冠脉CTA：冠脉解剖.ppt

《冠脉CTA：冠脉解剖.ppt》由会员分享，可在线阅读，更多相关《冠脉CTA：冠脉解剖.ppt（35页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、Coronary CTA:coronary anatomy&terminology-A cardiologists perspectiveJuile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University冠脉冠脉CTA：冠脉解剖：冠脉解剖 Juile Miller MDJuile Miller MDAssistant professor of Medicine Interventional CardiologyAssistant professor of Medicin

2、e Interventional CardiologyJohns Hopkins UniversityJohns Hopkins University Artery Descriptionn nOrigin:Originating cusp/sinus of valsalvan nCoursen nBranch namen nSize(caliber and distribution):small medium largen nDominancen nAdequacy of image quality for interpretation overall，per vessel，per segm

3、ent动脉的描述动脉的描述n n起点：起始点/valsalva窦n n行程n n分支名称n n大小（口径及分布）：小、中、大n n支配区域n n合适的图像质量：总体，每条血管，每个层面Normal Left Main(LM)n nOriginOrigin-left sinus valsalva-left sinus valsalva-Absent in 1%-Absent in 1%Separate,adjacent Separate,adjacent LAD LCXLAD LCX ostia-0.5 ostia-0.5%n nBranches:Branches:LAD&LCXLAD&LCX=

4、85=85%LAD,LCX and Ramus 10-15%LAD,LCX and Ramus 10-15%n nCritical issues:Critical issues:stenosis due to risk region stenosis due to risk region Presence of ostial diseasePresence of ostial disease Other:aneurysms anomalous take Other:aneurysms anomalous take off off 左冠状动脉主干（左冠状动脉主干（LM)n n起点：左valsal

5、va窦（左冠窦）1例外直接分出直接分出LAD LCXLAD LCX占占0.50.5n n分支：分出分支：分出LAD LCXLAD LCX占占58%58%LAD,LCX LAD,LCX 和和 中间支中间支 10-15%10-15%n n关键问题：关键问题：狭窄致局部供血不足狭窄致局部供血不足冠状动脉口疾病冠状动脉口疾病动脉瘤，（内膜）不规则剥离动脉瘤，（内膜）不规则剥离Left Anterior Descending(LAD)n nOrigin:Origin:-Form Left Main 95-99%-Form Left Main 95-99%-1-3%separate ostium Left

6、 sinus-1-3%separate ostium Left sinusn nCourseCoursen nAnterior intraventriculaAnterior intraventricula n ngroove toward apexgroove toward apexn n2 variations in termination2 variations in terminationn nBranches:Branches:DiagonalsDiagonals septal perforatorsseptal perforatorsn nCritical issuesCritic

7、al issuesPresence of ostial/proximal diseasePresence of ostial/proximal diseaseMyocardial bridgesMyocardial bridgesOther:aneurysms anomalous take off Other:aneurysms anomalous take off 左前降支（左前降支（LAD）n n起点：95959999起源于起源于LMLM 1-3%1-3%直接开口于左冠窦直接开口于左冠窦n n行程：心室前方心室前方 经室间沟达心尖经室间沟达心尖 最后分为两支最后分为两支n n分支：角支角支

8、 室间隔支室间隔支n n关键问题：冠状动脉近端或冠状关键问题：冠状动脉近端或冠状 动脉口疾病动脉口疾病 心肌桥心肌桥 动脉瘤，（内膜）不规则动脉瘤，（内膜）不规则 剥离剥离 Normal Anrtomy（LAD)Left Circumflex(LCX)n nOrigin:Origin:Originating form LM in 96-98%Originating form LM in 96-98%5-2%separate ostium 5-2%separate ostium LCX origin form right sinus or RCA LCX origin form right si

9、nus or RCA(0.4%)(0.4%)n nCourse:down distal left AV grooveCourse:down distal left AV grooven nBranchesBranches obtuse marginal obtuse marginal branches branches Left posterior-lateral:define by acute Left posterior-lateral:define by acute marginmargin and supply PL wall and supply PL wall Left poste

