冠脉CTA冠脉解剖课件.ppt

1、Coronary CTA:coronary anatomy&terminology-A cardiologists perspectiveJuile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University冠脉CTA冠脉解剖1冠脉CTA：冠脉解剖 Juile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University 冠脉CTA冠脉解剖2Artery

2、Description Origin:Originating cusp/sinus of valsalva Course Branch name Size(caliber and distribution):small medium large Dominance Adequacy of image quality for interpretation overall，per vessel，per segment冠脉CTA冠脉解剖3动脉的描述 起点：起始点/valsalva窦 行程 分支名称 大小（口径及分布）：小、中、大 支配区域 合适的图像质量：总体，每条血管，每个层面冠脉CTA冠脉解剖4

3、Normal Left Main(LM)Origin-left sinus valsalva-Absent in 1%Separate,adjacent LAD LCX ostia-0.5%Branches:LAD&LCX=85%LAD,LCX and Ramus 10-15%Critical issues:stenosis due to risk region Presence of ostial disease Other:aneurysms anomalous take off 冠脉CTA冠脉解剖5左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）1例外直接分出LAD LCX占0

4、.5 分支：分出LAD LCX占58%LAD,LCX 和 中间支 10-15%关键问题：狭窄致局部供血不足冠状动脉口疾病动脉瘤，（内膜）不规则剥离冠脉CTA冠脉解剖6Left Anterior Descending(LAD)Origin:-Form Left Main 95-99%-1-3%separate ostium Left sinus Course Anterior intraventricula groove toward apex 2 variations in termination Branches:Diagonals septal perforators Critical i

5、ssuesPresence of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off 冠脉CTA冠脉解剖7左前降支（LAD）起点：9599起源于LM 1-3%直接开口于左冠窦 行程：心室前方 经室间沟达心尖 最后分为两支 分支：角支 室间隔支 关键问题：冠状动脉近端或冠状 动脉口疾病 心肌桥 动脉瘤，（内膜）不规则 剥离 冠脉CTA冠脉解剖8Normal Anrtomy（LAD)冠脉CTA冠脉解剖9Left Circumflex(LCX)Origin:Originating form LM in

6、 96-98%5-2%separate ostium LCX origin form right sinus or RCA(0.4%)Course:down distal left AV groove Branches obtuse marginal branches Left posterior-lateral:define by acute margin and supply PL wall Left posterior descending(if dominant)Critical issues dominance(15-20%)冠脉CTA冠脉解剖10 起点：96-98%起源于LM 5-

7、2%单独开口 LCX起源于右冠窦或RCA约0.4%行程：沿着左房室沟下降 分支：钝缘支 左后外侧支（营养后外侧壁）左后降支(左侧优势）关键问题：左侧优势（15%-20%)冠脉CTA冠脉解剖11Normal Anatomy(LCX)冠脉CTA冠脉解剖12Normal Anatomy(LCX)冠脉CTA冠脉解剖13Ramus intermedius（中间支）冠脉CTA冠脉解剖14Normal Right coronary artery(RCA)Origin:right sinus of valsalva (lower than LM)Anomalous form LSV=0.1%Course:do

8、wn distal right AV groove toward crux of heart Branches Right posterior descending(85%)Acute marginal branches Right posterior lateral Critical issues:dominance(15-20%)冠脉CTA冠脉解剖15右冠状动脉(RCA)起点：左valsalva窦（右冠窦）0.1%起源于左心室 行程：沿右房室沟下降至房室交点 分支：后降支 PDA（85%）锐缘支 AM 右室后侧支 PL 关键问题：右侧优势（85%）冠脉CTA冠脉解剖16Normal ana

9、tomy(RCA)冠脉CTA冠脉解剖17Normal anatomy(RCA)冠脉CTA冠脉解剖18Other branches SA nodal Artery-Approx 60%RCA 40%LCX AV Nodal Artery-RCA Conus Artery-RCA-Proximal many with separate origin-May supply collateral冠脉CTA冠脉解剖19其他分支 窦房结动脉：约60%起源于RCA,40%LCX 房室结动脉：RCA 圆锥动脉：RCA冠脉CTA冠脉解剖20Right dominance冠脉CTA冠脉解剖21Left domin

10、ance冠脉CTA冠脉解剖22Lesion description Location-Ostial(first 2-3mm)-Proximal-Mid-Distal Bifurcation Length(stenosis)-Discrete/focal lesion(20mm)Concentric/eccentric Tortuosity Thrombus soft plaque calcium Ulcerated/concentric冠脉CTA冠脉解剖23病变的描述 定位：开口，邻近，中间，末梢 分叉 长度（狭窄）：间断/局灶性病变（20MM)同心环/偏心的 曲折的 血栓 软粥样斑块 钙化

11、溃疡冠脉CTA冠脉解剖24Diffuse LAD Disease冠脉CTA冠脉解剖25Focal ulcerated plaque冠脉CTA冠脉解剖26Coronary anomalies Benign(0.5-1%)(80%of anomalies)Separate LAD/LCX ostia LCX origin from RSA or RCA LCX courses behind aorta Anomalous origin from aorta High anterior origin of RCA LM Small fistula冠脉CTA冠脉解剖27冠状动脉异常 良性(0.5-1%

12、)(80%of 异常)LAD/LCX 口 LCX 起源于 RSA or RCA LCX 行程在主动脉后 从主动脉异常起源 RCA前高位起源 小的瘘管冠脉CTA冠脉解剖28Coronary anomalies Potentially 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冠脉CTA冠脉解剖29 潜在危险(20%of 异常)起源与主动脉窦对面的室壁瘤(0.1-0.2%)异常起源于PA(0.01%)多发或大的冠状动脉瘘 单一冠状动脉冠脉CTA冠脉解剖30Coronary anomalies冠脉CTA冠脉解剖31Absent Left Main(separate LAD/LCX origins)冠脉CTA冠脉解剖32Anomalous RCA冠脉CTA冠脉解剖33Anomalous LM from RSV冠脉CTA冠脉解剖34冠脉CTA冠脉解剖35