Quiz 11

Question 5

Cardiology Quiz

Student:

Question 11

The cineangiogram of the patients saphenous vein graft to the RCA shows a subtotal lesion involving the ostium and very proximal portion of the aorto-graft anastamosis, which is shown below in the RAO projection.

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The angiogram was performed using a 6 French Judkins JR4 catheter. On the basis of the angiogram, what size PTCA balloon would you select to best match the size of the graft:

A. 4.0 mm
B. 5.0 mm
C. 6.0 mm
D. 6.5 mm
E. 3.0 mm

Please check the box that is the most likely correct answer.

Answer A

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Answer B

You selected the correct answer.
One French (F) =1/3 mm. Thus, the diameter of the 6 F catheter is equal to 2 mm. The saphenous graft just distal to the subtotal lesion is approximately 2 1/2 time the size of the catheter or 5 mm in diameter. Many experienced cardiologists can "eye ball" an estimate of the vessel diameter. However, quantitative digital measurements of the vessel should be employed when there is any doubt or when the operator does not have vast experience.
In this case the cardiologist chose a 4.5 mm PTCA balloon with a compliance curve that would achieve an expected diameter of 4.75 mm at high inflation pressures. The ideal PTCA balloon size would have been a 4.75 mm, expandable to 5.0 mm but this was not available. A 5.0 mm PTCA balloon (expandable to 5.25 mm) may have been acceptable but not chosen for fear of dissecting the aorto-graft junction and extending this to the ascending aorta. It was felt that one could always upsize to a 5 mm PTCA balloon if subsequently needed.
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Answer C

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Answer D

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Answer E

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Student:

Question 10

Quiz

The cineangiogram of the patients saphenous vein graft to the RCA shows a subtotal lesion involving the ostium and very proximal portion of the aorto-graft anastamosis, which is shown below in the RAO projection.

The angiogram was performed using a 6 French Judkins JR4 catheter. On the basis of the angiogram, what size PTCA balloon would you select to best match the size of the graft:

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