心房解剖學(xué)習(xí)教案

1、會(huì)計(jì)學(xué)1心房心房(xnfng)解剖解剖第一頁，共42頁。Fischer等將右房峽部分等將右房峽部分(b fen)為三區(qū)為三區(qū)區(qū)：三尖瓣環(huán)下腔靜脈區(qū)：三尖瓣環(huán)下腔靜脈 成功率成功率70%區(qū)：三尖瓣環(huán)冠狀竇口區(qū)：三尖瓣環(huán)冠狀竇口 成功率成功率30%區(qū)：冠狀竇口下腔靜脈區(qū)：冠狀竇口下腔靜脈 成功率成功率10%第2頁/共42頁第二頁，共42頁。第3頁/共42頁第三頁，共42頁。第4頁/共42頁第四頁，共42頁。Figure 6. Figure 5第5頁/共42頁第五頁，共42頁。Illustration showing the importance of obtaining both RAO and

2、LAO views to ascertain multielectrode catheter position. The top panel in the RAO view the catheter tip points posteriorly. The bottom panel shows correct positioning of the catheter. Note the tip of the catheter is in the plane of the CS and when advanced will not advance posteriorly as the case wh

3、en positioned behind the Eustachian ridge.第6頁/共42頁第六頁，共42頁。第7頁/共42頁第七頁，共42頁。左房腔體左房腔體Heart Rhythm, 7(2):269 2010第8頁/共42頁第八頁，共42頁。左房腔體左房腔體第9頁/共42頁第九頁，共42頁。The heart has been cut through the ridge to show its pointed profile formed by the infolding of the atrial wall. Note the continuation of LA muscul

4、ature onto the LSPV. The broken line marks the isthmus between the orifice of the LIPV and the mitral annulus.左房腔體左房腔體Heart Rhythm, 7(2):269 2010第10頁/共42頁第十頁，共42頁。第11頁/共42頁第十一頁，共42頁。第12頁/共42頁第十二頁，共42頁。第13頁/共42頁第十三頁，共42頁。carina fibers must have an endocardial to epicardial route near the perimeter of

5、 the veins and thus are less amenable to endocardial ablation at the perimeter周界周界(zhu ji).第14頁/共42頁第十四頁，共42頁。compact atrioventricular nodeCompact Atrioventricular NodeHeart Rhythm, 7(2):269 2010第15頁/共42頁第十五頁，共42頁。第16頁/共42頁第十六頁，共42頁。第17頁/共42頁第十七頁，共42頁。第18頁/共42頁第十八頁，共42頁。rspvripvlspvlipvLAa第19頁/共42頁第

6、十九頁，共42頁。第20頁/共42頁第二十頁，共42頁。第21頁/共42頁第二十一頁，共42頁。RARVA左房的毗鄰左房的毗鄰(pln)ALVLARVPALALVRARVPAA前壁前壁: AO,PA后壁后壁: 食道食道(shdo)，降主動(dòng)脈，降主動(dòng)脈第22頁/共42頁第二十二頁，共42頁。第23頁/共42頁第二十三頁，共42頁。第24頁/共42頁第二十四頁，共42頁。Possible determinants of the risk of thermal damage to the esophagus: 1.fat pad surrounding the esophagus, 2.wall t

7、hickness of the LA and esophagus, 3.spatial relationship of the esophagus and LAThere is a protective layer of fat between the esophagus and the posterior LA, yet this layer is often discontinuous and, in 2% of normal subjects, completely absent.Esophagus第25頁/共42頁第二十五頁，共42頁。Esophagus第26頁/共42頁第二十六頁，共

8、42頁。食管食管(shgun)前壁平均厚度前壁平均厚度1.9- 5.3 mm, LA后壁的平均厚度后壁的平均厚度 1.3- 3.1 mm.食管食管(shgun)與與LA之間最小距離為之間最小距離為 3.3 mm; 1.9+1.3+3.3=6.5 mmEsophagus第27頁/共42頁第二十七頁，共42頁。CirculationCirculation. . 2004;110:3655-36602004;110:3655-3660Esophagus第28頁/共42頁第二十八頁，共42頁。第29頁/共42頁第二十九頁，共42頁。Esophagus第30頁/共42頁第三十頁，共42頁。Circula

9、tionCirculation. . 2004;110:3655-36602004;110:3655-3660食管食管(shgun) (shgun) EsophagusEsophagus第31頁/共42頁第三十一頁，共42頁。Cardiac Dyna CT第32頁/共42頁第三十二頁，共42頁。The view of the cardiac base has most of the atrial walls removed to show the proximity of the LAA to the left coronary artery and the pulmonary trunk.

10、Note the relationship of the aorta to the anterior walls of the atria.Aorta第33頁/共42頁第三十三頁，共42頁。Aortathe posterior LA is directly opposed by a large portion of the anterior surface of the descending aorta, with an average contact area of 18.9 4.4 mm . aorta compressing the LA and left inferior PV第34頁

11、/共42頁第三十四頁，共42頁。Left Circumflex ArteryLCx is located in the posterior atrioventricular groove in continuity with the CS; there is commonly a separating layer of fat. The LCX is also located in close proximity to the inferior aspect of the LAA. The mean distance between the LCx and the LAA was 3.3 mm (0.719.6 mm), and the median distance between the CS and the LCx was 2.0 mm (0.49.7 mm).第35頁/共42頁第三十五頁，共42頁。Bronchial TreeAPPA第36頁/共42頁第三十六頁，共42頁。BAthe PVs, particularly the superior PVs, are in close contact w