10、rior descending(if dominant)Left posterior descending(if dominant)n nCritical issues dominance(15-20%)dominance(15-20%)n n起点：96-98%96-98%起源于起源于LMLMn n5-2%5-2%单独开口单独开口n nLCXLCX起源于右冠窦或起源于右冠窦或RCARCA约约0.4%0.4%n n行程：沿着左房室沟下降行程：沿着左房室沟下降n n分支：钝缘支分支：钝缘支 左后外侧支（营养后外侧壁）左后外侧支（营养后外侧壁）n n 左后降支左后降支(左侧优势）左侧优势）n n关键

11、问题：左侧优势（关键问题：左侧优势（15%-20%)15%-20%)Normal Anatomy(LCX)Normal Anatomy(LCX)Ramus intermedius（中间支）（中间支）Normal Right coronary artery(RCA)n nOrigin:Origin:right sinus of valsalva right sinus of valsalva (lower than LM)(lower than LM)n nAnomalous form LSV=0.1%Anomalous form LSV=0.1%n nCourse:Course:down di

12、stal right AV groovedown distal right AV groove toward crux of hearttoward crux of heartn nBranchesBranchesn nRight posterior descending(85%)Right posterior descending(85%)n nAcute marginal branchesAcute marginal branchesn nRight posterior lateralRight posterior lateraln nCritical issues:Critical is

13、sues:dominance(15-20%)dominance(15-20%)右冠状动脉右冠状动脉(RCA)n n起点：左左valsalvavalsalva窦（右冠窦）窦（右冠窦）n n0.1%0.1%起源于左心室起源于左心室n n行程：沿右房室沟下降至房室行程：沿右房室沟下降至房室交点交点n n分支：后降支分支：后降支 PDA PDA（85%85%）n n 锐缘支锐缘支 AM AMn n 右室后侧支右室后侧支 PL PL n n关键问题：右侧优势（关键问题：右侧优势（85%85%）Normal anatomy(RCA)Normal anatomy(RCA)Other branchesn nS

14、A nodal Artery-Approx 60%RCA 40%LCX-Approx 60%RCA 40%LCXn nAV Nodal Artery-RCAn nConus Artery-RCA-Proximal many with separate origin-Proximal many with separate origin-May supply collateral-May supply collateral其他分支其他分支n n窦房结动脉：约60%起源于RCA,40%LCXn n房室结动脉：RCAn n圆锥动脉：RCARight dominanceLeft dominanceLes

15、ion descriptionn nLocationLocation-Ostial(first 2-3mm)-Ostial(first 2-3mm)-Proximal-Proximal-Mid-Mid-Distal-Distaln nBifurcationBifurcationn nLength(stenosis)Length(stenosis)-Discrete/focal lesion(10mm)-Discrete/focal lesion(20mm)-Long/diffuse(20mm)n nConcentric/eccentricConcentric/eccentricn nTortu

16、osity Tortuosity n nThrombus soft plaque calciumThrombus soft plaque calciumn nUlcerated/concentricUlcerated/concentric病变的描述病变的描述n n定位：开口，邻近，中间，末梢n n分叉n n长度（狭窄）：间断/局灶性病变（20MM)n n同心环/偏心的n n曲折的n n血栓 软粥样斑块 钙化n n溃疡Diffuse LAD DiseaseFocal ulcerated plaqueCoronary anomaliesn nBenign(0.5-1%)(80%of anomali

17、es)n nSeparate LAD/LCX ostian nLCX origin from RSA or RCA LCX origin from RSA or RCA n nLCX courses behind aortaLCX courses behind aortan nAnomalous origin from aortaAnomalous origin from aortan nHigh anterior origin of RCAHigh anterior origin of RCAn nLMLMn nSmall fistulaSmall fistula冠状动脉异常冠状动脉异常n

18、n良性(0.5-1%)(80%of 异常)n nLAD/LCX 口n nLCX 起源于 RSA or RCAn nLCX 行程在主动脉后n n从主动脉异常起源n n RCA前高位起源n n小的瘘管Coronary anomaliesn nPotentially serious(20%of anomalies)n nOrigin of CA opposite aortics sinus(0.1-0.2%)n nAnomalous origin form PA(0.01%)n nMultiple or Large coronary fistulae n nSingle Coronary arteryn n潜在危险(20%of 异常)n n起源与主动脉窦对面的室壁瘤(0.1-0.2%)n n异常起源于PA(0.01%)n n多发或大的冠状动脉瘘n n单一冠状动脉Coronary anomaliesAbsent Left Main(separate LAD/LCX origins)Anomalous RCAAnomalous LM from RSV