冠脉cta：冠脉解剖课件

CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity冠脉CTA：冠脉解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegmentNormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:

－stenosisduetoriskregion

－Presenceofostialdisease

－Other:aneurysmsanomaloustakeoff左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）1％例外直接分出LADLCX占0.5％分支：分出LADLCX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LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffNormalAnrtomy（LAD)LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(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%)NormalAnatomy(LCX)Ramusintermedius（中间支）NormalRightcoronaryartery

(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroove

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)Normalanatomy(RCA)Normalanatomy(RCA)OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-MaysupplycollateralRightdominanceLeftdominanceLesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentricDiffuseLADDiseaseFocalulceratedplaqueCoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryartery潜在危险(20%of异常)起源与主