冠脉CTA：冠脉解剖.ppt

CoronaryCTA:coronaryanatomy&terminology-Acardiologistsperspective,JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity,冠脉CTA：冠脉解剖,JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity,ArteryDescription,Origin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment,动脉的描述,起点：起始点/valsalva窦行程分支名称大小（口径及分布）：小、中、大支配区域合适的图像质量：总体，每条血管，每个层面,NormalLeftMain(LM),Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:stenosisduetoriskregionPresenceofostialdiseaseOther:aneurysmsanomaloustakeoff,左冠状动脉主干（LM),起点：左valsalva窦（左冠窦）1例外直接分出LADLCX占0.5分支：分出LADLCX占58%LAD,LCX和中间支10-15%关键问题：狭窄致局部供血不足冠状动脉口疾病动脉瘤，（内膜）不规则剥离,LeftAnteriorDescending(LAD),Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventriculagroovetowardapex2variationsinterminationBranches:DiagonalsseptalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff,左前降支（LAD）,起点：9599起源于LM1-3%直接开口于左冠窦行程：心室前方经室间沟达心尖最后分为两支分支：角支室间隔支关键问题：冠状动脉近端或冠状动脉口疾病心肌桥动脉瘤，（内膜）不规则剥离,NormalAnrtomy（LAD),LeftCircumflex(LCX),Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%),起点：96-98%起源于LM5-2%单独开口LCX起源于右冠窦或RCA约0.4%行程：沿着左房室沟下降分支：钝缘支左后外侧支（营养后外侧壁）左后降支(左侧优势）关键问题：左侧优势（15%-20%),NormalAnatomy(LCX),NormalAnatomy(LCX),Ramusintermedius（中间支）,NormalRightcoronaryartery(RCA),Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroovetowardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%),右冠状动脉(RCA),起点：左valsalva窦（右冠窦）0.1%起源于左心室行程：沿右房室沟下降至房室交点分支：后降支PDA（85%）锐缘支AM右室后侧支PL关键问题：右侧优势（85%）,Normalanatomy(RCA),Normalanatomy(RCA),Otherbranches,SAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-Maysupplycollateral,其他分支,窦房结动脉：约60%起源于RCA,40%LCX房室结动脉：RCA圆锥动脉：RCA,Rightdominance,Leftdominance,Lesiondescription,Location-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentric,病变的描述,定位：开口，邻近，中间，末梢分叉长度（狭窄）：间断/局灶性病变（20MM)同心环/偏心的曲折的血栓软粥样斑块钙化溃疡,DiffuseLADDisease,Focalulceratedplaque,Coronaryanomalies,Benign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistula,冠状动脉异常,良性(0.5-1%)(80%of异常)LAD/LCX口LCX起源于RSAorRCALCX行程在主动脉后从主动脉异常起源RCA前高位起源小的瘘管,Coronaryanomalies,Potentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryarter