資源描述：
《冠狀動(dòng)脈造影abc課件》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫(kù)。
1、冠心病介入診療--ABC1929年,德國(guó)醫(yī)生WennerForssmann在自己身上進(jìn)行了人類首例心導(dǎo)管檢查術(shù).他將導(dǎo)管經(jīng)左肘前靜脈,鎖骨下靜脈,上腔靜脈送入右心房,并拍了醫(yī)學(xué)史上第一張右心導(dǎo)管胸片,從此揭開(kāi)了介入心臟病學(xué)的序幕.1959年MasonSones利用特制的尖端呈弧形的造影導(dǎo)管,經(jīng)肱動(dòng)脈送入主動(dòng)脈根部進(jìn)行主動(dòng)脈造影,無(wú)意中將造影劑直接注入右冠狀動(dòng)脈內(nèi)使其清晰顯影,這一偶然事件開(kāi)創(chuàng)了冠脈介入診斷技術(shù)的新紀(jì)元冠脈造影50余年的歷程!CAintroducedbyF.MasonSones,Jr,MD(首次冠脈造影)Thefirsthumanstudies-severit
2、yandextentofCAD(首個(gè)人體研究)EarliestnaturalhistorystudiesofprovenCADDynamicvisualizationofLVperformance(左室造影)DemonstrationofpromptandcompleterevascularizationbyCABGRefinementofnaturalhistorystudiesofunoperatedCADpatientsDiscoveryofthebenefitofCABGvs.MedRxinsubsetsofpatientsDelineationofcoronary
3、vasospasmandPrinzmetal’sangina(冠脈痙攣)Significanceofcoronarypathoanatomy(ulceration,thrombus,dissection,aneurysm,musclebridge,collateralvessels)IntroductionofPTCAanddelineationofrestenosis(PTCA及再狹窄)Firstangiographicevidenceofclotlysisinacoronaryvessel1950s1960s1970sRyanCirculation2002,106:75
4、2-756冠脈造影50余年的歷程!Thrombolyticera,withthedemonstrationofspontaneousfibrinolysisduring24hrsofacuteocclusions(心梗24小時(shí)內(nèi)的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治療斑塊消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的發(fā)病機(jī)制)Est
5、imatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分級(jí))Brachytherapy,latestentthrombosis,andpharmocotherapyThecoronarycatheterandnewerimagingdevices(intravascularultrasound,MRI)1980s1990sRyanCirculation2002,106:752-7562013冠脈造影股動(dòng)脈
6、及橈動(dòng)脈路徑股神經(jīng)股總動(dòng)脈股靜脈穿刺位置股骨頭腹股溝韌帶尺動(dòng)脈橈動(dòng)脈肱動(dòng)脈解剖學(xué)橈動(dòng)脈掌淺弓尺動(dòng)脈Allen試驗(yàn)Allen試驗(yàn)解讀AssementofulnararchbyoxymetryAllen’stestissubjectiveanddifficulttointerpretBarbeauscoreBarbeau.Getal;AmHeartJ2004;147:489–932minBarbeau.Getal;AmHeartJ2004;147:489–93NOBarbeauscore冠脈造影導(dǎo)管JudkinsAmplatzTiger導(dǎo)管JR4導(dǎo)管冠脈解剖學(xué)左主干(LM)左前
7、降支(LAD)對(duì)角支(D1,D2)間隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM左前降支Radiographics2007;27:1569-1582Radiographics2007;27:1569-1582右冠狀動(dòng)脈MarginalbranchConusbranchMarginalbranch回旋支回旋支(Cx)鈍緣支(OM1,OM2)OM1CXOM2LADRadiographics2007;27:1569-1582回旋支OMOMLMSCXCXOMRadiographics20
