冠脈CTA：冠脈解剖課件

,*,單擊此處編輯母版標(biāo)題樣式,.,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),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 Cardiology,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(dòng)脈的描述,起點(diǎn)：起始點(diǎn)/valsalva竇,行程,分支名稱(chēng),大?。趶郊胺植迹盒?、中、大,支配區(qū)域,合適的圖像質(zhì)量：總體，每條血管，每個(gè)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(dòng)脈主干（LM),起點(diǎn)：左valsalva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(guān)鍵問(wèn)題：,狹窄致局部供血不足,冠狀動(dòng)脈口疾病,動(dòng)脈瘤，（內(nèi)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:,Diagonals,septal perforators,Critical issues,Presence of ostial/proximal disease,Myocardial bridges,Other:aneurysms anomalous take off,.,左前降支（LAD）,起點(diǎn),：,9599起源于LM,1-3%直接開(kāi)口于左冠竇,行程,：,心室前方,經(jīng)室間溝達(dá)心尖,最后分為兩支,分支,：,角支 室間隔支,關(guān)鍵問(wèn)題：冠狀動(dòng)脈近端或冠狀 動(dòng)脈口疾病,心肌橋,動(dòng)脈瘤，（內(nèi)膜）不規(guī)則,剝離,.,Normal Anrtomy（LAD),.,Left Circumflex(LCX),Origin:,Originating 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(diǎn)：,96-98%起源于LM,5-2%單獨(dú)開(kāi)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(cè)支（營(yíng)養(yǎng)后外側(cè)壁）,左后降支(左側(cè)優(yōu)勢(shì)）,關(guān)鍵問(wèn)題：左側(cè)優(yōu)勢(shì)（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 distal 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(dòng)脈(RCA),起點(diǎn)：,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(diǎn),分支：后降支 PDA（85%）,銳緣支 AM,右室后側(cè)支 PL,關(guān)鍵問(wèn)題：右側(cè)優(yōu)勢(shì)（85%）,.,Normal anatomy(RCA),.,Normal 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(jié)動(dòng)脈：約60%起源于RCA,40%LCX,房室結(jié)動(dòng)脈：RCA,圓錐動(dòng)脈：RCA,.,Right dominance,.,Left dominance,.,Lesion description,Location,-Ostial(first 2-3mm),-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(kāi)口，鄰近，中間，末梢,分叉,長(zhǎng)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 anomalies,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(dòng)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(dòng)脈后,從主動(dòng)脈異常起源,RCA前高位起源,小的瘺管,.,Coronary anomalies,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(xiǎn)(20%of 異常),起源與主動(dòng)脈竇對(duì)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(dòng)脈瘺,單一冠狀動(dòng)脈,.,Coronary anomalies,.,Absent Left Main,(separate LAD/LCX origins),.,Anomalous RCA,.,Anomalous LM from RSV,.,.,