心房解剖課件

1、心房及其毗鄰的解剖與影像學(xué)對(duì)消融治療的指導(dǎo)意義Cavotricuspid Isthmus 三尖瓣環(huán)與歐氏瓣和下腔靜脈開口之間的峽部寬度約為23cm，是房撲折返環(huán)中最窄、傳導(dǎo)最為緩慢的共同通道。峽部肌小梁交錯(cuò)、重疊，電傳導(dǎo)各向異性并呈雙向傳導(dǎo)。Fischer等將右房峽部分為三區(qū)區(qū)：三尖瓣環(huán)下腔靜脈 成功率70%區(qū)：三尖瓣環(huán)冠狀竇口 成功率30%區(qū)：冠狀竇口下腔靜脈 成功率10%Illustration showing the importance of obtaining both RAO and LAO views to ascertain multielectrode catheter po

2、sition. 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 when positioned behind the Eustachian ridge.左心房左房腔體

3、 心耳肺靜脈口二尖瓣環(huán)左房腔體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 musculature onto the LSPV. The broken line marks the isthmus between the orifice of the LIPV and the mitral annulus.左房腔體Heart Rhythm, 7(2):269 2

4、010carina fibers must have an endocardial to epicardial route near the perimeter of the veins and thus are less amenable to endocardial ablation at the perimeter周界.肺靜脈77%的人有雙側(cè)肺靜脈左側(cè)肺靜脈開口較右側(cè)高下肺靜脈的開口更接近于后壁上肺靜脈與水平面的夾角較下肺靜脈大AFCARTO MERGE左心房肺靜脈解剖變異肺靜脈解剖肺靜脈解剖rspvripvlspvlipvLAa左房毗鄰前壁:主動(dòng)脈，肺動(dòng)脈后壁:食道，降主動(dòng)脈后下壁:冠

5、狀靜脈頂壁: 肺動(dòng)脈底部: 左室Esophagus食管前壁平均厚度1.9- 5.3 mm, LA后壁的平均厚度 1.3- 3.1 mm.食管與LA之間最小距離為 3.3 mm; 1.9+1.3+3.3=6.5 mmEsophagusCirculation. 2004;110:3655-3660Esophagus食管 Esophagus左房和食管接觸的長(zhǎng)度和寬度: 長(zhǎng)度: 5814 mm 寬度: 13 6 mm.食管和左房之間解剖方向的復(fù)雜性: 56%的病人食管與左側(cè)肺靜脈平行,其中36%為左上肺靜脈向右下肺靜脈斜行;其余44%偏右或居中EsophagusCirculation. 2004;11

6、0:3655-3660食管 EsophagusCardiac Dyna CTThe 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. Note the relationship of the aorta to the anterior walls of the atria.AortaAortathe posterior LA is directly o

7、pposed 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 PVLeft Circumflex ArteryLCx is located in the posterior atrioventricular groove in continuity with the CS; there is commonly a separatin

8、g 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).Bronchial TreeAPPABAthe PVs, particularly the superior PVs, are in close contact with the bronchial tre