冠脉CTA冠脉解剖-课件

,*,冠脉,CTA,冠脉解剖,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,冠脉,CTA,冠脉解剖,Juile Miller MD,Assistant professor of Medicine Interventional Cardiology,Johns Hopkins University,冠脉,CTA,冠脉解剖,Juile Miller MD,Assistant professor of Medicine Interventional Cardiology,Johns Hopkins University,冠脉,CTA,冠脉解剖,Origin:Originating cusp/sinus of valsalva,Course,Branch name,Size(caliber and distribution):small medium large,Dominance,Adequacy of image quality for interpretation,overall,，,per vessel,，,per segment,冠脉,CTA,冠脉解剖,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,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,冠脉,CTA,冠脉解剖,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,Origin:,-Form Left Main 95-99%,-1-3%separate ostium Left sinus,Course,Anterior intraventricula,groove toward apex,2 variations in termination,Branches:,Diagonals,septal perforators,Critical issues,Presence of ostial/proximal disease,Myocardial bridges,Other:aneurysms anomalous take off,冠脉,CTA,冠脉解剖,起点,：,95,99,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,冠脉,CTA,冠脉解剖,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 groove,Branches,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,起点：,96-98%,起源于,LM,5-2%,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,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,Origin:,right sinus of valsalva,(lower than LM),Anomalous form LSV=0.1%,Course:,down distal right AV groove,toward crux of heart,Branches,Right posterior descending(85%),Acute marginal branches,Right posterior lateral,Critical issues:,dominance(15-20%),冠脉,CTA,冠脉解剖,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,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,SA nodal Artery,-Approx 60%RCA 40%LCX,AV Nodal Artery-RCA,Conus Artery-RCA,-Proximal many with separate origin,-May supply collateral,冠脉,CTA,冠脉解剖,窦房结动脉：约,60%,起源于,RCA,40%LCX,房室结动脉：,RCA,圆锥动脉：,RCA,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,Location,-Ostial(first 2-3mm),-Proximal,-Mid,-Distal,Bifurcation,Length(stenosis),-Discrete/focal lesion(20mm),Concentric/eccentric,Tortuosity,Thrombus soft plaque calcium,Ulcerated/concentric,冠脉,CTA,冠脉解剖,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,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,Benign(0.5-1%)(80%of anomalies),Separate LAD/LCX ostia,LCX origin from RSA or RCA,LCX courses behind aorta,Anomalous origin from aorta,High anterior origin of RCA,LM,Small fistula,冠脉,CTA,冠脉解剖,良性,(0.5-1%)(80%of,异常,),LAD/LCX,口,LCX,起源于,RSA or RCA,LCX,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,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,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,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,冠脉,CTA,冠脉解剖,