Left coronary angiogram by transradial route in post MVR case

Left coronary angiogram by transradial route in post MVR case

Tiger catheter tip is seen in the left coronary ostium. The transradial route is evident by the absence of catheter shaft in the descending aorta. The angiogram has been recorded in LAO caudal view. LMCA: left main coronary artery; LAD: left anterior descending coronary artery; LCX: left circumflex coronary artery; OM: obtuse marginal branch of LCX. The mitral prosthetic valve ring as well as two tilting disc leaflets are seen in the open position. Bileaflet valves give a central laminar inflow into the left ventricle.

Transradial route was chosen in this case to reduce the chance of local bleeding as the person was on anticoagulation following mitral valve replacement which was done a few years back. Additional severe aortic regurgitation had developed necessitating aortic valve replacement. Diagnostic coronary angiogram was done prior to aortic valve replacement. Warfarin was withdrawn five days prior and heparin therapy initiated. Morning dose of heparin was skipped and it was restarted along with warfarin in the evening after ensuring hemostasis. Heparin was continued till therapeutic INR of prothrombin time was achieved.