1、心房及其毗邻的解剖与影像心房及其毗邻的解剖与影像学对消融治疗的指导意义学对消融治疗的指导意义Cavotricuspid Isthmus 三尖瓣环与欧氏瓣和下腔静脉开口之三尖瓣环与欧氏瓣和下腔静脉开口之间的峡部宽度约为间的峡部宽度约为23cm，是房扑折，是房扑折返环中最窄、传导最为缓慢的共同通返环中最窄、传导最为缓慢的共同通道。峡部肌小梁交错、重叠，电传导道。峡部肌小梁交错、重叠，电传导各向异性并呈双向传导。各向异性并呈双向传导。Fischer等将右房峡部分为三区等将右房峡部分为三区区：三尖瓣环下腔静脉区：三尖瓣环下腔静脉 成功率成功率70%区：三尖瓣环冠状窦口区：三尖瓣环冠状窦口 成功率成功率
2、30%区：冠状窦口下腔静脉区：冠状窦口下腔静脉 成功率成功率10%Figure 6. Figure 5Illustration showing the importance of obtaining both RAO and LAO views to ascertain multielectrode catheter position. The top panel in the RAO view the catheter tip points posteriorly. The bottom panel shows correct positioning of the catheter. Not
3、e 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.左心房左心房 左房腔体左房腔体 心耳心耳 肺静脉口肺静脉口 二尖瓣环二尖瓣环左房腔体左房腔体Heart Rhythm, 7(2):269 2019左房腔体左房腔体The heart has been cut through the ridge to show its pointed pro
4、file 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.左房腔体左房腔体Heart Rhythm, 7(2):269 2019Carinacarina fibers must have an endocardial to epicardial route near th
5、e perimeter of the veins and thus are less amenable to endocardial ablation at the perimeter周界.compact atrioventricular nodeCompact Atrioventricular NodeHeart Rhythm, 7(2):269 2019肺静脉肺静脉 77%77%的人有双侧肺静脉的人有双侧肺静脉 左侧肺静脉开口较右侧高左侧肺静脉开口较右侧高 下肺静脉的开口更接近于后壁下肺静脉的开口更接近于后壁 上肺静脉与水平面的夹角较下肺静脉大上肺静脉与水平面的夹角较下肺静脉大AFAFCA
6、RTO MERGECARTO MERGE 左心房肺静脉解剖变异左心房肺静脉解剖变异肺静脉解剖肺静脉解剖肺静脉解剖肺静脉解剖rspvripvlspvlipvLAa左房毗邻左房毗邻 前壁前壁: :主动脉，肺动脉主动脉，肺动脉 后壁后壁: :食道，降主动脉食道，降主动脉 后下壁后下壁: :冠状静脉冠状静脉 顶壁顶壁: : 肺动脉肺动脉 底部底部: : 左室左室RARVA左房的毗邻左房的毗邻ALVLARVPALALVRARVPAA前壁前壁: AO,PA后壁后壁: 食道，降主动脉食道，降主动脉Possible determinants of the risk of thermal damage to t
7、he esophagus: 1.fat pad surrounding the esophagus, 2.wall thickness of the LA and esophagus, 3.spatial relationship of the esophagus and LAThere is a protective layer of fat between the esophagus and the posterior LA, yet this layer is often discontinuous and, in 2% of normal subjects, completely ab
8、sent.EsophagusEsophagus食管前壁平均厚度食管前壁平均厚度1.9- 5.3 mm, LA后壁的平均厚度后壁的平均厚度 1.3- 3.1 mm.食管与食管与LA之间最小距离为之间最小距离为 3.3 mm; 1.9+1.3+3.3=6.5 mmEsophagusCirculation. 2019;110:3655-3660Esophagus食管食管 Esophagus 左房和食管接触的长度和宽度左房和食管接触的长度和宽度: : 长度长度: 58: 58 14 mm14 mm 宽度宽度: 13: 13 6 mm. 6 mm. 食管和左房之间解剖方向的复杂性食管和左房之间解剖方向的
9、复杂性: 56%: 56%的的病人食管与左侧肺静脉平行病人食管与左侧肺静脉平行, ,其中其中36%36%为左为左上肺静脉向右下肺静脉斜行上肺静脉向右下肺静脉斜行; ;其余其余44%44%偏右偏右或居中或居中EsophagusCirculation. 2019;110:3655-3660食管食管 EsophagusEsophagusCardiac 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
10、 artery and the pulmonary trunk. Note the relationship of the aorta to the anterior walls of the atria.AortaAortathe posterior LA is directly opposed 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 in
11、ferior PVLeft Circumflex ArteryLCx is located in the posterior atrioventricular groove in continuity with the CS; there is commonly a separating 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
12、.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 tree. Phrenic Nerve左左房房腔腔体体 Weve been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor ?te ? ?1t?e ?铰?销? ? ?铰e? ?9铰 ?1 ?1? ae? ?9e ? ?. 43谢谢！谢谢！
