投照体位的选择.ppt

冠状动脉造影基础--如何选择最佳的投照体位 中山大学附属第一医院心内科 李 怡 正常冠状动脉的解剖及供血范围 多体位及多角度投照的意义 冠状动脉的基础投照体位 右冠 左主干 前降支 回旋支 Right Coronary Artery 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 withpart of “its territory” supplied by an acute marginal branch. Supplies 25% to 35% of Left Ventricle Right Coronary Artery Other Branches Conus Artery usually very proximal; (~50% have a separate origin)-courses anteriorly and upward over the RV outflow tract toward the LAD. May be an important source of collaterals. SA Nodal Artery (~60%) usually 2nd branch of RCA-courses obliquely backward through upper portion of atrial septum and anteromedial wall of the RA-supplies SA node, usually RA and sometimes LA. Right Coronary Artery Other Branches Right Ventricular (Acute Marginal Branches) Arise from mid RCA; supply anterior RV; may be a collateral source. AV Nodal Artery Arises at or near crux; supplies AV node. PDA Supplies inferior wall, ventricular septum, posteromedial papillary muscle. Left Coronary Artery Left Main Coronary Artery Origin upper portion of left aortic sinus just below the sinotubular ridge. Typically 0-10 mm in length. Rarely no LM (separate origins). Left Anterior Descending Artery Course down the anterior interventricular groove-usually reaches apex. In 22% of cases does not reach apex. 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. Left Circumflex Artery Origin from distal LMCA. Course down distal left AV groove. Branches obtuse marginal, posterolaterals-supply posterolateral LV, anterolateral papillary muscle. SA node artery- 38%. Supplies 15%-25% of LV, unless dominan