心房解剖学习教案

1、会计学1心房心房(xnfng)解剖解剖第一页，共42页。Fischer等将右房峡部分等将右房峡部分(b fen)为三区为三区区：三尖瓣环下腔静脉区：三尖瓣环下腔静脉 成功率成功率70%区：三尖瓣环冠状窦口区：三尖瓣环冠状窦口 成功率成功率30%区：冠状窦口下腔静脉区：冠状窦口下腔静脉 成功率成功率10%第2页/共42页第二页，共42页。第3页/共42页第三页，共42页。第4页/共42页第四页，共42页。Figure 6. Figure 5第5页/共42页第五页，共42页。Illustration showing the importance of obtaining both RAO and

2、LAO views to ascertain multielectrode catheter position. The top panel in the RAO view the catheter tip points posteriorly. The bottom panel shows correct positioning of the catheter. Note the tip of the catheter is in the plane of the CS and when advanced will not advance posteriorly as the case wh

3、en positioned behind the Eustachian ridge.第6页/共42页第六页，共42页。第7页/共42页第七页，共42页。左房腔体左房腔体Heart Rhythm, 7(2):269 2010第8页/共42页第八页，共42页。左房腔体左房腔体第9页/共42页第九页，共42页。The heart has been cut through the ridge to show its pointed profile formed by the infolding of the atrial wall. Note the continuation of LA muscul

4、ature onto the LSPV. The broken line marks the isthmus between the orifice of the LIPV and the mitral annulus.左房腔体左房腔体Heart Rhythm, 7(2):269 2010第10页/共42页第十页，共42页。第11页/共42页第十一页，共42页。第12页/共42页第十二页，共42页。第13页/共42页第十三页，共42页。carina fibers must have an endocardial to epicardial route near the perimeter of

5、 the veins and thus are less amenable to endocardial ablation at the perimeter周界周界(zhu ji).第14页/共42页第十四页，共42页。compact atrioventricular nodeCompact Atrioventricular NodeHeart Rhythm, 7(2):269 2010第15页/共42页第十五页，共42页。第16页/共42页第十六页，共42页。第17页/共42页第十七页，共42页。第18页/共42页第十八页，共42页。rspvripvlspvlipvLAa第19页/共42页第

6、十九页，共42页。第20页/共42页第二十页，共42页。第21页/共42页第二十一页，共42页。RARVA左房的毗邻左房的毗邻(pln)ALVLARVPALALVRARVPAA前壁前壁: AO,PA后壁后壁: 食道食道(shdo)，降主动脉，降主动脉第22页/共42页第二十二页，共42页。第23页/共42页第二十三页，共42页。第24页/共42页第二十四页，共42页。Possible determinants of the risk of thermal damage to the esophagus: 1.fat pad surrounding the esophagus, 2.wall t

7、hickness of the LA and esophagus, 3.spatial relationship of the esophagus and LAThere is a protective layer of fat between the esophagus and the posterior LA, yet this layer is often discontinuous and, in 2% of normal subjects, completely absent.Esophagus第25页/共42页第二十五页，共42页。Esophagus第26页/共42页第二十六页，共

8、42页。食管食管(shgun)前壁平均厚度前壁平均厚度1.9- 5.3 mm, LA后壁的平均厚度后壁的平均厚度 1.3- 3.1 mm.食管食管(shgun)与与LA之间最小距离为之间最小距离为 3.3 mm; 1.9+1.3+3.3=6.5 mmEsophagus第27页/共42页第二十七页，共42页。CirculationCirculation. . 2004;110:3655-36602004;110:3655-3660Esophagus第28页/共42页第二十八页，共42页。第29页/共42页第二十九页，共42页。Esophagus第30页/共42页第三十页，共42页。Circula

9、tionCirculation. . 2004;110:3655-36602004;110:3655-3660食管食管(shgun) (shgun) EsophagusEsophagus第31页/共42页第三十一页，共42页。Cardiac Dyna CT第32页/共42页第三十二页，共42页。The view of the cardiac base has most of the atrial walls removed to show the proximity of the LAA to the left coronary artery and the pulmonary trunk.

10、Note the relationship of the aorta to the anterior walls of the atria.Aorta第33页/共42页第三十三页，共42页。Aortathe posterior LA is directly opposed by a large portion of the anterior surface of the descending aorta, with an average contact area of 18.9 4.4 mm . aorta compressing the LA and left inferior PV第34页

11、/共42页第三十四页，共42页。Left Circumflex ArteryLCx is located in the posterior atrioventricular groove in continuity with the CS; there is commonly a separating layer of fat. The LCX is also located in close proximity to the inferior aspect of the LAA. The mean distance between the LCx and the LAA was 3.3 mm (0.719.6 mm), and the median distance between the CS and the LCx was 2.0 mm (0.49.7 mm).第35页/共42页第三十五页，共42页。Bronchial TreeAPPA第36页/共42页第三十六页，共42页。BAthe PVs, particularly the superior PVs, are in close contact w