冠脈cta：冠脈解剖課件

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

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegmentNormalLeftMain(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(guān)鍵問題：狹窄致局部供血不足冠狀動脈口疾病動脈瘤，（內(nèi)膜）不規(guī)則剝離LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffNormalAnrtomy（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(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）關(guān)鍵問題：左側(cè)優(yōu)勢（15%-20%)NormalAnatomy(LCX)Ramusintermedius（中間支）NormalRightcoronaryartery

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

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)Normalanatomy(RCA)Normalanatomy(RCA)OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-MaysupplycollateralRightdominanceLeftdominanceLesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentricDiffuseLADDiseaseFocalulceratedplaqueCoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryartery潛在危險(20%of異常)起源與主