造影结果的判读及病变类型的分析_黄文晖.ppt

造影结果的判读及病变类型的分析黄文晖广东省人民医院广东省心血管病研究所

从造影片我们要看什么？如何体位的片中判断正常的冠脉血管？如何判断病变的血管？常用的一些分类通过不同的病变类型如何考虑介入治疗的难度？

从造影片我们要看什么？血管的情况肺野的情况心包情况现场还要注意压力的变化

正常冠状动脉

RCABasicAnatomyOriginrightaorticsinus(loweroriginthanLCA)CourseDownrightAVgroovetowardcruxoftheheart,givesoffPDA(85%)fromwhichseptalsarise,continuesinLAVgroovegivingoffposteriorLVbranches(posterolaterals).PDAmayoriginatemoreproximally,bifurcateearlyorbesmallwithpartof“itsterritory”suppliedbyanacutemarginalbranch.

RCAOtherBranchesConusArtery(圆锥支)usuallyveryproximal;coursesanteriorlyandupwardovertheRVoutflowtracttowardtheLAD.MaybeanimportantSourceofcollaterals.SANodalArtery(窦房结动脉)(~60%)usually2ndbranchofRCA-coursesobliquelybackwardthroughuperportionofaterialseptumandanteromedialwalloftheRA-suppliesSAnode,usuallyRAandsometimesLA

RCAOtherBranchesPDA(后降支)Suppliesinferiorwall,ventricularseptum,posteromedialpapillarymuscle.AVNodalArtery(房室结支)Arisesatornearcrux;suppliesAVnode.Rightventricular(AcutemarginalBranches锐缘支)ArisefrommidRCA;SupplyanteriorRV;maybeacollateralsource.

RCAOptimalView(s)LAO(30)Cranial(30)particularlyfordistalbifurcation(APcranialmaybebetter).RAOmainshaft;cranialenhancesdistalvesselsandveryproximal;caudalmayhelpwithshepherd’scrook.LateralbifurcationswithRVbranches-distalbifurcation,particularlywithcranial.

RCA圆锥支窦房结支右室支锐缘支后降支后侧支

LCALMOptimalViewsLAOcaudalandcranial;AP-caudal,cranialorflat.Limitviews.MayneedIVUSLADCoursedowntheanteriorinterventriculargroove-usuallyreachesapex.In22%ofcasesdoesnotreachapex

LCABranchesseptalsanddiagonals-supplylateralwallofLV,anterolateralpapillarymuscle;37%havemedianramus(courseslike1stdiagonal).LADsuppliesanterolateral,apexandseptum;~45%-55%ofleftventricle.

LCXBranchesobtusemarginal,posterolaterals-supplyp