《冠脈CTA：冠脈解剖課件》由會員分享，可在線閱讀，更多相關《冠脈CTA：冠脈解剖課件（35頁珍藏版）》請在裝配圖網上搜索。
1、,*,單擊此處編輯母版標題樣式,.,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,Coronary CTA:coronary anatomy&terminology-A cardiologists perspective,Juile Miller MD,Assistant professor of Medicine Interventional Cardiology,Johns Hopkins University,.,冠脈CTA：冠脈解剖,Juile Miller MD,Assistant professor of Medicine Interventional Cardiolo
2、gy,Johns Hopkins University,.,Artery Description,Origin:Originating cusp/sinus of valsalva,Course,Branch name,Size(caliber and distribution):small medium large,Dominance,Adequacy of image quality for interpretation,overall，per vessel，per segment,.,動脈的描述,起點：起始點/valsalva竇,行程,分支名稱,大?。趶郊胺植迹盒 ⒅?、大,支配區(qū)域,
3、合適的圖像質量：總體，每條血管，每個層面,.,Normal Left Main(LM),Origin,-left sinus valsalva,-Absent in 1%,Separate,adjacent,LAD LCX,ostia-0.5,%,Branches:,LAD&LCX,=85,%,LAD,LCX and Ramus 10-15%,Critical issues:,stenosis due to risk region,Presence of ostial disease,Other:aneurysms anomalous take off,.,左冠狀動脈主干（LM),起點：左va
4、lsalva竇（左冠竇）,1例外,直接分出LAD LCX占0.5,分支：分出LAD LCX占58%,LAD,LCX 和 中間支 10-15%,關鍵問題：,狹窄致局部供血不足,冠狀動脈口疾病,動脈瘤，（內膜）不規(guī)則剝離,.,Left Anterior Descending(LAD),Origin:,-Form Left Main 95-99%,-1-3%separate ostium Left sinus,Course,Anterior intraventricula,groove toward apex,2 variations in termination,Branches:,Diagona
5、ls,septal perforators,Critical issues,Presence of ostial/proximal disease,Myocardial bridges,Other:aneurysms anomalous take off,.,左前降支（LAD）,起點,：,9599起源于LM,1-3%直接開口于左冠竇,行程,：,心室前方,經室間溝達心尖,最后分為兩支,分支,：,角支 室間隔支,關鍵問題：冠狀動脈近端或冠狀 動脈口疾病,心肌橋,動脈瘤，（內膜）不規(guī)則,剝離,.,Normal Anrtomy（LAD),.,Left Circumflex(LCX),Origin:,O
6、riginating form LM in 96-98%,5-2%separate ostium,LCX origin form right sinus or RCA(0.4%),Course:down distal left AV groove,Branches,obtuse marginal,branches,Left posterior-lateral:define by acute margin,and supply PL wall,Left posterior descending(if dominant),Critical issues,dominance(15-20%),.,起點
7、：,96-98%起源于LM,5-2%單獨開口,LCX起源于右冠竇或RCA約0.4%,行程：沿著左房室溝下降,分支：鈍緣支,左后外側支（營養(yǎng)后外側壁）,左后降支(左側優(yōu)勢）,關鍵問題：左側優(yōu)勢（15%-20%),.,Normal Anatomy(LCX),.,Normal Anatomy(LCX),.,Ramus intermedius（中間支）,.,Normal Right coronary artery(RCA),Origin:,right sinus of valsalva,(lower than LM),Anomalous form LSV=0.1%,Course:,down dista
8、l right AV groove,toward crux of heart,Branches,Right posterior descending(85%),Acute marginal branches,Right posterior lateral,Critical issues:,dominance(15-20%),.,右冠狀動脈(RCA),起點：,左valsalva竇（右冠竇）,0.1%起源于左心室,行程：沿右房室溝下降至房室交點,分支：后降支 PDA（85%）,銳緣支 AM,右室后側支 PL,關鍵問題：右側優(yōu)勢（85%）,.,Normal anatomy(RCA),.,Normal
9、 anatomy(RCA),.,Other branches,SA nodal Artery,-Approx 60%RCA 40%LCX,AV Nodal Artery-RCA,Conus Artery-RCA,-Proximal many with separate origin,-May supply collateral,.,其他分支,竇房結動脈：約60%起源于RCA,40%LCX,房室結動脈：RCA,圓錐動脈：RCA,.,Right dominance,.,Left dominance,.,Lesion description,Location,-Ostial(first 2-3mm)
10、,-Proximal,-Mid,-Distal,Bifurcation,Length(stenosis),-Discrete/focal lesion(20mm),Concentric/eccentric,Tortuosity,Thrombus soft plaque calcium,Ulcerated/concentric,.,病變的描述,定位：開口，鄰近，中間，末梢,分叉,長度（狹窄）：間斷/局灶性病變（20MM),同心環(huán)/偏心的,曲折的,血栓 軟粥樣斑塊 鈣化,潰瘍,.,Diffuse LAD Disease,.,Focal ulcerated plaque,.,Coronary ano
11、malies,Benign(0.5-1%)(80%of anomalies),Separate LAD/LCX ostia,LCX origin from RSA or RCA,LCX courses behind aorta,Anomalous origin from aorta,High anterior origin of RCA,LM,Small fistula,.,冠狀動脈異常,良性,(0.5-1%)(80%of 異常),LAD/LCX 口,LCX 起源于 RSA or RCA,LCX 行程在主動脈后,從主動脈異常起源,RCA前高位起源,小的瘺管,.,Coronary anomali
12、es,Potentially serious(20%of anomalies),Origin of CA opposite aortics sinus(0.1-0.2%),Anomalous origin form PA(0.01%),Multiple or Large coronary fistulae,Single Coronary artery,.,潛在危險(20%of 異常),起源與主動脈竇對面的室壁瘤(0.1-0.2%),異常起源于PA(0.01%),多發(fā)或大的冠狀動脈瘺,單一冠狀動脈,.,Coronary anomalies,.,Absent Left Main,(separate LAD/LCX origins),.,Anomalous RCA,.,Anomalous LM from RSV,.,.,
冠脈CTA：冠脈解剖課件
