冠脉解剖简析及冠脉造影体位解读.PPT

* View used to engage catheters for the left coronary artery and to position balloons/stents in the LAD. Straightens the proximal circumflex artery. Separates the circumflex and OM. Separates LAD and diagonals (if principle diagonal is inferior to the LAD in the lateral view). Grossly foreshortens the left system. * This illustrates how the ribs “mimic” the right hand, therefore, is a RAO view. * Straightens the LAD, although proximal segment is usually foreshortened. Isolates origins of diagonal branches. One of the best views for diagonal branches. Left main is foreshortened but distal portion can often reveal stenosis. * View used to determine coaxial engagement of the guide catheter tip for the left coronary system. Known as “Spider View”. Used to visualize disease in the left main. Used to visualize origins of the LAD and the circumflex. Excellent view of all left proximal vessels. Should be used when any of the following exist Long left main and proximal LAD Multiple vessel overlap of proximal LAD Horizontal heart Grossly foreshortened left main in LAO cranial * This illustrates the RCA resembling a capital “C”, therefore, it is an LAO view. * This illustrates the RCA resembling a capital “L”, therefore, it is an RAO view. The PDA travels away from you in the RAO view. 冠状动脉的解剖简析及冠脉造影体位解读 右冠状动脉 (RCA) 右冠状动脉 起源 右冠窦(低于左冠起源) 走行 沿右AV沟绕向心十字交叉部， 发出PDA(85%)； 继续前行,在左房室沟发出PL。 支配心肌 支配25％－35％的左心室 右冠状动脉 其他分支血管 圆锥动脉（Conus A）：通常其起源非常近端，经过RV流出道向前向上行走，其方向指向LAD。 窦房结动脉（SAN A）：斜向后通过房间隔的上部和RA的前壁，供应窦房结。 右冠状动脉 其他分支血管 右室支（Right Ventricular），锐缘支（Acute Marginal）：起源于RCA的中段，供应RV前壁。 房室结动脉（AVN A）：起源于或靠近心十字交叉部，供应房室结。 后降支 （PDA）：供应下壁，室间隔，乳头肌后中部。 左冠状动脉 起源 左主干起源于左冠窦的上部，有时左主干缺如。 左主干 (Left Main, LM) 左冠状动脉 走行 沿前室间沟下行,通常到达心尖部，22%的正常人LAD未到达心尖部。 左前降支 (Left Anterior Descending Artery, LAD) 分支 间隔支（Septals）和对角支（Diagonals），供应LV侧壁，乳头肌前侧部，37％的正常人有中间支（Ramus） 支配心肌 供应心室的前侧壁、心尖部和间隔部；45％-55％的左心室 左冠状动脉 走行 沿左室间沟下行。 左回旋支 (Left Circumflex Artery, LCX) 分支 钝缘支（Obtuse Marginal）后侧支（postero-laterals），供应LV后侧壁，