冠脉CTA冠脉解剖课件.ppt

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1、Coronary CTA:coronary anatomy & terminology-A cardiologists perspective,Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University,冠脉CTA冠脉解剖,1,Coronary CTA:coronary anatomy,冠脉CTA：冠脉解剖,Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns

2、Hopkins University,冠脉CTA冠脉解剖,2,冠脉CTA：冠脉解剖 Juile Miller MD冠脉,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,冠脉CTA冠脉解剖,3,Artery Desc

3、riptionOrigin: Orig,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,冠脉CTA冠脉解剖,4,动脉的描述起点：起始点/valsalva窦冠脉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: sten

4、osis due to risk region Presence of ostial disease Other: aneurysms anomalous take off,冠脉CTA冠脉解剖,5,Normal Left Main (LM)Origin冠脉C,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,冠脉CTA冠脉解剖,6,左冠状动脉主干（LM)起点： 左valsalva窦（左冠窦）,Left A

5、nterior 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

6、,冠脉CTA冠脉解剖,7,Left Anterior Descending(LAD)O,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,冠脉CTA冠脉解剖,8,左前降支（LAD）起点：9599起源于LM冠脉CTA冠脉,Normal Anrtomy（LAD),冠脉CTA冠脉解剖,9,Normal Anrtomy（LAD)冠脉CTA冠脉解剖9,Left Circumflex (LCX),Origin: Originating form

7、 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%),冠脉CTA冠脉解剖,10,Left

8、 Circumflex (LCX) Origin:冠,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%),冠脉CTA冠脉解剖,11,起点：96-98%起源于LM冠脉CTA冠脉解剖11,Normal Anatomy (LCX),冠脉CTA冠脉解剖,12,Normal Anatomy (LCX)冠脉CTA冠脉解剖1,Normal Anatomy (LCX),冠脉CTA冠脉解剖,13,Normal Anatomy (LCX)冠脉CTA冠脉解剖1,Ra

9、mus intermedius （中间支）,冠脉CTA冠脉解剖,14,Ramus intermedius （中间支）冠脉CTA冠脉,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 post

10、erior lateralCritical issues: dominance (15-20%),冠脉CTA冠脉解剖,15,Normal Right coronary artery(,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%）,冠脉CTA冠脉解剖,16,右冠状动脉(RCA)起点：左valsalva窦（右冠窦）冠脉,Normal anatomy(RCA),冠脉CTA冠脉解剖,17,Normal anatomy(RCA)冠脉CTA冠脉解剖17

11、,Normal anatomy(RCA),冠脉CTA冠脉解剖,18,Normal anatomy(RCA)冠脉CTA冠脉解剖18,Other branches,SA nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA-Proximal many with separate origin-May supply collateral,冠脉CTA冠脉解剖,19,Other branchesSA nodal Artery冠,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,冠

12、脉CTA冠脉解剖,20,其他分支窦房结动脉：约60%起源于RCA,40%LCX冠脉C,Right dominance,冠脉CTA冠脉解剖,21,Right dominance冠脉CTA冠脉解剖21,Left dominance,冠脉CTA冠脉解剖,22,Left dominance冠脉CTA冠脉解剖22,Lesion description,Location-Ostial(first 2-3mm )-Proximal-Mid-DistalBifurcationLength (stenosis)-Discrete/focal lesion (20mm)Concentric/eccentricTo

13、rtuosity Thrombus soft plaque calciumUlcerated/concentric,冠脉CTA冠脉解剖,23,Lesion descriptionLocation冠脉CT,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,冠脉CTA冠脉解剖,24,病变的描述定位：开口，邻近，中间，末梢冠脉CTA冠脉解剖24,Diffuse LAD Disease,冠脉CTA冠脉解剖,25,Diffuse LAD Disease冠脉CTA冠脉解剖25,Focal ulcerated plaque,

14、冠脉CTA冠脉解剖,26,Focal ulcerated plaque冠脉CTA冠脉解,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,冠脉CTA冠脉解剖,27,Coronary anomaliesBenign(0.5-1,冠状动脉异常,良性(0.5-1%)

15、 (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,冠脉CTA冠脉解剖,28,冠状动脉异常良性(0.5-1%) (80% of 异常)冠脉,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 Coronar

16、y artery,冠脉CTA冠脉解剖,29,Coronary anomaliesPotentially,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,冠脉CTA冠脉解剖,30,潜在危险(20% of 异常)冠脉CTA冠脉解剖30,Coronary anomalies,冠脉CTA冠脉解剖,31,Coronary anomalies冠脉CTA冠脉解剖31,Absent Left Main(separate LAD/LCX origins),冠脉CTA冠脉解剖,32,Absent Left Main(separate LAD,Anomalous RCA,冠脉CTA冠脉解剖,33,Anomalous RCA冠脉CTA冠脉解剖33,Anomalous LM from RSV,冠脉CTA冠脉解剖,34,Anomalous LM from RSV冠脉CTA冠脉解剖,冠脉CTA冠脉解剖,35,冠脉CTA冠脉解剖35,