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With this next video we're gonna review how to measure coronary artery heights.

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I'm going to be showing you a manual approach using my pacs just with standard

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multiplanar,

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reformatted double O bleak images if you use a software program to assist

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you.

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They have some different approaches that are even simpler than what I'm showing,

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but I,

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I just wanna show the kind of the most basic way to do it that's most accessible

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to anybody watching these videos. So, so this is just, um,

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using my standard packs and then I'm gonna go into, uh,

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multiplanar reformatting mode.

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And so in this mode we have the three different orthogonal views, axial,

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coronal, and sagittal. This view in the left upper hand corner you can ignore,

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that's defined by this red plane,

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which we're not actually gonna be using this in this particular video.

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So I would start just like we've done, um, with the previous annulus video,

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I would start with identifying the aortic annulus. So in this particular case,

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we're gonna start with the coronal image.

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I always start with the coronal and find where you see those, um,

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valve cusps coming together in the middle of the aortic valve.

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And then rotate your axial plane counterclockwise so that it is parallel to the

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aortic valve. I'm just gonna move this red plane with it as well.

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And now you're part of the way to getting a nice short axis view of the annulus.

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We're gonna then go on our second long axis view and again,

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move the cross hairs into the middle of the aortic valve.

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We're gonna rotate this plane counterclockwise again

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to make it parallel with the aortic valve.

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So now we have two long axis views and in each of them the

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oblique axial plane is parallel to the aortic valve.

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And that leaves us with this view up here in the right hand corner,

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which shows you this short axis view of the aortic valve.

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This is actually a nice case.

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It shows that there's partial fusion of the right and the left cusps here.

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So this would be a partially fused by cuspid valve.

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And you can see that there's restricted opening of the valve leaflets.

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This is an image taken in systole and there's a lot of valve classification.

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Now we wanna make sure that we're lined up with the aortic valve annulus.

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And if you remember from the other video that we're looking for symmetry of the

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different valve leaflets and making sure that they disappear from the image at

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the same time. In this case,

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looks like these leaflets are perhaps a little bit more prominent than the more

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posterior leaflets.

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So I'm gonna make a slight adjustment to increase the symmetry there.

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And sometimes it helps to adjust your plane so that bi dissects,

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that posterior leaflet when you know the posterior leaflet's,

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the one that's giving you trouble like so.

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And now I think I'm fairly symmetric between these valve leaflets where

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I've got a little bit of leaflet here on the right and the left and the non,

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there's just a little bit of leaflet showing. And then as I scroll down,

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wanna make sure they all disappear at the same time. So right, left

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Non, almost gone and now they're gone.

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So I think we're right at the annulus there. So now we're at the valve annulus.

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And now the, this becomes important.

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You don't wanna move this plane up or down in any direction, um,

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because now we're gonna measure the coronaries from this particular plane.

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So what you can do now is you wanna basically just spin your, um,

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long access views around this plane.

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So I'm gonna grab this long axis view and just start spinning until

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I see the coronary. So there's the left corner origin

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and by convention the way you measure the coronary heights as you take a

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distance measurement from the bottom of the coronary origin to the

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annulus right there.

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And so it's a straight perpendicular dropped to the annulus just like that.

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And that's your coronary height 17, which is great. You know,

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usually you want to be above 10, ideally above 12.

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And we're well within that safety threshold for this particular patient.

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So that's the left coronary origin. Now if we keep spinning,

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we should see the right coronary origin come into view.

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You can also look at your planes over here.

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I can see that I have a plane bisecting this right side of my coronary cuff.

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So over here on the right side of my image,

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I should see a coronary coming into view sometime soon.

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And there it is, it's actually here on the bottom right hand image,

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it has a slightly different orientation.

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And if you look here in the right coronary origin, you can see, you know,

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the bottom of the orange is somewhere in this region.

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Usually I'm fairly conservative,

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so it looks like there's kind of a wide neck here.

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And the bottom of the neck is kind of right about here.

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And I'm gonna drop that down a perpendicular right to the, um, annular plane.

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And we get 19 millimeters. So conceptually,

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this is how all of the advanced software does this measurement.

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You define the annular plane and then you figure out the distance from the

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annular plane to the bottom of the coronary artery origins using a perpendicular

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measurement. I'm showing you here how to do it manually,

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more or less with just a simple double oblique N P R measurement.

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But like I said, all of the different software approaches that you use will, um,

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apply this same concepts to a slightly less manual and more assisted way

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to obtain the measurements. So in summary,

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this is the standardized approach to getting optimal measurements of the

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coronary artery origins.