愛(ài)愛(ài)醫(yī)資源冠脈CTA冠脈解剖

1、愛(ài)愛(ài)醫(yī)資源冠脈CTA冠脈解剖冠脈CTA：冠脈解剖 Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University Artery DescriptionOrigin: Originating cusp / sinus of valsalvaCourseBranch nameSize (caliber and distribution):small medium largeDominanceAdequacy of image quality for interpreta

2、tion overall， per vessel ，per segment動(dòng)脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇行程分支名稱(chēng)大小口徑及分布：小、中、大支配區(qū)域適宜的圖像質(zhì)量：總體，每條血管，每個(gè)層面Normal Left Main (LM)Origin-left sinus valsalva-Absent in 1%Separate,adjacent LAD LCX%Branches: LAD & LCX =85% LAD,LCX and Ramus 10-15%Critical issues: stenosis due to risk region Presence of ostial

3、disease Other: aneurysms anomalous take off 左冠狀動(dòng)脈主干LM)起點(diǎn)： 左valsalva竇左冠竇1例外直接分出LAD LCX占0.5分支：分出LAD LCX占58% LAD,LCX 和 中間支 10-15%關(guān)鍵問(wèn)題：狹窄致局部供血缺乏冠狀動(dòng)脈口疾病動(dòng)脈瘤，內(nèi)膜不規(guī)那么剝離Left Anterior Descending(LAD)Origin:-Form Left Main 95-99%-1-3% separate ostium Left sinusCourseAnterior intraventricula groove toward apex2

4、variations in terminationBranches:Diagonals septal perforatorsCritical issuesPresence of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off 左前降支LAD起點(diǎn)：9599起源于LM 1-3%直接開(kāi)口于左冠竇行程：心室前方 經(jīng)室間溝達(dá)心尖 最后分為兩支分支：角支 室間隔支關(guān)鍵問(wèn)題：冠狀動(dòng)脈近端或冠狀 動(dòng)脈口疾病 心肌橋 動(dòng)脈瘤，內(nèi)膜不規(guī)那么 剝離 Normal AnrtomyLAD)Left Circumfle

5、x (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 domi

6、nance (15-20%)起點(diǎn)：96-98%起源于LM5-2%單獨(dú)開(kāi)口LCX起源于右冠竇或RCA約0.4%行程：沿著左房室溝下降分支：鈍緣支 左后外側(cè)支營(yíng)養(yǎng)后外側(cè)壁 左后降支 (左側(cè)優(yōu)勢(shì)關(guān)鍵問(wèn)題：左側(cè)優(yōu)勢(shì)15%-20%)Normal Anatomy (LCX)Normal Anatomy (LCX)Ramus intermedius 中間支Normal Right coronary artery(RCA) Origin: right sinus of valsalva (lower than LM)Anomalous form LSV =0.1%Course: down distal rig

7、ht AV groove toward crux of heartBranchesRight posterior descending (85%)Acute marginal branchesRight posterior lateralCritical issues: dominance (15-20%)右冠狀動(dòng)脈(RCA)起點(diǎn)：左valsalva竇右冠竇0.1%起源于左心室行程：沿右房室溝下降至房室交點(diǎn)分支：后降支 PDA85% 銳緣支 AM 右室后側(cè)支 PL 關(guān)鍵問(wèn)題：右側(cè)優(yōu)勢(shì)85%Normal anatomy(RCA)Normal anatomy(RCA)Other branchesS

8、A nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA-Proximal many with separate origin-May supply collateral其他分支竇房結(jié)動(dòng)脈：約60%起源于RCA,40%LCX房室結(jié)動(dòng)脈：RCA圓錐動(dòng)脈：RCARight dominanceLeft dominanceLesion descriptionLocation-Ostial(first 2-3mm )-Proximal-Mid-DistalBifurcationLength (stenosis)-Disc

9、rete/focal lesion (20mm)Concentric/eccentricTortuosity Thrombus soft plaque calciumUlcerated/concentric病變的描述定位：開(kāi)口，鄰近，中間，末梢分叉長(zhǎng)度狹窄：連續(xù)/局灶性病變20MM)同心環(huán)/偏心的曲折的血栓 軟粥樣斑塊 鈣化潰瘍Diffuse LAD DiseaseFocal ulcerated plaqueCoronary anomaliesBenign(0.5-1%) (80% of anomalies)Separate LAD/LCX ostiaLCX origin from RSA o

10、r RCA LCX courses behind aortaAnomalous origin from aortaHigh anterior origin of RCALMSmall fistula冠狀動(dòng)脈異常良性(0.5-1%) (80% of 異常)LAD/LCX 口LCX 起源于 RSA or RCALCX 行程在主動(dòng)脈后從主動(dòng)脈異常起源 RCA前高位起源小的瘺管Coronary anomaliesPotentially 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潛在危險(xiǎn)