爱爱医资源冠脉cta：冠脉解剖课件

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

2、 Originating cusp / sinus of valsalvaCourseBranch nameSize (caliber and distribution):small medium largeDominanceAdequacy of image quality for interpretation overall， per vessel ，per segment动脉的描述起点：起始点/valsalva窦行程分支名称大小（口径及分布）：小、中、大支配区域合适的图像质量：总体，每条血管，每个层面左冠状动脉主干（LM)起点： 左valsalva窦（左冠窦）1例外直接分出LAD LCX

3、占0.5分支：分出LAD LCX占58% LAD,LCX 和 中间支 10-15%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Left Anterior Descending(LAD)Origin:-Form Left Main 95-99%-1-3% separate ostium Left sinusCourseAnterior intraventricula groove toward apex2 variations in terminationBranches:Diagonals septal perforatorsCritical issuesPresenc

4、e of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off Normal Anrtomy（LAD)Left Circumflex (LCX) Origin: Originating form LM in 96-98% 5-2% separate ostium LCX origin form right sinus or RCA (0.4%)Course:down distal left AV grooveBranches obtuse marginal branches Left poster

5、ior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant)Critical issues dominance (15-20%)起点：96-98%起源于LM5-2%单独开口LCX起源于右冠窦或RCA约0.4%行程：沿着左房室沟下降分支：钝缘支 左后外侧支（营养后外侧壁） 左后降支 (左侧优势）关键问题：左侧优势（15%-20%)Normal Anatomy (LCX)Normal Anatomy (LCX)Ramus intermedius （中间支）右冠状动脉(RC

6、A)起点：左valsalva窦（右冠窦）0.1%起源于左心室行程：沿右房室沟下降至房室交点分支：后降支 PDA（85%） 锐缘支 AM 右室后侧支 PL 关键问题：右侧优势（85%）Normal anatomy(RCA)Other branchesSA nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA-Proximal many with separate origin-May supply collateral其他分支窦房结动脉：约60%起源于RCA,40%LCX房室结动脉：RCA圆锥动脉：RCARigh

7、t dominanceLeft dominanceLesion descriptionLocation-Ostial(first 2-3mm )-Proximal-Mid-DistalBifurcationLength (stenosis)-Discrete/focal lesion (20mm)Concentric/eccentricTortuosity Thrombus soft plaque calciumUlcerated/concentric病变的描述定位：开口，邻近，中间，末梢分叉长度（狭窄）：间断/局灶性病变（20MM)同心环/偏心的曲折的血栓 软粥样斑块 钙化溃疡Focal u

8、lcerated plaqueCoronary anomaliesBenign(0.5-1%) (80% of anomalies)Separate LAD/LCX ostiaLCX origin from RSA or RCA LCX courses behind aortaAnomalous origin from aortaHigh anterior origin of RCALMSmall fistulaCoronary anomaliesPotentially serious(20% of anomalies)Origin of CA opposite aortics sinus (0.1-0.2%)Anomalous origin form PA (0.01%)Multiple or Large coronary fistulae Single Coronary artery潜在危险(20% of 异常)起源与主动脉窦对面的室壁瘤(0