造影结果的判读及病变类型的分析-黄文晖

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1、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%)fromwhichsepta

2、lsarise,continuesinLAVgroovegivingoffposteriorLVbranches(posterolaterals).PDAmayoriginatemoreproximally,bifurcateearlyorbesmallwithpartof“itsterritory”suppliedbyanacutemarginalbranch.RCAOtherBranchesConusArtery(圆锥支)usuallyveryproximal;coursesanteriorlyandupwardovertheRVoutf

3、lowtracttowardtheLAD.MaybeanimportantSourceofcollaterals.SANodalArtery(窦房结动脉)(~60%)usually2ndbranchofRCA-coursesobliquelybackwardthroughuperportionofaterialseptumandanteromedialwalloftheRA-suppliesSAnode,usuallyRAandsometimesLARCAOtherBranchesPDA(后降支)Suppliesinferiorwall,ve

4、ntricularseptum,posteromedialpapillarymuscle.AVNodalArtery(房室结支)Arisesatornearcrux;suppliesAVnode.Rightventricular(AcutemarginalBranches锐缘支)ArisefrommidRCA;SupplyanteriorRV;maybeacollateralsource.RCAOptimalView(s)LAO(30)Cranial(30)particularlyfordistalbifurcation(APcranialm

5、aybebetter).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.Ma

6、yneedIVUSLADCoursedowntheanteriorinterventriculargroove-usuallyreachesapex.In22%ofcasesdoesnotreachapexLCABranchesseptalsanddiagonals-supplylateralwallofLV,anterolateralpapillarymuscle;37%havemedianramus(courseslike1stdiagonal).LADsuppliesanterolateral,apexandseptum;~45%-55

7、%ofleftventricle.LCXBranchesobtusemarginal,posterolaterals-supplyposterolateralLV,anterolteralpapillarymuscles.SAnodeartery38%Supplies15%-25%ofLV,unlessdominant(supplies40-50%ofLV).APCaudalviewofLCAAPCranialLAOCranialViewLAOCaudalViewAHA/ACC冠脉病变分类A型病变散在病变(长度<10mm)向心型狭窄容易插管到

8、病灶部位各节段间成角<450血管表面较平滑无钙化或很轻度钙化不是管腔完全闭塞狭窄部位不在血管开口处无重要分支狭窄管腔内无血栓B型病变病变成管状(10-20mm).偏