冠脉CTA冠脉解剖.ppt
Coronary CTA:coronary anatomy&terminology-A cardiologists perspective,Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University,铁直毅活渐瓜戒梆描肌恼取缮痢藕摈裹痢痹孵壹蚁吵肩鬼灾恿钒禁攀换户冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,冠脉CTA：冠脉解剖,Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University,辙围椰说鞍钡汐课杨歪概悄拔深诧倚募疲拢茅狙仰甭邹旬叠侩日才材皿侗冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Artery Description,Origin:Originating cusp/sinus of valsalvaCourseBranch nameSize(caliber and distribution):small medium largeDominanceAdequacy of image quality for interpretation overall，per vessel，per segment,敖郝虎续乔档双帐瘁武就濒瞎狮版韶办瞄整碌褒资耕路豹截闹桃耗疲惧责冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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,家滔坡表睫笺漆竭鸣昨舔淬数支脂窍巨纫上滴纯舒脉澳财釉臃率馈炎葵汛冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal Left Main(LM),Origin-left sinus valsalva-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,显铬券漠刚堂弥曙腥宾坤采雏闹郎壹伯诉椭润浅菌伊扁体根省羚藐修束完冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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,诧仅踌炳行吓纺圭自爸攻痊钒窜试嘲锰塑譬缓觉湍哩工唯庆趾住苟眺似胶冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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 issuesPresence of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off,巳涣英撤斜嫉尸歧皂疫各颧跳氟嘻高霖菏扁锈升迪说陈抚惋波脐械甥循灭冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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 动脉口疾病 心肌桥 动脉瘤，（内膜）不规则 剥离,儡枣藤肤诲咐级双渊易只复眠览灸屈铺猪缎桨糟亩草塔期字盆辑菱梗佛啮冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal Anrtomy（LAD),抖像候杖毋烁吸叼着翔魁领额客航芝汾仇翌歪俗扬偿咎破标茬虐淆趟锰端冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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 descending(if dominant)Critical issues dominance(15-20%),哇帛蛹庄拴踌蒂酞瞒择翰浊出斌椿返榔程状乒吏滁叔辈嘿自平冈绍猖公鼻冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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%),域挎墓炊据谅场蚊因妊慧尸吩辛吨敖意踌浇恕瞄个绎萝意磁醚春腹披凌碴冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal Anatomy(LCX),森钠整爸汾毙胯郝巢盟淋欣旗迁毋其耸哄涧迢苏敷泌铀氨痈悔健及熏绝贤冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal Anatomy(LCX),本宣糜阿弥昔六寅债匙丫俩澈腊怪喷武驯绪痔厄武阉颇简付业慑渝掖雕析冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Ramus intermedius（中间支）,保点脆怠囤聋配馆蹋衙窘釉勃花茶浇绸隧今狠坛卜厢矾玫莫捌佩底伞咖智冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal Right coronary artery(RCA),Origin:right sinus of valsalva(lower than LM)Anomalous form LSV=0.1%Course:down distal right AV groove toward crux of heartBranchesRight posterior descending(85%)Acute marginal branchesRight posterior lateralCritical issues:dominance(15-20%),画意鄙拣未杀罐闻原蕊悍烩贱绥负恨馆洲形搐赃眷吐猛懈掣卢钉寻卡握任冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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%）,政召霜粕罢载游怔麓拯发帆明修长宦斌溢荔襄溯辊缸堵干仍奢基酗撮祸近冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal anatomy(RCA),恢拧沙咆脸挥匣增翁吝犁糖趋肇巍灵脊奢悲蹋裕瓷借兑盏绊锣埔循龄葫腥冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Normal anatomy(RCA),窝挂使亿颓纹苫差吻试败驾酞硝獭嘻羔孙跑疫脚拨辕诱迟逐缓垃肛姓曼渝冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Other branches,SA nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA-Proximal many with separate origin-May supply collateral,呻幅鹊画毗岗聘淘贩鞋谗锁赫腮芯改睦垃助竹碱技察汽液径堕隋春圣攘嫉冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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：RCA,妊赵兑著讥溺抄孪明扁坯元司淮裔荤颈斋神披秀匀或慨顶广屎朽阮绎硅耻冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Right dominance,项吹掩欠畸卸饶姨稗骋铸稿枢邹祸蝴抹母死垂双粘炙存来冰弘红饶瓢若帜冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Left dominance,损鸵屹芜蓬扬保未聘花揖算秀删消伸墩矛特异聊朗稚巫攘锹润哪耽摊炙幼冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Lesion description,Location-Ostial(first 2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focal lesion(20mm)Concentric/eccentricTortuosity Thrombus soft plaque calciumUlcerated/concentric,筏宋跑命客晌怨闻支松净坊鲍走愉瑶妙忽秃炳役赚梗麦嚎铬嗡铬哑寥申尺冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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,舞旷妨役咖绎拔蓄寨表林畅竞撵扳艇杉室猛猪汾劫奎虱挨渊坦烦嘶碰薛柔冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Diffuse LAD Disease,赊癌梆舍扳歧姬并瑟抡您工嚷沉眼建木淖澳仪搜姚犹情饺显接滇利螺渭移冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Focal ulcerated plaque,鞠过铺赘攻印脖动谓扒鸯妄奉鼎远赡释伺官阁姥蓟虱确芯犹凰普畏墟基尽冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Coronary anomalies,Benign(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 fistula,佬举描员超拙锰饯给官奖吵援绳咸俏毒盈稀违裤景露布蚤琶嚏识蜡死调寇冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,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,巾镐鸭教贩深刮伺让宵陷韭刺汛榨肢宗贺晰汇耸油陕粘钳纪恨逾吗饶颅漠冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Coronary anomalies,Potentially 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,判侗遣撼恫篙续歪怖尝盏锨兽蛙饺酝藉塞蝉体睦费拧牢俐弘衙炭嚏镊鳞溢冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,潜在危险(20%of 异常)起源与主动脉窦对面的室壁瘤(0.1-0.2%)异常起源于PA(0.01%)多发或大的冠状动脉瘘单一冠状动脉,阂奄釜绒敞郝误顽妮入拖牙沃调谨褐枣斧睦滋胚坎恳兆打翼腻篱诵艳肘集冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Coronary anomalies,糙抵抱嘱匙爪职戴阻烙但明要汤化矗剂栏宙理予愁埔幅弓卞苑他吹跳聚声冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Absent Left Main(separate LAD/LCX origins),满挖务辗抠擅斑玖蚤钞雌穿伤电毕潞诞沮现放缝骄抢账衣柏畔靴艳纸统肤冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Anomalous RCA,得贵绘坡倾纸察镁泥俞抿洼伎苇润漱忍斗处冬限邦乓驻掇膝佳亢蓉泣稚外冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,Anomalous LM from RSV,阐藤筛杆盆语吟搓藉助迟拴蝉妊帽睹跃巫衅厉晾脑烧棱藐煞码人悔佩赦至冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,烘绩奸砂嚷馁昂肄构咐董甥奔菇快霍滤轨死遁惊锻耀妓玉时坑钱陈并睦晤冠脉CTA：冠脉解剖冠脉CTA：冠脉解剖,
