《心房解剖》課件

心房及其毗鄰的解剖與影像學(xué)對消融治療的指導(dǎo)意義心房及其毗鄰的解剖與影像學(xué)對消融治療的指導(dǎo)意義1《心房解剖》課件2CavotricuspidIsthmus

三尖瓣環(huán)與歐氏瓣和下腔靜脈開口之間的峽部寬度約為2~3cm，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、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)Ⅰ區(qū)：三尖瓣環(huán)－下腔靜脈成功率70%Ⅱ區(qū)：三尖瓣環(huán)－冠狀竇口成功率30%Ⅲ區(qū)：冠狀竇口－下腔靜脈成功率10%CavotricuspidIsthmus三尖瓣環(huán)與3《心房解剖》課件4《心房解剖》課件5Figure6.

Figure5Figure6.

Figure56IllustrationshowingtheimportanceofobtainingbothRAOandLAOviewstoascertainmultielectrodecatheterposition.ThetoppanelintheRAOviewthecathetertippointsposteriorly.Thebottompanelshowscorrectpositioningofthecatheter.NotethetipofthecatheterisintheplaneoftheCSandwhenadvancedwillnotadvanceposteriorlyasthecasewhenpositionedbehindtheEustachianridge.Illustrationshowingtheimpor7左心房左房腔體心耳肺靜脈口二尖瓣環(huán)左心房左房腔體8左房腔體HeartRhythm,7(2):2692019左房腔體HeartRhythm,7(2):2692019左房腔體左房腔體10Thehearthasbeencutthroughthe"ridge"toshowitspointedprofileformedbytheinfoldingoftheatrialwall.NotethecontinuationofLAmusculatureontotheLSPV.ThebrokenlinemarkstheisthmusbetweentheorificeoftheLIPVandthemitralannulus.左房腔體HeartRhythm,7(2):2692019Thehearthasbeencutthroug11《心房解剖》課件12CarinaCarina13《心房解剖》課件14carinafibersmusthaveanendocardialtoepicardialrouteneartheperimeteroftheveinsandthusarelessamenabletoendocardialablationattheperimeter周界.carinafibersmusthaveanend15compactatrioventricularnodeCompactAtrioventricularNodeHeartRhythm,7(2):2692019compactatrioventricularnodeC16肺靜脈77%的人有雙側(cè)肺靜脈左側(cè)肺靜脈開口較右側(cè)高下肺靜脈的開口更接近于后壁上肺靜脈與水平面的夾角較下肺靜脈大肺靜脈77%的人有雙側(cè)肺靜脈17AF－CARTOMERGE左心房－肺靜脈解剖變異AF－CARTOMERGE左心房－肺靜脈解剖變異18肺靜脈解剖肺靜脈解剖19肺靜脈解剖rspvripvlspvlipvLAa肺靜脈解剖rspvripvlspvlipvLAa20《心房解剖》課件21左房毗鄰前壁:主動脈，肺動脈后壁:食道，降主動脈后下壁:冠狀靜脈頂壁:肺動脈底部:左室左房毗鄰前壁:主動脈，肺動脈22RARVA左房的毗鄰ALVLARVPALALVRARVPAA前壁:AO,PA后壁:食道，降主動脈RARVA左房的毗鄰ALVLARVPALALVRARVPAA23《心房解剖》課件24《心房解剖》課件25Possibledeterminantsoftheriskofthermaldamagetotheesophagus:

1.fatpadsurroundingtheesophagus,2.wallthicknessoftheLAandesophagus,3.spatialrelationshipoftheesophagusandLAThereisaprotectivelayeroffatbetweentheesophagusandtheposteriorLA,yetthislayerisoftendiscontinuousand,in2%ofnormalsubjects,completelyabsent.EsophagusPossibledeterminantsofther26EsophagusEsophagus27食管前壁平均厚度1.9-5.3mm,LA后壁的平均厚度1.3-3.1mm.食管與LA之間最小距離為3.3mm;1.9+1.3+3.3=6.5mmEsophagus食管前壁平均厚度1.9-5.3mm,LA后壁的平均厚度28Circulation.2019;110:3655-3660EsophagusCirculation.2019;110:3655-36629食管Esophagus左房和食管接觸的長度和寬度:長度:58

14mm寬度:13

6mm.食管和左房之間解剖方向的復(fù)雜性:56%的病人食管與左側(cè)肺靜脈平行,其中36%為左上肺靜脈向右下肺靜脈斜行;其余44%偏右或居中食管Esophagus左房和食管接觸的長度和寬度:30EsophagusEsophagus31Circulation.2019;110:3655-3660食管EsophagusCirculation.2019;110:3655-36632CardiacDynaCTCardiacDynaCT33TheviewofthecardiacbasehasmostoftheatrialwallsremovedtoshowtheproximityoftheLAAtotheleftcoronaryarteryandthepulmonarytrunk.Notetherelationshipoftheaortatotheanteriorwallsoftheatria.AortaTheviewofthecardiacbaseh34AortatheposteriorLAisdirectlyopposedbyalargeportionoftheanteriorsurfaceofthedescendingaorta,withanaveragecontactareaof18.9

4.4mm.aortacompressingtheLAandleftinferiorPVAortatheposteriorLAisdirec35LeftCircumflexArteryLCxislocatedintheposterioratrioventriculargrooveincontinuitywiththeCS;thereiscommonlyaseparatinglayeroffat.TheLCXisalsolocatedincloseproximitytotheinferioraspectoftheLAA.ThemeandistancebetweentheLCxandtheLAAwas3.3mm(0.7–19.6mm),andthemediandistancebetweentheCSandtheLCxwas2.0mm(0.4–9.7mm).LeftCircumflexArteryLCxisl36BronchialTreeAPPABronchialTreeAPPA37BAthePVs,particularlythesuperiorPVs,areinclosecontactwiththebronchialtree.BAthePVs,particularlythesu38《心房解剖》課件39PhrenicNervePhrenicNerve40左房腔體左房腔體41We'vebeenallthewa