《心房解剖》ppt課件

1、心房及其毗鄰的解剖與影像心房及其毗鄰的解剖與影像學(xué)對(duì)消融治療的指點(diǎn)意義學(xué)對(duì)消融治療的指點(diǎn)意義Cavotricuspid Isthmus 三尖瓣環(huán)與歐氏瓣和下腔靜脈開(kāi)口之間的峽部寬度約為23cm，是房撲折返環(huán)中最窄、傳導(dǎo)最為緩慢的共同通道。峽部肌小梁交錯(cuò)、重疊，電傳導(dǎo)各向異性并呈雙向傳導(dǎo)。Fischer等將右房峽部分為三區(qū)等將右房峽部分為三區(qū)區(qū)：三尖瓣環(huán)下腔靜脈區(qū)：三尖瓣環(huán)下腔靜脈 勝利率勝利率70%區(qū)：三尖瓣環(huán)冠狀竇口區(qū)：三尖瓣環(huán)冠狀竇口 勝利率勝利率30%區(qū)：冠狀竇口下腔靜脈區(qū)：冠狀竇口下腔靜脈 勝利率勝利率10%Figure 6. Figure 5Illustration showing

2、the importance of obtaining both RAO and LAO views to ascertain multielectrode catheter position. The top panel in the RAO view the catheter tip points posteriorly. The bottom panel shows correct positioning of the catheter. Note the tip of the catheter is in the plane of the CS and when advanced wi

3、ll not advance posteriorly as the case when positioned behind the Eustachian ridge.左心房左心房 左房腔體左房腔體 心耳心耳 肺靜脈口肺靜脈口 二尖瓣環(huán)二尖瓣環(huán)左房腔體左房腔體Heart Rhythm, 7(2):269 2021左房腔體左房腔體The heart has been cut through the ridge to show its pointed profile formed by the infolding of the atrial wall. Note the continuation o

4、f LA musculature onto the LSPV. The broken line marks the isthmus between the orifice of the LIPV and the mitral annulus.左房腔體左房腔體Heart Rhythm, 7(2):269 2021Carinacarina fibers must have an endocardial to epicardial route near the perimeter of the veins and thus are less amenable to endocardial ablat

5、ion at the perimeter周界周界.compact atrioventricular nodeCompact Atrioventricular NodeHeart Rhythm, 7(2):269 2021肺靜脈肺靜脈 77%77%的人有雙側(cè)肺靜脈的人有雙側(cè)肺靜脈 左側(cè)肺靜脈開(kāi)口較右側(cè)高左側(cè)肺靜脈開(kāi)口較右側(cè)高 下肺靜脈的開(kāi)口更接近于后壁下肺靜脈的開(kāi)口更接近于后壁 上肺靜脈與程度面的夾角較下肺靜脈大上肺靜脈與程度面的夾角較下肺靜脈大AFAFCARTO MERGECARTO MERGE 左心房肺靜脈解剖變異左心房肺靜脈解剖變異肺靜脈解剖肺靜脈解剖肺靜脈解剖肺靜脈解剖rspvripvl

6、spvlipvLAa左房毗鄰左房毗鄰 前壁前壁: :自動(dòng)脈，肺動(dòng)脈自動(dòng)脈，肺動(dòng)脈 后壁后壁: :食道，降自動(dòng)脈食道，降自動(dòng)脈 后下壁后下壁: :冠狀靜脈冠狀靜脈 頂壁頂壁: : 肺動(dòng)脈肺動(dòng)脈 底部底部: : 左室左室RARVA左房的毗鄰左房的毗鄰ALVLARVPALALVRARVPAA前壁前壁: AO,PA后壁后壁: 食道，降自動(dòng)脈食道，降自動(dòng)脈Possible determinants of the risk of thermal damage to the esophagus: 1.fat pad surrounding the esophagus, 2.wall thickness of

7、 the LA and esophagus, 3.spatial relationship of the esophagus and LAThere is a protective layer of fat between the esophagus and the posterior LA, yet this layer is often discontinuous and, in 2% of normal subjects, completely absent.EsophagusEsophagus食管前壁平均厚度食管前壁平均厚度1.9- 5.3 mm, LA后壁的平均厚度后壁的平均厚度 1

8、.3- 3.1 mm.食管與食管與LA之間最小間隔為之間最小間隔為 3.3 mm; 1.9+1.3+3.3=6.5 mmEsophagusCirculation. 2004;110:3655-3660Esophagus食管食管 Esophagus 左房和食管接觸的長(zhǎng)度和寬度左房和食管接觸的長(zhǎng)度和寬度: : 長(zhǎng)度長(zhǎng)度: 58: 5814 mm14 mm 寬度寬度: 13: 13 6 mm. 6 mm. 食管和左房之間解剖方向的復(fù)雜性食管和左房之間解剖方向的復(fù)雜性: 56%: 56%的的病人食管與左側(cè)肺靜脈平行病人食管與左側(cè)肺靜脈平行, ,其中其中36%36%為左為左上肺靜脈向右下肺靜脈斜行上肺靜

9、脈向右下肺靜脈斜行; ;其他其他44%44%偏右偏右或居中或居中EsophagusCirculation. 2004;110:3655-3660食管食管 EsophagusEsophagusCardiac Dyna CTThe view of the cardiac base has most of the atrial walls removed to show the proximity of the LAA to the left coronary artery and the pulmonary trunk. Note the relationship of the aorta to

10、the anterior walls of the atria.AortaAortathe posterior LA is directly opposed by a large portion of the anterior surface of the descending aorta, with an average contact area of 18.9 4.4 mm . aorta compressing the LA and left inferior PVLeft Circumflex ArteryLCx is located in the posterior atrioven

11、tricular groove in continuity with the CS; there is commonly a separating layer of fat. The LCX is also located in close proximity to the inferior aspect of the LAA. The mean distance between the LCx and the LAA was 3.3 mm (0.719.6 mm), and the median distance between the CS and the LCx was 2.0 mm (0.49.7 mm).Bronchial TreeAPPABAthe PVs, particularly the superior PVs, are in close contact with the bronchial tree. Phr