心室解剖与电生理

心室流出道解剖正常心脏外部形态SuperiorView2心脏大血管方向3RAO角度4流出道解剖RVOTLVOT5右室流出道解剖右室流出道结构示意图7右室流出道三维结构89右室流出道解剖：瓣下10右室流出道解剖：瓣下11右室流出道解剖：瓣上12右室流出道解剖：肺动脉主干13右室流出道解剖：瓣上14右室流出道解剖：瓣上15右室流出道内消融导管16右室流出道内Array标测与消融导管操作17右室流出道内Array标测与消融导管操作18右室流出道内Array标测与消融导管操作19右室流出道内消融导管操作20LVOT/RVOT相对关系：

LassoattheAorticRoot/ArrayattheRVOT21ComparisonofLVOTvs.RVOTandPALVOTRVOTPAPARAOLAOLVOT/RVOT的关系22肺动脉瓣上下起源的

室速鉴别HiroshiTada,etal:HeartRhythm2008;5:419–42624HiroshiTada,etal:HeartRhythm2008;5:419–42625HiroshiTada,etal:HeartRhythm2008;5:419–42626左室流出道解剖LVOT与RVOT关系28房室分界平面29LVOT/RVOT的关系JCE,Vol.20,pp.955-968,August20093031左室流出道三维结构32333435363738394041424344左室流出道解剖：瓣上45左室流出道解剖：瓣上46左室流出道解剖：瓣上474849左室流出道解剖：瓣上

——冠状动脉开口50左室流出道解剖：瓣上

——主动脉瓣关闭运动51左室流出道解剖：瓣上

——主动脉瓣关闭运动52左室流出道三维结构53左室流出道解剖：瓣上54左室流出道解剖：瓣上55左室流出道解剖：瓣下56左室流出道解剖：瓣下57左室流出道解剖：瓣下58左室流出道瓣下消融导管操作59CAG60Pacingtarget61左室流出道消融导管操作6263ProximitytoLeftMain64AblationatAMC65LVOT的标测66RVOTandAorticCusps67流出道室速：12导联V1形态68流出道室速：12导联V1形态69AorticCusps70AorticCusps71AorticCusps72VTOriginatedfromAorticSinusCuspsASCASCRVOTRVOT73JCardiovascElectrophysiol,Vol.20,pp.955-968,August2009V1ECGforDifferentiationofOutflowVT74RVOTAortaLALAALMPVLCARAAAnatomicalRelation:AorticSinusValsalva,LAA,LCA,andGCVRCAGCV7527-31%ofidiopathicVA72-78%ofidiopathicLVVA68%16%16%TadaH,JACC2005;45:877–88676VTOriginatedfromCoronaryCuspsOuyangF,etal.JACCCardiol2002;39:500–877LVOT/RVOT相对关系：

LassoattheAorticRoot/ArrayattheRVOT78ComparisonofLVOTvs.RVOTandPALVOTRVOTPAPARAOLAOLVOT/RVOT的关系79PVCActivationMapping:

LeftCoronaryCuspisearlierthanLasso1,2atPA

LCCPA(Lasso1,2)80PacemappingatLeftCoronaryCusp

PVC

Pacing

81PVCActivationMapping:

LVOTandPAareearlierthanRVOT

LVOTRVOTPA82RAOAblationCatheterattheLeftCoronaryCuspABLRAO83PVCActivationMapping:

LeftCoronaryCuspisearlierthanLasso1,2atPA

LCCPA(Lasso1,2)84PVCActivationMapping:

LeftCoronaryCuspisearlierthanLasso1,2atPA

LCCPA(Lasso1,2)85LVOT-AnatomyModifiedfrom:TheHeartandCoronaryArteries.McAlpine.197286LeftVentricuarostiumAorto-VentricularMembraneAttachmentofRightAorticAnnuliAttachmentofLeftAorticAnnuliAttachmentofNonCCAorticAnnuliRALLALPInterLeafletTriangleAnteriorMitralValveLeafletLeftFibrousTrigoneLeftAnteriorFibrousTrigoneRightAnteriorFibrousTrigoneRVLVModifiedfrom:TheHeartandCoronaryArteries.McAlpine.197287TheLeftVentricularOStiumTheHeartandCoronoaryArteries.McAlpine,WA!975CircArrhythmiaElectrphysiol2008;1:396-404AortoVentricularUnit1-LVMuscle2-AorticSinuses3-AorticLeafelts4-AorticannuliRFTLFT88RCALCANCCMVInterleafletTriangles123AorticRootPortionRelatedStructureNoncoronarysinusLA,RA,transversesinusRightcoronarysinusRA,freepericardialspaceLeftcoronarysinusLA,freepericardiumRC/LCILT(1)SpacebetweenaortaandpulmonarytrunkNC/RCILT(2)RA,conductionsystem,septalleafletofTV,RVLC/NCILT(3)LA,AMC(aorticleafletofMV),transversesinusRCCLCCLVAnnThoracSurg1995;59:419-27123SinotubularJunctionVentricle-arterialRingandjunctionLV89RVOTRNCLVSeptumLACircArrhythmiaElectrphysiol2008;1:396-404RightCoronaryCusp解剖90RightCoronaryCusp解剖Clin.Anat.10:307–312,1997RCCandRVOTinfundibulum91RightCoronaryCuspRAOLAO92RightCoronaryCuspRAOLAO93HISRAOLAO94LeftCoronaryCuspCircArrhythmiaElectrphysiol2008;1:396-404AMVLNCLCAMVLPVLFT95LeftCoronaryCuspRAOLAO96LeftCoronaryCusp979899100HeartRhythm.2009.InPress101LVOT-AortoMitralContinuity102IIIIIIaVRaVLaVFV1V6AbdAbpAI-GCVdAI-G