冠状动脉和冠状静脉的解剖(英文).pptx

Anatomy of the coronary circulationAngiographic VISUALIZATION;OUTLINE;Coronary arterial anatomy;The coronary arteries and their major branches are sub-epicardially located;;;The LEIDEN convention;;;Right coronary artery;Right coronary artery;Right coronary artery;Right coronary artery;Right coronary artery;Clinical division of the RCA;Left coronary artery;Left anterior descending artery;LAD(contd);Clinical division of the LAD;Left circumflex artery;;Clinical division of the LCX;Coronary segment classification system;Prognostication scores; “Dominance”;Nodal blood supply;Arterial anastomoses;Coronary artery variations;Coronary artery variations;? Coronary artery Variation vs Anomalies A broad spectrum of variations of which some may cause adverse effects Most of the coronary variations may have no clinical implications as can be proven by myocardial perfusion studies. The regional distribution of a coronary artery, rather than its absolute origin and characteristics. ;Level of variables 1) Ostium 2) Size 3) Proximal course 4) Mid-course 5) Intramyocardial ramifications 6) Termination Anomalies without a shunt: 1. Abnormal number : 1/ 3/ 4 ostia 2. Anomalous origin: a) Outside SOV b) Independent origin from same sinus c) Opposite sinus d) Other artery 3. Myocardial bridge 4. Segmental stenosis/hypoplasia Anomalies with shunt: 1) Fistula 2) APOCA C. Aneurysms ;A puzzling issue…..;The most common coronary variation (Cleveland Clinic-1,26,000 patients) was separate ostia for LAD LCX – 0.41% and 2nd commonest was LCX from RCS / RCA – 0.37% However, in another series of 1950 angiograms coronary anomalies were seen in 5.6% cases and split RCA (1.2%) was the commonest.;Level of variables 1) Ostium 2) Size 3) Proximal course