冠脈CTA：冠脈解剖課件

CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversityCoronaryCTA:coronaryanatomy1冠脈CTA：冠脈解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

冠脈CTA：冠脈解剖JuileMillerMD2ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegmentArteryDescriptionOrigin:Orig3動(dòng)脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇行程分支名稱大?。趶郊胺植迹盒　⒅?、大支配區(qū)域合適的圖像質(zhì)量：總體，每條血管，每個(gè)層面動(dòng)脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇4NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoffNormalLeftMain(LM)Origin5左冠狀動(dòng)脈主干（LM)起點(diǎn)：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(guān)鍵問題：狹窄致局部供血不足冠狀動(dòng)脈口疾病動(dòng)脈瘤，（內(nèi)膜）不規(guī)則剝離左冠狀動(dòng)脈主干（LM)起點(diǎn)：左valsalva竇（左冠竇）6LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffLeftAnteriorDescending(LAD)O7左前降支（LAD）起點(diǎn)：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(dá)心尖最后分為兩支分支：角支室間隔支關(guān)鍵問題：冠狀動(dòng)脈近端或冠狀動(dòng)脈口疾病心肌橋動(dòng)脈瘤，（內(nèi)膜）不規(guī)則剝離

左前降支（LAD）起點(diǎn)：95－99％起源于LM8NormalAnrtomy（LAD)NormalAnrtomy（LAD)9LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)LeftCircumflex(LCX)Origin:10起點(diǎn)：96-98%起源于LM5-2%單獨(dú)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(cè)支（營養(yǎng)后外側(cè)壁）左后降支(左側(cè)優(yōu)勢(shì)）關(guān)鍵問題：左側(cè)優(yōu)勢(shì)（15%-20%)起點(diǎn)：96-98%起源于LM11NormalAnatomy(LCX)NormalAnatomy(LCX)12NormalAnatomy(LCX)NormalAnatomy(LCX)13Ramusintermedius（中間支）Ramusintermedius（中間支）14NormalRightcoronaryartery

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

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)NormalRightcoronaryartery

(15右冠狀動(dòng)脈(RCA)起點(diǎn)：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(diǎn)分支：后降支PDA（85%）銳緣支AM右室后側(cè)支PL

關(guān)鍵問題：右側(cè)優(yōu)勢(shì)（85%）右冠狀動(dòng)脈(RCA)起點(diǎn)：左valsalva竇（右冠竇）16Normalanatomy(RCA)Normalanatomy(RCA)17Normalanatomy(RCA)Normalanatomy(RCA)18OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-MaysupplycollateralOtherbranchesSAnodalArtery19其他分支竇房結(jié)動(dòng)脈：約60%起源于RCA,40%LCX房室結(jié)動(dòng)脈：RCA圓錐動(dòng)脈：RCA其他分支竇房結(jié)動(dòng)脈：約60%起源于RCA,40%LCX20RightdominanceRightdominance21LeftdominanceLeftdominance22LesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentricLesiondescriptionLocation23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病變的描述定位：開口，鄰近，中間，末梢24DiffuseLADDiseaseDiffuseLADDisease25FocalulceratedplaqueFocalulceratedplaque26CoronaryanomaliesBenign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistulaCoronaryanomaliesBenign(0.5-127冠狀動(dòng)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(dòng)脈后從主動(dòng)脈異常起源RCA前高位起源小的瘺管冠狀動(dòng)脈異常良性(0.5-1%)(80%of異常)28CoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryarteryCoronaryanomaliesPotentially29潛在危險(xiǎn)(20%of異常)起源與主動(dòng)脈竇對(duì)面的室壁瘤(0.1-0.2%)異常起源于PA(0.01%)多發(fā)或大的冠狀動(dòng)脈瘺單一冠狀動(dòng)脈潛在危險(xiǎn)(20%of異常)30CoronaryanomaliesCoronaryanomalies31AbsentLeftMain

(separateLAD/LCXorigins)AbsentLeftMain

(separateLAD32AnomalousRCAAnomalousRCA33AnomalousLMfromRSVAnomalousLMfromRSV34冠脈CTA：冠脈解剖課件35CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversityCoronaryCTA:coronaryanatomy36冠脈CTA：冠脈解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

冠脈CTA：冠脈解剖JuileMillerMD37ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegmentArteryDescriptionOrigin:Orig38動(dòng)脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇行程分支名稱大?。趶郊胺植迹盒?、中、大支配區(qū)域合適的圖像質(zhì)量：總體，每條血管，每個(gè)層面動(dòng)脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇39NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoffNormalLeftMain(LM)Origin40左冠狀動(dòng)脈主干（LM)起點(diǎn)：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(guān)鍵問題：狹窄致局部供血不足冠狀動(dòng)脈口疾病動(dòng)脈瘤，（內(nèi)膜）不規(guī)則剝離左冠狀動(dòng)脈主干（LM)起點(diǎn)：左valsalva竇（左冠竇）41LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffLeftAnteriorDescending(LAD)O42左前降支（LAD）起點(diǎn)：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(dá)心尖最后分為兩支分支：角支室間隔支關(guān)鍵問題：冠狀動(dòng)脈近端或冠狀動(dòng)脈口疾病心肌橋動(dòng)脈瘤，（內(nèi)膜）不規(guī)則剝離

左前降支（LAD）起點(diǎn)：95－99％起源于LM43NormalAnrtomy（LAD)NormalAnrtomy（LAD)44LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)LeftCircumflex(LCX)Origin:45起點(diǎn)：96-98%起源于LM5-2%單獨(dú)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(cè)支（營養(yǎng)后外側(cè)壁）左后降支(左側(cè)優(yōu)勢(shì)）關(guān)鍵問題：左側(cè)優(yōu)勢(shì)（15%-20%)起點(diǎn)：96-98%起源于LM46NormalAnatomy(LCX)NormalAnatomy(LCX)47NormalAnatomy(LCX)NormalAnatomy(LCX)48Ramusintermedius（中間支）Ramusintermedius（中間支）49NormalRightcoronaryartery

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

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)NormalRightcoronaryartery

(50右冠狀動(dòng)脈(RCA)起點(diǎn)：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(diǎn)分支：后降支PDA（85%）銳緣支AM右室后側(cè)支PL

關(guān)鍵問題：右側(cè)優(yōu)勢(shì)（85%）右冠狀動(dòng)脈(RCA)起點(diǎn)：左valsalva竇（右冠竇）51Normalanatomy(RCA)Normalanatomy(RCA)52Normalanatomy(RCA)Normalanatomy(RCA)53OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-MaysupplycollateralOtherbranchesSAnodalArtery54其他分支竇房結(jié)動(dòng)脈：約60%起源于RCA,40%LCX房室結(jié)動(dòng)脈：RCA圓錐動(dòng)脈：RCA其他分支竇房結(jié)動(dòng)脈：約60%起源于RCA,40%LCX55RightdominanceRightdominance56LeftdominanceLeftdominance57LesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentricLesiondescriptionLocation58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病變的描述定位：開口，鄰近，中間，末梢59