冠脉CTA冠脉解剖

CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity1精选课件冠脉CTA：冠脉解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

2精选课件ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment3精选课件动脉的描述起点：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4精选课件NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:

－stenosisduetoriskregion

－Presenceofostialdisease

－Other:aneurysmsanomaloustakeoff5精选课件左冠状动脉主干（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6精选课件LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff7精选课件左前降支（LAD）起点：95－99％起源于LM1-3%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口疾病心肌桥动脉瘤，（内膜）不规则剥离

8精选课件NormalAnrtomy（LAD)9精选课件LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)10精选课件起点：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%)11精选课件NormalAnatomy(LCX)12精选课件NormalAnatomy(LCX)13精选课件Ramusintermedius（中间支）14精选课件NormalRightcoronaryartery

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

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)15精选课件右冠状动脉(RCA)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%）16精选课件Normalanatomy(RCA)17精选课件Normalanatomy(RCA)18精选课件OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-Maysupplycollateral19精选课件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：RCA20精选课件Rightdominance21精选课件Leftdominance22精选课件LesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentric23精选课件病变的描述定位：开口，邻近，中间，末梢分叉长度（狭窄）：间断/局灶性病变（<10MM)

连续/弥漫（>20MM)同心环/偏心的曲折的血栓软粥样斑块钙化溃疡24精选课件DiffuseLADDisease25精选课件Focalulceratedplaque26精选课件CoronaryanomaliesBenign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistula27精选课件冠状动脉异常良性(0.5-1%)(80%of异常)LAD/LCX口LCX起源于RSAorRCALCX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28精选课件CoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryartery29精选课件潜在危险(20