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Normal Left Main (LM)Origin-left sinus valsa

3、lva-Absent in 1%Separate,adjacent LAD LCX ostia - 0.5%Branches: LAD & LCX =85% LAD,LCX and Ramus 10-15%Critical issues: stenosis due to risk region Presence of ostial disease Other: aneurysms anomalous take off Left Anterior Descending(LAD)Origin:-Form Left Main 95-99%-1-3% separate ostium Left sinu

4、sCourseAnterior intraventricula groove toward apex2 variations in terminationBranches:Diagonals septal perforatorsCritical issuesPresence of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off 左前降支（LAD）起点：9599起源于LM 1-3%直接开口于左冠窦行程：心室前方 经室间沟达心尖 最后分为两支分支：角支 室间隔支关键问题：冠状动脉近端或冠状 动脉

5、口疾病 心肌桥 动脉瘤，（内膜）不规则 剥离 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 posterior-lateral: define by acute margin and supply PL wall Left posterior descend

6、ing (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)Ramus intermedius （中间支）Normal Right coronary artery(RCA) Origin: right sinus of valsalva (lower than LM)Anomalous form LSV =0.1%

7、Course: down distal right AV groove toward crux of heartBranchesRight posterior descending (85%)Acute marginal branchesRight posterior lateralCritical issues: dominance (15-20%)Normal anatomy(RCA)Normal anatomy(RCA)Other branchesSA nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA

8、-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：RCARight dominanceLeft dominance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Diffuse LAD DiseaseCoronary anomaliesBenign(0.5-1%) (80% of anomalies)Separate LAD/LCX ostiaLCX origin fr

9、om RSA or RCA LCX courses behind aortaAnomalous origin from aortaHigh anterior origin of RCALMSmall fistula冠状动脉异常良性(0.5-1%) (80% of 异常)LAD/LCX 口LCX 起源于 RSA or RCALCX 行程在主动脉后从主动脉异常起源 RCA前高位起源小的瘘管Coronary 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