造影结果的判读及病变类型的分析精选.pptVIP

造影结果的判读及病变类型的分析 黄文晖 广东省人民医院 广东省心血管病研究所 从造影片我们要看什么？ 如何体位的片中判断正常的冠脉血管？ 如何判断病变的血管？ 常用的一些分类 通过不同的病变类型如何考虑介入治疗的难度？ 从造影片我们要看什么？ 血管的情况 肺野的情况 心包情况 现场还要注意压力的变化 正常冠状动脉 RCA Basic Anatomy Origin right aortic sinus(lower origin than LCA) Course Down right AV groove toward crux of the heart, gives off PDA(85%) from which septals arise, continues in LAV groove giving off posterior LV branches(posterolaterals). PDA may originate more proximally, bifurcate early or be small with part of “its territory” supplied by an acute marginal branch. RCA Other Branches Conus Artery(圆锥支) usually very proximal; courses anteriorly and upward over the RV outflow tract toward the LAD. May be an important Source of collaterals. SA Nodal Artery(窦房结动脉) (~60%) usually 2nd branch of RCA-courses obliquely backward through uper portion of aterial septum and anteromedial wall of the RA-supplies SA node,usually RA and sometimes LA RCA Other Branches PDA(后降支) Supplies inferior wall, ventricular septum, posteromedial papillary muscle. AV Nodal Artery (房室结支) Arises at or near crux; supplies AV node. Right ventricular(Acute marginal Branches锐缘支) Arise from mid RCA; Supply anterior RV; may be a collateral source. RCA Optimal View(s) LAO(30) Cranial(30) particularly for distal bifurcation(AP cranial may be better). RAO main shaft; cranial enhances distal vessels and very proximal; caudal may help with shepherd’s crook. Lateral bifurcations with RV branches-distal bifurcation, particularly with cranial. RCA 圆锥支 窦房结支 右室支 锐缘支 后降支 后侧支 LCA LM Optimal Views LAO caudal and cranial; AP-caudal, cranial or flat. Limit views. May need IVUS LAD Course down the anterior interventricular groove-usually reaches apex. In 22% of cases does not reach apex LCA Branches septals and diagonals-supply lateral wall of LV, anterolateral papillary muscle; 37% have median ramus( courses like 1st diagonal). LAD supplies anterolateral, apex and septum; ~45%-55% of left ventricle.