投照体位的选择

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1、冠状动脉造影基础--如何选择最佳的投照体位中山大学附属第一医院心内科李怡正常冠状动脉的解剖及供血范围多体位及多角度投照的意义冠状动脉的基础投照体位右冠左主干前降支回旋支RightCoronaryArteryOriginRightaorticsinus(loweroriginthanLCA)CourseDownrightAVgroovetowardcruxoftheheart,givesoffPDA(85%)fromwhichseptalsarise,continuesinLAVgroovegivingoffposteriorLVbranches(posterolaterals).P

2、DAmayoriginatemoreproximally,bifurcateearlyorbesmallwithpartof“itsterritory”suppliedbyanacutemarginalbranch.Supplies25%to35%ofLeftVentricleRightCoronaryArteryOtherBranchesConusArteryusuallyveryproximal;(~50%haveaseparateorigin)-coursesanteriorlyandupwardovertheRVoutflowtracttowardtheLAD.Maybea

3、nimportantsourceofcollaterals.SANodalArtery(~60%)usually2ndbranchofRCA-coursesobliquelybackwardthroughupperportionofatrialseptumandanteromedialwalloftheRA-suppliesSAnode,usuallyRAandsometimesLA.RightCoronaryArteryOtherBranchesRightVentricular(AcuteMarginalBranches)ArisefrommidRCA;supplyanterio

4、rRV;maybeacollateralsource.AVNodalArteryArisesatornearcrux;suppliesAVnode.PDASuppliesinferiorwall,ventricularseptum,posteromedialpapillarymuscle.LeftCoronaryArteryLeftMainCoronaryArteryOriginupperportionofleftaorticsinusjustbelowthesinotubularridge.Typically0-10mminlength.RarelynoLM(separateor

5、igins).LeftAnteriorDescendingArteryCoursedowntheanteriorinterventriculargroove-usuallyreachesapex.In22%ofcasesdoesnotreachapex.Branchesseptalsanddiagonals-supplylateralwallofLV,anterolateralpapillarymuscle;37%havemedianramus(courseslike1stdiagonal).LADSuppliesanterolateral,apexandseptum;~45%-5

6、5%ofleftventricle.LeftCircumflexArteryOriginfromdistalLMCA.CoursedowndistalleftAVgroove.Branchesobtusemarginal,posterolaterals-supplyposterolateralLV,anterolateralpapillarymuscle.SAnodeartery-38%.Supplies15%-25%ofLV,unlessdominant(supplies40-50%ofLV).冠状动脉造影的常用投照体位投照体位的定义：冠状动脉造影时，投照体位以影像增强器的位置而

7、定，即从影像增强器位置来观察心脏，而不是根据X线束的方位来定位。冠状动脉造影的常用投照体位正位：图象增强器直接对着胸骨左、右侧位：图象增强器分别位于受检者左侧或右侧，其X线与正位垂直左、右前斜位：图象增强器分别位于受检者左侧或右侧且斜向观测心脏头位、足位：图象增强器分别位于受检者的头部或足部右前斜+头位（右肩位）：从受检者右肩观测心脏左前斜+头位（左肩位）：从受检者左肩观测心脏右前斜+足位（肝位）：从受检者肝区观测心脏左前斜+足位（脾位、蜘蛛位）：从受检者脾区观测心