冠脈冠脈解剖

冠脈冠脈解剖冠脈CTA：冠脈解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment動脈的描述起點：起始點/valsalva竇行程分支名稱大小〔口徑及分布〕：小、中、大支配區(qū)域適宜的圖像質量：總體，每條血管，每個層面LAD,LCXandRamus10-15%Branches:Diagonalsseptalperforators定位：開口，鄰近，中間，末梢左冠狀動脈主干〔LM)關鍵問題：右側優(yōu)勢〔85%〕LCX起源于右冠竇或RCA約0.－Other:aneurysmsanomaloustakeoff分支：分出LADLCX占58%towardcruxofheartBranches:LAD&LCX=85%Normalanatomy(RCA)Rightposteriordescending(85%)Course:downdistalrightAVgrooveNormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoff左冠狀動脈主干〔LM)起點：左valsalva竇〔左冠竇〕1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中間支10-15%關鍵問題：狹窄致局部供血缺乏冠狀動脈口疾病動脈瘤，〔內膜〕不規(guī)那么剝離LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffLCXcoursesbehindaortaLAD,LCXandRamus10-15%AssistantprofessorofMedicineInterventionalCardiology分支：角支室間隔支ThrombussoftplaquecalciumNormalanatomy(RCA)起源與主動脈竇對面的室壁瘤(0.銳緣支AM動脈瘤，〔內膜〕不規(guī)那么Branches:DiagonalsseptalperforatorsThrombussoftplaquecalcium動脈瘤，〔內膜〕不規(guī)那么-1-3%separateostiumLeftsinusLength(stenosis)分支：分出LADLCX占58%左前降支〔LAD〕起點：95－99％起源于LM1-3%直接開口于左冠竇行程：心室前方經(jīng)室間溝達心尖最后分為兩支分支：角支室間隔支關鍵問題：冠狀動脈近端或冠狀動脈口疾病心肌橋動脈瘤，〔內膜〕不規(guī)那么剝離

NormalAnrtomy〔LAD)LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)起點：96-98%起源于LM5-2%單獨開口LCX起源于右冠竇或RCA約0.4%行程：沿著左房室溝下降分支：鈍緣支左后外側支〔營養(yǎng)后外側壁〕左后降支(左側優(yōu)勢〕關鍵問題：左側優(yōu)勢〔15%-20%)NormalAnatomy(LCX)NormalAnatomy(LCX)(lowerthanLM)經(jīng)室間溝達心尖起點：起始點/valsalva竇－Other:aneurysmsanomaloustakeoffAnomalousoriginformPA(0.-Absentin1%左后外側支〔營養(yǎng)后外側壁〕Normalanatomy(RCA)Rightposteriordescending(85%)obtusemarginalbranchesLAD,LCXandRamus10-15%Leftdominance1-3%直接開口于左冠竇AVNodalArtery-RCABranches:LAD&LCX=85%Ramusintermedius〔中間支〕NormalRightcoronaryartery

(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroove

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)心肌橋Criticalissues左后降支(左側優(yōu)勢〕剝離overall，pervessel，persegmentCriticalissuesDiffuseLADDiseasegroovetowardapex起源與主動脈竇對面的室壁瘤(0.起源與主動脈竇對面的室壁瘤(0.5-1%)(80%of異常)心肌橋Criticalissues:起點：96-98%起源于LMBranchname右冠狀動脈(RCA)起點：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分支：后降支PDA〔85%〕銳緣支AM右室后側支PL

關鍵問題：右側優(yōu)勢〔85%〕Normalanatomy(RCA)Normalanatomy(RCA)OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-Maysupplycollateral其他分支竇房結動脈：約60%起源于RCA,40%LCX房室結動脈：RCA圓錐動脈：RCARightdominanceLeftdominanceLesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentric病變的描述定位：開口，鄰近，中間，末梢分叉長度〔狹窄〕：間斷/局灶性病變〔<10MM)連續(xù)/彌漫〔>20MM)同心環(huán)/偏心的曲折的血栓軟粥樣斑塊鈣化潰瘍DiffuseLADDiseaseFocalulceratedplaqueCoronaryanomaliesBenign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistula冠狀動脈異常良性(0.5-1%)(80%of異常)LAD/LCX口LCX起源于RSAorRCALCX行程在主動脈后從主動脈異常起源RCA前高位起源小的瘺管CoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)Anomalousori