冠脉CTA冠脉解剖ppt课件

Coronary CTA:coronary anatomy & terminology-A cardiologists perspective Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University 1 冠脉 CTA：冠脉解剖 Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University 2 Artery Description n Origin: Originating cusp / sinus of valsalva n Course n Branch name n Size (caliber and distribution):small medium large n Dominance n Adequacy of image quality for interpretation overall， per vessel ， per segment 3 动脉的描述 n 起点：起始点 /valsalva窦 n 行程 n 分支名称 n 大小（口径及分布）：小、中、大 n 支配区域 n 合适的图像质量：总体，每条血管，每个 层面 4 Normal Left Main (LM) n Origin -left sinus valsalva -Absent in 1% Separate,adjacent LAD LCX ostia - 0.5% n Branches: LAD & LCX =85% LAD,LCX and Ramus 10-15% n Critical issues: stenosis due to risk region Presence of ostial disease Other: aneurysms anomalous take off 5 左冠状动脉主干（ LM) n 起点： 左 valsalva窦（左冠 窦） 1例外 直接分出 LAD LCX占 0.5 n 分支：分出 LAD LCX占 58% LAD,LCX 和 中间支 10-15% n 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 6 Left Anterior Descending(LAD) n Origin: -Form Left Main 95-99% -1-3% separate ostium Left sinus n Course n Anterior intraventricula n groove toward apex n 2 variations in termination n Branches:Diagonals septal perforators n Critical issues Presence of ostial/proximal disease Myocardial bridges Other:aneurysms anomalous take off 7 左前降支（ LAD） n 起点 ： 95 99起源于 LM 1-3%直接开口于左冠窦 n 行程 ： 心室前方 经室间沟达心尖 最后分为两支 n 分支 ： 角支 室间隔支 n 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 8 Normal Anrtomy（ LAD) 9 Left Circumflex (LCX) n Origin: Originating form LM in 96-98% 5-2% separate ostium LCX origin form right sinus or RCA (0.4%) n Course:down distal left AV groove n Branches obtuse marginal branches Left posterior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant) nCritical issues dominance (15-20%) 10 n 起点： 96-98%起源于 LM n 5-2%单独开口 n LCX起源于右冠窦或 RCA约 0.4% n 行程：沿着左房室沟下降 n 分支：钝缘支 左后外侧支（营养后外侧壁） n 左后降支 (左侧优势） n 关键问题：左侧优势（ 15%-20%) 11 Normal Anatomy (LCX) 12 Normal Anatomy (LCX) 13 Ramus intermedius （中间支） 14 Normal Right coronary artery (RCA) n Origin: right sinus of valsalva (lower than LM) n Anomalous form LSV =0.1% n Course: down distal right AV groove toward crux of heart n Branches n Right posterior descending (85%) n Acute marginal branches n Right posterior lateral n Critical issues: dominance (15-20%) 15 右冠状动脉 (RCA) n 起点： 左 valsalva窦（右冠窦） n 0.1%起源于左心室 n 行程：沿右房室沟下降至房室 交点 n 分支：后降支 PDA（ 85%） n 锐缘支 AM n 右室后侧支 PL n 关键问题：右侧优势（ 85%） 16 Normal anatomy(RCA) 17 Normal anatomy(RCA) 18 Other branches n SA nodal Artery -Approx 60%RCA 40%LCX n AV Nodal Artery-RCA n Conus Artery-RCA -Proximal many with separate origin -May supply collateral 19 其他分支 n 窦房结动脉：约 60%起源于 RCA,40%LCX n 房室结动脉： RCA n 圆锥动脉： RCA 20 Right dominance 21 Left dominance 22 Lesion descriptionn Location -Ostial(first 2-3mm ) -Proximal -Mid -Distal n Bifurcation n Length (stenosis) -Discrete/focal lesion (20mm) n Concentric/eccentric n Tortuosity n Thrombus soft plaque calcium n Ulcerated/concentric 23 病变的描述 n 定位：开口，邻近，中间，末梢 n 分叉 n 长度（狭窄）：间断 /局灶性病变（ 20MM) n 同心环 /偏心的 n 曲折的 n 血栓 软粥样斑块 钙化 n 溃疡 24 Diffuse LAD Disease 25 Focal ulcerated plaque 26 Coronary anomalies n Benign(0.5-1%) (80% of anomalies) n Separate LAD/LCX ostia n LCX origin from RSA or RCA n LCX courses behind aorta n Anomalous origin from aorta n High anterior origin of RCA n LM n Small fistula 27 冠状动脉异常 n 良性 (0.5-1%) (80% of 异常 ) nLAD/LCX 口 n LCX 起源于 RSA or RCA n LCX 行程在主动脉后 n 从主动脉异常起源 n RCA前高位起源 n 小的瘘管 28 Coronary anomalies n Potentially serious(20% of anomalies) n Origin of CA opposite aortics sinus (0.1-0.2%) n Anomalous origin form PA (0.01%) n Multiple or Large coronary fistulae n Single Coronary artery 29 n 潜在危险 (2