Modified mother-child technique for selective cannulation of complex take-off left coronary artery

An 85-year-old male patient, with long-standing hypertension, was admitted to our hospital for a late inferior myocardial infarction. An elective coronary angiogram was performed, but due to severe iliac artery tortuosity, thoracic aortic dilatation, high left coronary artery take-off, and separated origin of the left descending coronary artery and circumflex, selective cannulation with different catheter shapes was not possible. Thus, we decided to utilize a modified mother-child technique by cutting the first 10 cm from the hub of a conventional 7 F Judkins left 4 guiding catheter and inserting it into a 7 F valved sheath. Then, we introduced a conventional 6 F Amplatz Left 2 diagnostic catheter inside it. In this way, we were able to easily reach both separate ostia and to perform complete left coronary angiography. The technique we described herewith could represent a valid solution to allow utilization of standard coronary catheters with different shapes commercially available in cases of complex coronary artery origin. © 2010 Italian Federation of Cardiology.