2019年《心房解剖》課件

2019年《心房解剖》課件第一頁，共42頁。第二頁，共42頁。CavotricuspidIsthmus

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2~3cm，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)Ⅰ區(qū)：三尖瓣環(huán)－下腔靜脈成功率70%Ⅱ區(qū)：三尖瓣環(huán)－冠狀竇口成功率30%Ⅲ區(qū)：冠狀竇口－下腔靜脈成功率10%第三頁，共42頁。第四頁，共42頁。第五頁，共42頁。Figure6.

Figure5第六頁，共42頁。IllustrationshowingtheimportanceofobtainingbothRAOandLAOviewstoascertainmultielectrodecatheterposition.ThetoppanelintheRAOviewthecathetertippointsposteriorly.Thebottompanelshowscorrectpositioningofthecatheter.NotethetipofthecatheterisintheplaneoftheCSandwhenadvancedwillnotadvanceposteriorlyasthecasewhenpositionedbehindtheEustachianridge.第七頁，共42頁。左心房左房腔體心耳肺靜脈口二尖瓣環(huán)第八頁，共42頁。左房腔體HeartRhythm,7(2):2692010第九頁，共42頁。左房腔體第十頁，共42頁。Thehearthasbeencutthroughthe"ridge"toshowitspointedprofileformedbytheinfoldingoftheatrialwall.NotethecontinuationofLAmusculatureontotheLSPV.ThebrokenlinemarkstheisthmusbetweentheorificeoftheLIPVandthemitralannulus.左房腔體HeartRhythm,7(2):2692010第十一頁，共42頁。第十二頁，共42頁。Carina第十三頁，共42頁。第十四頁，共42頁。carinafibersmusthaveanendocardialtoepicardialrouteneartheperimeteroftheveinsandthusarelessamenabletoendocardialablationattheperimeter周界.第十五頁，共42頁。compactatrioventricularnodeCompactAtrioventricularNodeHeartRhythm,7(2):2692010第十六頁，共42頁。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第十七頁，共42頁。AF－CARTOMERGE左心房－肺靜脈解剖變異第十八頁，共42頁。肺靜脈解剖第十九頁，共42頁。肺靜脈解剖rspvripvlspvlipvLAa第二十頁，共42頁。第二十一頁，共42頁。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:冠狀靜脈頂壁:肺動(dòng)脈底部:左室第二十二頁，共42頁。RARVA左房的毗鄰ALVLARVPALALVRARVPAA前壁:AO,PA后壁:食道，降主動(dòng)脈第二十三頁，共42頁。第二十四頁，共42頁。第二十五頁，共42頁。Possibledeterminantsoftheriskofthermaldamagetotheesophagus:

1.fatpadsurroundingtheesophagus,2.wallthicknessoftheLAandesophagus,3.spatialrelationshipoftheesophagusandLAThereisaprotectivelayeroffatbetweentheesophagusandtheposteriorLA,yetthislayerisoftendiscontinuousand,in2%ofnormalsubjects,completelyabsent.Esophagus第二十六頁，共42頁。Esophagus第二十七頁，共42頁。食管前壁平均厚度1.9-5.3mm,LA后壁的平均厚度1.3-3.1mm.食管與LA之間最小距離為3.3mm;1.9+1.3+3.3=6.5mmEsophagus第二十八頁，共42頁。Circulation.2004;110:3655-3660Esophagus第二十九頁，共42頁。食管Esophagus左房和食管接觸的長度和寬度:長度:5814mm寬度:136mm.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%偏右或居中第三十頁，共42頁。Esophagus第三十一頁，共42頁。Circulation.2004;110:3655-3660食管Esophagus第三十二頁，共42頁。CardiacDynaCT第三十三頁，共42頁。TheviewofthecardiacbasehasmostoftheatrialwallsremovedtoshowtheproximityoftheLAAtotheleftcoronaryarteryandthepulmonarytrunk.Notetherelationshipoftheaortatotheanteriorwallsoftheatria.Aorta第三十四頁，共42頁。AortatheposteriorLAisdirectlyopposedbyalargeportionoftheanteriorsurfaceofthedescendingaorta,withanaveragecontactareaof18.94.4mm.aortacompressingtheLAandleftinferiorPV第三十五頁，共42頁。LeftCircumflexArteryLCxislocatedintheposterioratrioventriculargrooveincontinuitywiththeCS;thereiscommonlyaseparatinglayeroffat.TheLCXisalsolocatedincloseproximitytotheinferioraspectoftheLAA.ThemeandistancebetweentheLCxandtheLAAwas3.3mm(0.7–19.6mm),andthemediandistancebetweentheCSandtheLCxwas2.0mm(0.4–9.7mm).第三十六頁，共42頁。BronchialTreeAPPA第三十七頁，共42頁