2D and CFM)

Ostia of RCA and LCA

Visualisation of the origin is usually obtained by tilting more superior to the aortic valve cusps. It may be necessary to come a rib space higher

Ensure visualisation of the ostia is in continuity with the aorta

RCA ostium

may be appreciated at 11–12 o’ clock

LCA ostium

May be appreciated at approx. 3–4 o’ clock

Colour flow imaging may aid visualisation in the coronary artery. The colour scale will need to be reduced to allow flow in the coronary to be appreciated. The direction of the flow in the artery should be noted

Colour compare/simultaneous imaging can aid assessment. Use of the cine function allows frame by frame assessment

Parasternal short axis

(2D)

Bifurcation of the LCA

Visualisation of the bifurcation may be obtained by further clockwise rotation. The left anterior descending

LAD courses

superiorly and the circumflex

more inferiorly

Parasternal short axis

(2D)

Trifurcation of the LCA

In some patients it may be possible to demonstrate the trifurcation of the left coronary artery

Apical 5 chamber view

(2D)

Coronary course

The course of the coronary arteries may be appreciated from an aortic outflow view

The RCA is seen to course in the A-V groove

The LCA is seen to course in the left A-V groove