最新：冠脉cta：冠脉解剖文档资料.ppt

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1、冠脉CTA：冠脉解剖,Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University,Artery Description,Origin:Originating cusp/sinus of valsalvaCourseBranch nameSize(caliber and distribution):small medium largeDominanceAdequacy of image quality for interpretation overall，per

2、vessel，per segment,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,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 Ot

3、her:aneurysms anomalous take off,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,Left Anterior Descending(LAD),Origin:-Form Left Main 95-99%-1-3%separate ostium Left sinusCourseAnterior intraventricula groove toward apex2 variati

4、ons in terminationBranches:Diagonals septal perforatorsCritical issuesPresence of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off,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,Normal Anrtomy（LAD),Left Circumflex

5、(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

6、-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%),Normal Anatomy(LCX),Normal Anatomy(LCX),Ramus intermedius（中间支）,Normal Right coronary artery(RCA),Origin:right sinus of valsalva(lower than LM)Anomalous form LSV=0.1%Course:down distal right AV g

7、roove toward crux of heartBranchesRight posterior descending(85%)Acute marginal branchesRight posterior lateralCritical issues:dominance(15-20%),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%）,Normal anatomy(RCA),Normal anatomy(RCA),Other branches,

8、SA nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA-Proximal many with separate origin-May supply collateral,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,Right dominance,Left dominance,Lesion description,Location-Ostial(first 2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)

9、-Discrete/focal lesion(20mm)Concentric/eccentricTortuosity Thrombus soft plaque calciumUlcerated/concentric,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,Diffuse LAD Disease,Focal ulcerated plaque,Coronary anomalies,Benign(0.5-1%)(80%of anomalies)Separate LAD/LCX ostiaLCX origin

10、 from RSA or RCA LCX courses behind aortaAnomalous origin from aortaHigh anterior origin of RCALMSmall fistula,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,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,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,Coronary anomalies,Absent Left Main(separate LAD/LCX origins),Anomalous RCA,Anomalous LM from RSV,