《心房解剖》课件

心房及其毗邻的解剖与影像学对消融治疗的指导意义CavotricuspidIsthmus

三尖瓣环与欧氏瓣和下腔静脉开口之间的峡部宽度约为2~3cm，是房扑折返环中最窄、传导最为缓慢的共同通道。峡部肌小梁交错、重叠，电传导各向异性并呈双向传导。Fischer等将右房峡部分为三区Ⅰ区：三尖瓣环－下腔静脉成功率70%Ⅱ区：三尖瓣环－冠状窦口成功率30%Ⅲ区：冠状窦口－下腔静脉成功率10%Figure6.

Figure5IllustrationshowingtheimportanceofobtainingbothRAOandLAOviewstoascertainmultielectrodecatheterposition.ThetoppanelintheRAOviewthecathetertippointsposteriorly.Thebottompanelshowscorrectpositioningofthecatheter.NotethetipofthecatheterisintheplaneoftheCSandwhenadvancedwillnotadvanceposteriorlyasthecasewhenpositionedbehindtheEustachianridge.左心房左房腔体心耳肺静脉口二尖瓣环左房腔体HeartRhythm,7(2):2692019左房腔体Thehearthasbeencutthroughthe"ridge"toshowitspointedprofileformedbytheinfoldingoftheatrialwall.NotethecontinuationofLAmusculatureontotheLSPV.ThebrokenlinemarkstheisthmusbetweentheorificeoftheLIPVandthemitralannulus.左房腔体HeartRhythm,7(2):2692019Carinacarinafibersmusthaveanendocardialtoepicardialrouteneartheperimeteroftheveinsandthusarelessamenabletoendocardialablationattheperimeter周界.compactatrioventricularnodeCompactAtrioventricularNodeHeartRhythm,7(2):2692019肺静脉77%的人有双侧肺静脉左侧肺静脉开口较右侧高下肺静脉的开口更接近于后壁上肺静脉与水平面的夹角较下肺静脉大AF－CARTOMERGE左心房－肺静脉解剖变异肺静脉解剖肺静脉解剖rspvripvlspvlipvLAa左房毗邻前壁:主动脉，肺动脉后壁:食道，降主动脉后下壁:冠状静脉顶壁:肺动脉底部:左室RARVA左房的毗邻ALVLARVPALALVRARVPAA前壁:AO,PA后壁:食道，降主动脉Possibledeterminantsoftheriskofthermaldamagetotheesophagus:

1.fatpadsurroundingtheesophagus,2.wallthicknessoftheLAandesophagus,3.spatialrelationshipoftheesophagusandLAThereisaprotectivelayeroffatbetweentheesophagusandtheposteriorLA,yetthislayerisoftendiscontinuousand,in2%ofnormalsubjects,completelyabsent.EsophagusEsophagus食管前壁平均厚度1.9-5.3mm,LA后壁的平均厚度1.3-3.1mm.食管与LA之间最小距离为3.3mm;1.9+1.3+3.3=6.5mmEsophagusCirculation.2019;110:3655-3660Esophagus食管Esophagus左房和食管接触的长度和宽度:长度:5814mm宽度:136mm.食管和左房之间解剖方向的复杂性:56%的病人食管与左侧肺静脉平行,其中36%为左上肺静脉向右下肺静脉斜行;其余44%偏右或居中EsophagusCirculation.2019;110:3655-3660食管EsophagusCardiacDynaCTTheviewofthecardiacbasehasmostoftheatrialwallsremovedtoshowtheproximityoftheLAAtotheleftcoronaryarteryandthepulmonarytrunk.Notetherelationshipoftheaortatotheanteriorwallsoftheatria.AortaAortatheposteriorLAisdirectlyopposedbyalargeportionoftheanteriorsurfaceofthedescendingaorta,withanaveragecontactareaof18.94.4mm.aortacompressingtheLAandleftinferiorPVLeftCircumflexArteryLCxislocatedintheposterioratrioventriculargrooveincontinuitywiththeCS;thereiscommonlyaseparatinglayeroffat.TheLCXisalsolocatedincloseproximitytotheinferioraspectoftheLAA.ThemeandistancebetweentheLCxandtheLAAwas3.3mm(0.7–19.6mm),andthemediandistancebetweentheCSandtheLCxwas2.0mm(0.4–9.7mm).BronchialTreeAPPABAthePVs,particularlythesuperiorPVs,areinclosecontactwiththebronchialtree.PhrenicNerve左房腔体We'vebeenallthewaytoth