左房解剖及房间隔穿刺技巧要素.pptVIP

肺静脉的变异及其临床意义 为PV引流异常而致的先天性多发性心肺病,是由于右肺静脉开口于下腔静脉,部分PV回流异常而导致的一组病征。Scimitar syndrome, or pulmonary venolobar syndrome (肺静脉叶综合征), is a rare?congenital heart defect characterized by anomalous venous return from the right lung (to the systemic venous drainage, rather than directly to the LA).?This anomalous PVs return can be either partial (PAPVR) or total (TAPVR). The syndrome associated with PAPVR is more commonly known as?Scimitar syndrome?after the curvilinear pattern created on a chest radiograph by the PVs that drain to the IVC.? 弯刀综合征（scimitar?syndrome） 肺静脉的变异及其临床意义 Chest x-ray of a five-year-old girl with Scimitar syndrome. The heart (blue outline) is shifted into the right half of the chest, and the anomalous pulmonary venous return (red) has a shape reminiscent of a?Scimitar. 弯刀综合征（scimitar?syndrome） 左肺静脉与左心耳之间的脊 A Muscle sleeve andPV potential formation Myocardial muscle extensions to coving the outside of PV Muscle sleeve is thickest at the proximal end of vein(1-1.5 mm) Myocardial muscle fibers extend from LA to PV at length of 1-3 cm Usually the sleeve is thickest at the inferior wall of the superior PVs and at the superior wall of the inferior PVs ﹡ ﹡ 心脏大静脉肌袖解剖 远端 近端 心脏大静脉肌袖解剖 左肺静脉与左心耳之间的脊 LPV LAA MA RSPV RIPV LPV LAA PV LLA LAO LAO RAO RAO LSPV LIPV LAAP LAAP LAAP LAAP LSPV LSPV 左心耳和左上肺静脉 LL 二尖瓣环 Marshall静脉 LSPV LIPV LAA 冠状静脉窦 左上腔静脉永存 AP PA LAO 左上腔静脉永存 左心房憩室 Left Atrial Diverticula 左心房憩室较常见（46%），多呈囊型（cystiform），常见部位为近右上肺静脉左心房前上壁（88%），与性别、年龄、房颤类型和左心房大小无关。 ----Wilson L, et al. 2014 HRS 左心房憩室 Left Atrial Diverticula LA LA Nagai 2011 左心房憩室的临床意义： 1. 穿孔：平均LAD壁的厚度是： 0.9mm，而周围心房组织的 厚度是：2.4mm ---- Peng 2012 2. 血栓 左心房憩室 Left Atrial Diverticula Wilson L, et al. 2014 HRS 左心房憩室的临床意义： 1. 穿孔：平均LAD壁的厚度是： 0.9mm，而周围心房组织的 厚度是：2.4mm ---- Peng 2012 2. 血栓 3. 异位兴奋灶: 左心房憩室的组 成与邻近心房组织相近—梳 妆肌、有收缩性 Thanks! Descending Aorta * * 房间隔穿刺的X线影像及模式图 A、B分别为RAO 45°和后前位穿刺成功部位；C、D为相对应体位的左心房造影；E、F为穿间