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1、冠心病介入诊疗--ABC1929年,德国医生WennerForssmann在自己身上进行了人类首例心导管检查术.他将导管经左肘前静脉,锁骨下静脉,上腔静脉送入右心房,并拍了医学史上第一张右心导管胸片,从此揭开了介入心脏病学的序幕.1959年MasonSones利用特制的尖端呈弧形的造影导管,经肱动脉送入主动脉根部进行主动脉造影,无意中将造影剂直接注入右冠状动脉内使其清晰显影,这一偶然事件开创了冠脉介入诊断技术的新纪元冠脉造影50余年的历程!CAintroducedbyF.MasonSones,Jr,MD(首次冠脉造影)Thefirsthumanstudies-severit
2、yandextentofCAD(首个人体研究)EarliestnaturalhistorystudiesofprovenCADDynamicvisualizationofLVperformance(左室造影)DemonstrationofpromptandcompleterevascularizationbyCABGRefinementofnaturalhistorystudiesofunoperatedCADpatientsDiscoveryofthebenefitofCABGvs.MedRxinsubsetsofpatientsDelineationofcoronary
3、vasospasmandPrinzmetal’sangina(冠脉痉挛)Significanceofcoronarypathoanatomy(ulceration,thrombus,dissection,aneurysm,musclebridge,collateralvessels)IntroductionofPTCAanddelineationofrestenosis(PTCA及再狭窄)Firstangiographicevidenceofclotlysisinacoronaryvessel1950s1960s1970sRyanCirculation2002,106:75
4、2-756冠脉造影50余年的历程!Thrombolyticera,withthedemonstrationofspontaneousfibrinolysisduring24hrsofacuteocclusions(心梗24小时内的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治疗斑块消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的发病机制)Est
5、imatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分级)Brachytherapy,latestentthrombosis,andpharmocotherapyThecoronarycatheterandnewerimagingdevices(intravascularultrasound,MRI)1980s1990sRyanCirculation2002,106:752-7562013冠脉造影股动脉
6、及桡动脉路径股神经股总动脉股静脉穿刺位置股骨头腹股沟韧带尺动脉桡动脉肱动脉解剖学桡动脉掌浅弓尺动脉Allen试验Allen试验解读AssementofulnararchbyoxymetryAllen’stestissubjectiveanddifficulttointerpretBarbeauscoreBarbeau.Getal;AmHeartJ2004;147:489–932minBarbeau.Getal;AmHeartJ2004;147:489–93NOBarbeauscore冠脉造影导管JudkinsAmplatzTiger导管JR4导管冠脉解剖学左主干(LM)左前
7、降支(LAD)对角支(D1,D2)间隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM左前降支Radiographics2007;27:1569-1582Radiographics2007;27:1569-1582右冠状动脉MarginalbranchConusbranchMarginalbranch回旋支回旋支(Cx)钝缘支(OM1,OM2)OM1CXOM2LADRadiographics2007;27:1569-1582回旋支OMOMLMSCXCXOMRadiographics20
