冠状动脉和冠状静脉的解剖（英文）ppt课件.pptxVIP

Anatomy of the coronary circulationAngiographic VISUALIZATION Dr Sandeep Mohanan Department of Cardiology Calicut Medical College 1/10/12OUTLINECoronary arterial anatomyVariations in coronary circulationCoronary venous anatomyAngiographic views of coronary arteriesCoronary arterial anatomy1st anatomical drawings- Leonardo da VinciOblique inverted crownThe coronary arteries and their major branches are sub-epicardially locatedPericardium (Epicardium)Epicardial VesselSubepicardiumMyocardiumSubendocardiumLCA ostium ~ 4mmRCA ostium~ 3.2mmThe LEIDEN conventionEach artery arises from respective aortic sinuses - Right coronary sinus(anterior) - Left coronary sinus(left posterior) - Non-coronary sinus(right posterior)1R2LCx pattern Right coronary artery~ 9.8cm 1)Conus artery/ Infundibular/ Third coronary/ Adipose /Arteria of VieussensSeparate ostium in 23% - 51%- Circle of VieussensRight coronary artery2) Atrial branches of the RCA- 1mmSA nodal artery ( Ramus crista terminalis) – 55-65% Right coronary artery3) Right ventricular branchesAcute right marginal arteryRamus crista supraterminalis (Superior septal artery) – 12 -20% , malesRight coronary artery4) Posterior descending arteryDominancePosterior septal branches - 15mm5) AV nodal artery- 80 -90% Right coronary artery6) Postero-lateral branches to the LV- Inferior wall of the LVClinical division of the RCAProximal - Ostium to 1st main RV branchMid - 1st RV branch to acute marginal branchDistal - acute margin to the cruxLeft coronary artery LMCA10-15mm(upto 30mm) length 3-6mm(upto 10mm diameter)Trifurcates in 1/3rd : Ramus intermedius/ median artery/ left diagonal artery/straight LV arteryRare variations – absent LMCA/ pentafurcationLeft anterior descending artery - ~ 14.7 cm ; Type I (22%) , Type II Type III- 2-9 diagonal branches90deg bend after turning around P. conus as it gives off 2nd diagonal branchRight ventricular branches( left conal/pre-infundibular A)~ 10 septal perfo