2019年《心房解剖》ppt课件.pptVIP

心房及其毗邻的解剖与影像学对消融治疗的指导意义 Cavotricuspid Isthmus 三尖瓣环与欧氏瓣和下腔静脉开口之间的峡部宽度约为2~3cm，是房扑折返环中最窄、传导最为缓慢的共同通道。峡部肌小梁交错、重叠，电传导各向异性并呈双向传导。 Carina AF－CARTO MERGE 左心房－肺静脉解剖变异 食管 Esophagus 左房和食管接触的长度和宽度: 长度: 58?14 mm 宽度: 13? 6 mm. 食管和左房之间解剖方向的复杂性: 56%的病人食管与左侧肺静脉平行,其中36%为左上肺静脉向右下肺静脉斜行;其余44%偏右或居中 Weve been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor ??? ????? ????? ?????? ? ?????? ????? ?? ???? ?????? ?????? ??? ????. Figure 3.?(A) This cut through the sagittal plane shows the close relationship of the left atrium to the esophagus (Es), ascending aorta (AAo), and bifurcation of the pulmonary arteries (PA) in this case. Ao = descending aorta; Tr = trachea. (B) The left atrium is viewed from the left-inferior perspective to show the epicardial course of the remnant of the vein of Marshall and its connection to the junction between the great cardiac vein and coronary sinus. The ablation line along the so-called mitral isthmus on the endocardium relates to this area. LI = left inferior pulmonary vein; LS = left superior pulmonary vein. Figure 1 Anatomic considerations for isolation of the left atrial appendage (LAA). A: Anatomy of left myocardial extensions across the ostium of the LAA. Note the thickness of the fibers on the roof of the left atrium (LA) and LAA ostium (Bachmann bundle). Because the posterior wall of the LA typically conducts poorly and circumferential isolation around the pulmonary veins involves the posterior part of the LAA base, ablation on the inferior infero lateral Atrium anteriorly (left inferior pulmonary vein–mitral annulus ablation) may leave only Bachmann bundle conduction to activate the LAA. Ablation anywhere Along the course of these fibers may resultin in advertent LAA isolation, as reported by Chanetal.B:Posterolateral distal coronarysinus(CS) is the drainage site of the remnant of the left superior vena cava—the vein of Marshall. Ablation in the CS at this location may isolate this