IBHRE国际心律失常考官委员会英文资料：03 CRT Fluoroscopic views

1、Fluoroscopic views Anatomy Left Right Superior Inferior Lateral Medial Anterior Posterior Anatomy nervus phrenicus (= phrenic nerve) Anatomy of the right atrium Anatomy of the right atrium Eustachian ridge Anatomy of the CS Anatomy of the CS Venous system of the heart The CS ends at the Vieussens va

2、lve that is frequently seen at the ostium of the primary posterolateral vein, but can also be at the start of the great cardiac vein Anatomy exterior of the heart Anatomy exterior of the heart Anatomy exterior of the heart Anatomy exterior of the heart Area of Vieussens Valve Lateral Vein Posterior

3、Vein Coronary Sinus Vein of Marshal Back flow (from CS os to great cardiac vein) preventing valve. Acces not gained by holding gentle pressure on the valve, since the valves open in the direction of the blood flow. Venous system of the heart Coronary Sinus (CS) Starts at the CS OS and ends at the gr

4、eat cardiac vein. Coronary Sinus Ostium (CS OS) Located in the posterior right atrium and is the opening to the coronary sinus. Middle Cardiac Vein (MCV) Travels from the apex along the posterior interventricular septum to the CS. Great Cardiac Vein (GCV) Starts at the end of the CS and travels arou

5、nd the mitral valve annulus anteriorly until it reaches the anterior vein. Posterior Vein (PV) Venous branch on the posterior side of the LV. Lateral Vein (LatV) Venous branch on the lateral side of the LV. This vein is usually used for LV lead placement. Anterior Vein (AntV) Travels from the apex a

6、long the anterior interventricular septum to the great cardiac vein. Inter-Patient Variations Total Venograms analyzed N = 86 1 Vein between AIV and MCV N = 44/86 (51%) 2 Veins between AIV and MCV N = 40/86 (46%) More than 2 veins between AIV and MCV N = 2/86 (2%) Lateral (35%) Posterior (16%)2 Late

7、ral (8%) 2 Posterior (0%) Posterior and Lateral (38%) At least 1 Posterior 0% At least 1 Lateral 1% Narrow Veins 1% Circulation 2001;104:442-447 Oblique views of the heart Rotation of the camera allows for better views of certain structures. Primary plane of rotation is across the chest. LAO view: l

8、eft anterior oblique. RAO view: right anterior oblique. Cranial angulation: rotating camera toward the head. Caudal angulation: rotating camera toward the feet. Coronary Venous Anatomy Fluoroscopic Imaging Anterior Posterior view (AP) AP (also sometimes called PA) is a straight-down view into the he

9、art. The x-ray tube and intensifier line up directly over the spine and sternum. Spine is slightly left of the heart on the image Sternum is directly over the spine Ribs angle downward Silhouette of heart is right of center on image AP view AP AP Lateral Anterior Lateral LAO view In the LAO view, yo

10、u will see: The spine rightward of the heart The sternum to the left The ribs angled downward to the left The short axis silhouette of the heart In LAO, the left ventricle will have: The septal wall to the left of the image The lateral wall to the right of the image LAO view In LAO view for lead pla

11、cement: Determine anterior, lateral or posterior lead position LV lead should be on the right in the lateral vein LV lead should point out at the viewer Distance between LV and RV leads should be maximized LAO Anterior Posterior Lateral LAO Target LV lead in LAO 3 oclock 5 oclock LAO Align to CS OS

12、Middle Vein Anterior Lateral Posterior Right VenogramFinal LV Lead Placement RAO view Right anterior oblique (RAO) view: Long axis view of the heart Spine to the left Sternum to the right Perpendicular to the intraventricular septum RAO view In RAO view for lead placement: Determine apical, mid or b

13、asal lead position LV lead should appear to the right LV lead appears elongated LV and RV leads should be parallel RAO view basal medial apical Target LV lead in RAO RAO venogram Anterior RAO Basal Mid Apical VenogramFinal LV Lead Placement RAOAPLAO LAA LAOLAOAPAPRAORAO Align to CS OS/ Middle Vein A

14、nterior Lateral Posterior Right Basal Mid Apical Fluoroscopic views Coronary Veins Coronary Venous Anatomy Target LV Lead AP Enough distance between position LV and RV electrode Exercise RAO / AP / LAO? 1 = 2 = 3 = 2 1 3 Exercise LAO 1 = Antero-lateral? 2 = Great CV 3 = Lateral vein 2 1 3 Example 1

15、A HV Lead RVOT Example 1 A Mid Cardiac Vein Posterior Cardiac Vein Interventricular Anterior vein Posterior Lateral Vein Lateral Cariac Vein HV Lead RVOT Great Cardiac Vein Example 1B Example 1B Mid Cardiac Vein Posterior Cardiac Vein Interventricular Anterior vein Great Cardiac Vein Example 2A Exam

16、ple 2A Interventricular Anterior vein Posterior Lateral Vein Lateral Cariac Vein Great Cardiac Vein Example 2B Example 2B Posterior Cardiac Vein Interventricular Anterior vein Posterior Lateral Vein Lateral Cariac Vein Example 3A Example 3A Mid Cardiac Vein Posterior Cardiac Vein Interventricular An

17、terior vein Posterior Lateral Vein Lateral Cariac Vein Great Cardiac Vein Example 3B Example 3B Mid Cardiac Vein Posterior Cardiac Vein Interventricular Anterior vein Posterior Lateral Vein Lateral Cariac Vein Great Cardiac Vein Example 4A Example 4A Interventricular Anterior vein Lateral Cardiac Ve

18、in Anterior Vein Example 4B Example 4B Mid Cardiac Vein Posterior Cardiac Vein Interventricular Anterior vein Lateral Cariac Vein Example 5A Example 5A Mid Cardiac Vein Interventricular Anterior vein Posterior Lateral Vein Lateral Cariac Vein Example 5B Example 5B Interventricular Anterior vein Lateral Cariac Vein Posterior Lateral Vein Mid Cardiac Vein Valve of Vieussen During this venography, the balloon catheter could not be easily advanced beyond the coronary sinus proper into the great cardiac vein because of the