造影結(jié)果的判讀及病變類型的分析-黃文暉課件

1、造影結(jié)果的判讀及病變類型的分析黃文暉廣東省人民醫(yī)院廣東省心血管病研究所從造影片我們要看什么？如何體位的片中判斷正常的冠脈血管？如何判斷病變的血管？常用的一些分類通過不同的病變類型如何考慮介入治療的難度？從造影片我們要看什么？血管的情況肺野的情況心包情況現(xiàn)場(chǎng)還要注意壓力的變化正常冠狀動(dòng)脈RCABasic AnatomyOrigin right aortic sinus(lower origin than LCA)Course Down right AV groove toward crux of the heart, gives off PDA(85%) from which septals a

2、rise, continues in LAV groove giving off posterior LV branches(posterolaterals). PDA may originate more proximally, bifurcate early or be small with part of “its territory” supplied by an acute marginal branch.RCAOther BranchesConus Artery(圓錐支) usually very proximal; courses anteriorly and upward ov

3、er the RV outflow tract toward the LAD. May be an important Source of collaterals.SA Nodal Artery(竇房結(jié)動(dòng)脈) (60%) usually 2nd branch of RCA-courses obliquely backward through uper portion of aterial septum and anteromedial wall of the RA-supplies SA node,usually RA and sometimes LA RCAOther BranchesPDA

4、(后降支) Supplies inferior wall, ventricular septum, posteromedial papillary muscle.AV Nodal Artery (房室結(jié)支) Arises at or near crux; supplies AV node.Right ventricular(Acute marginal Branches銳緣支) Arise from mid RCA; Supply anterior RV; may be a collateral source.LCALMOptimal Views LAO caudal and cranial;

5、 AP-caudal, cranial or flat. Limit views. May need IVUSLADCourse down the anterior interventricular groove-usually reaches apex. In 22% of cases does not reach apexLCABranches septals and diagonals-supply lateral wall of LV, anterolateral papillary muscle; 37% have median ramus( courses like 1st dia

6、gonal).LAD supplies anterolateral, apex and septum; 45%-55% of left ventricle.LCXBranches obtuse marginal, posterolaterals-supply posterolateral LV, anterolteral papillary muscles. SA node artery 38%Supplies 15%-25% of LV, unless dominant(supplies 40-50% of LV).LAO Caudal ViewAHA/ACC冠脈病變分類A型病變散在病變(長(zhǎng)

7、度10mm)向心型狹窄容易插管到病灶部位各節(jié)段間成角450 血管表面較平滑無鈣化或很輕度鈣化不是管腔完全閉塞狹窄部位不在血管開口處無重要分支狹窄管腔內(nèi)無血栓B型病變病變成管狀(10-20mm).偏心型狹窄近端節(jié)段中度彎曲各節(jié)段間成角450 -900 血管表面不光滑中度或重度鈣化管腔完全閉塞2cm)近端節(jié)段過度彎曲節(jié)段間成角900管腔完全閉塞3個(gè)月不能防止主要的分支受損移植靜脈退行性變易碎破TIMI心肌灌注分級(jí)(TMPG)0級(jí):心肌無明顯組織灌注,罪犯血管區(qū)域無毛玻璃樣改變或心肌顯影,提示組織水平灌注低下。1級(jí)：造影劑緩慢灌注心肌，但不能從微血管排空，毛玻璃樣改變或罪犯血管區(qū)域心肌顯影不能從微血管清除，心肌顯影在開始下一個(gè)造影序列（間隔30秒）時(shí)仍然存在。TIMI心肌灌注分級(jí)(TMPG)2級(jí)：造