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1、CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity冠脈CTA：冠脈解剖JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversityArteryDescriptionOrigin:Originatingcusp/sinus
2、ofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment動脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇行程分支名稱大小（口徑及分布）：小、中、大支配區(qū)域合適的圖像質(zhì)量：總體，每條血管，每個層面NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-
3、0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoff左冠狀動脈主干（LM)起點(diǎn)：左valsalva竇（左冠竇）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中間支10-15%關(guān)鍵問題：狹窄致局部供血不足冠狀動脈口疾病動脈瘤，（內(nèi)膜）不規(guī)則剝離LeftAnteriorDescending(LAD)Origin:-FormLe
4、ftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventriculagroovetowardapex2variationsinterminationBranches:DiagonalsseptalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff左前降支（LAD）起點(diǎn)：95－99％起源于LM1-3%直接開口于左冠竇行程：心室前方經(jīng)室間溝達(dá)心尖最后分為兩支分支
5、：角支室間隔支關(guān)鍵問題：冠狀動脈近端或冠狀動脈口疾病心肌橋動脈瘤，（內(nèi)膜）不規(guī)則剝離NormalAnrtomy（LAD)LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordesc
6、ending(ifdominant)Criticalissuesdominance(15-20%)起點(diǎn)：96-98%起源于LM5-2%單獨(dú)開口LCX起源于右冠竇或RCA約0.4%行程：沿著左房室溝下降分支：鈍緣支左后外側(cè)支（營養(yǎng)后外側(cè)壁）左后降支(左側(cè)優(yōu)勢）關(guān)鍵問題：左側(cè)優(yōu)勢（15%-20%)NormalAnatomy(LCX)NormalAnatomy(LCX)Ramusintermedius（中間支）NormalRightcoronaryartery (RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1
7、%Course:downdistalrightAVgroovetowardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)右冠狀動脈(RCA)起點(diǎn)：左valsalva竇（右冠竇）0.1%起源于左心室行程：沿右房室溝下降至房室交點(diǎn)分支：后降支PDA（85%）銳緣支A
