冠脉CTA：冠脉解剖.ppt

CoronaryCTA coronaryanatomy terminology Acardiologist sperspective 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 stenosisduetoriskregion Presenceofostialdisease Other 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 95 99 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 MultipleorLargecoronaryfistulaeSingleCoronaryartery 潜在危险 20 of异常 起源与主动脉窦对面的室壁瘤 0 1 0 2 异