《冠脉CTA：冠脉解剖》.ppt

Absent Left Main(separate LAD/LCX origins) Anomalous RCA Anomalous LM from RSV 冠脉CTA：冠脉解剖 冠脉CTA：冠脉解剖 Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University Artery Description Origin: Originating cusp / sinus of valsalva Course Branch name Size (caliber and distribution):small medium large Dominance Adequacy of image quality for interpretation overall， per vessel ，per segment 动脉的描述 起点：起始点/valsalva窦 行程 分支名称 大小（口径及分布）：小、中、大 支配区域 合适的图像质量：总体，每条血管，每个层面 Normal Left Main (LM) Origin -left sinus valsalva -Absent in 1% Separate,adjacent LAD LCX ostia - 0.5% Branches: LAD LCX =85% LAD,LCX and Ramus 10-15% Critical issues: － stenosis due to risk region －Presence of ostial disease －Other: aneurysms anomalous take off 左冠状动脉主干（LM) 起点： 左valsalva窦（左冠窦） 1％例外 直接分出LAD LCX占0.5％ 分支：分出LAD LCX占58% LAD,LCX 和 中间支 10-15% 关键问题： 狭窄致局部供血不足 冠状动脉口疾病 动脉瘤，（内膜）不规则剥离 Left Anterior Descending(LAD) Origin: -Form Left Main 95-99% -1-3% separate ostium Left sinus Course Anterior intraventricula groove toward apex 2 variations in termination Branches:Diagonals septal perforators Critical issues Presence of ostial/proximal disease Myocardial bridges Other:aneurysms anomalous take off 左前降支（LAD） 起点：95－99％起源于LM 1-3%直接开口于左冠窦 行程：心室前方 经室间沟达心尖 最后分为两支 分支：角支 室间隔支 关键问题：冠状动脉近端或冠状 动脉口疾病 心肌桥 动脉瘤，（内膜）不规则 剥离 Normal Anrtomy（LAD) Left Circumflex (LCX) Origin: Originating form LM in 96-98% 5-2% separate ostium LCX origin form right sinus or RCA (0.4%) Course:down distal left AV groove Branches obtuse marginal branches Left posterior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant) Critical issues dominance (15-20%) 起点：96-98%起源于LM 5-2%单独开口 LCX起源于右冠窦或RCA约0.4% 行程：沿着左房室沟下降 分支