Anatomia Coronariana Dr Olariu Ioan.

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Presentation transcript:

Anatomia Coronariana Dr Olariu Ioan

. 1. Artera coronara stanga(ACS)- TACS (10-20mm lungime si diametrul de 3-6mm) ia nastere din sinusul coronar stang deasupra valvei aortice si de obicei se divide in: - Artera descendenta anterioara(ADA) - Artera circumflexa(ACX). Uneori TACS se divide in trei ramuri: ADA, ACX si un ram intermediar. 2. Artera coronara dreapta.

ADA(aprox 130mm lungime si diametrul proximal de aprox 3-4mm) Parcurge santul interventricular anterior catre apex pe care il inconjoara si se continua cu 1-2 cm in santul interventricular posterior(artera recurenta) . Da urmatoarele ramuri: - arterele diagonale: iriga peretele anterior al VS si o parte din muschiul papilar antero-lateral. - arterele septale anteriore: iriga 2/3 anterioare ale SIV, ramura drepta si stanga a fasciculului HIS. -ramuri septale posterioare(din artera recurenta): iriga 1/3 posterioara a SIV. -ramuri ventriculare drepte anteriore(artera stanga a conului pulmonarei). Se imparte in 3 segmente: Segmentul I (proximal): intre TACS si prima diagonala(cand aceasta lipseste pana la prima septala). Segmentul II (mediu): intre prima diagonala si a doua diagonala. Segmentul III(distal): distal de originea celei de-a doua diagonale.

ACX(aprox 90mm lungime si diametrul proximal de aprox 3mm) Inconjoara cordul prin segmentul stang al santului coronar, se termina variabil la stanga sau la dreapta fata de crux cordis cel mai adesea dupa ce da 2-3 ramuri pentru peretele lateral al VS (arterele marginale) si ramuri posterolaterale pt peretele posterior VS, sau coboara in santul interventricular posterior ca artera descendenta posteriora(dominanta stanga sau codominanta). Ramuri colaterale: - Ramuri ventriculare stangi(OMI, OMII) -Artera atriului stang cu artera nodului sinusal(45%). - ADP si SLP (15% din cazuri) Se imparte in doua segmente: -Segmentul proximal (de la origine pana la emergenta OMI) -Segmentul distal (de la emergenta OMI pana distal). Iriga peretele lateral si posterior al VS si o parte din muschiul papilar antero-lateral.

Principalele incidente angiografice pt TACS, ADA si ACX.

ACD(aprox 110mm lungime si 4mm diametru in segmentul proximal) Origine in sinusul coronar drept, strabate jumatatea dreapta a santului coronar. Traiectul de ansamblu al ACD este general simetric contralateral cu traiectul ACX realizand impreuna un cerc frontal. In tipul de dominanta dreapta ACD la nivelul crux cordis se continua cu ADP si SLP. Ramurile colaterale sunt: -Artera conului(participa la inelul lui Vieussens impreuna cu ramurile ventriculare drepte din ADA)(20-30% din cazuri are origine separata direct din Ao) - Artera nodului sinusal(55%) -Artera marginala dreapta(iriga VD si apexul ). -Artera nodului atrioventricular (iriga NAV). -Artera descendenta posterioara(iriga 1/3 posteriora a SIV, ) -Sistemul postero-lateral. In dominanta dreapta ACD iriga: peretele inferior al VS, SIV inferior, NAV, ramul drept si portiunea posteriora al ramului stang al fasciculului HIS, muschiul papilar postero- medial. Angiografic se imparte in 3 segmente: -Segmentul I (de la origine pana la prima curbura). -Segmentul II (de la prima curbura pana la a doua curbura) - Segmentul III (de la cea de-a doua curbura pana la crux cordis)

Principalele incidente angiografice pentru ACD

Anatomia coronariana

Anatomia coronariana in plan atrioventricular si interventricular.

Notiunea de dominanta Artera care vascularizeaza fata inferiora a inimii este numita ,,dominanta” si este reprezentata de ADP si SPL, vase care pot fi ramuri ale ACD(85% din cazuri) sau ACX (8%din cazuri). Sistem coronarian echilibrat (7% din cazuri): sistemul in care ADP este data ACD iar SPL de ACX.

Dominanta coronariana

Sistem coronarian cu dominanta dreapta

Sistem coronarian cu dominanta stanga .

Sistem coronarian echilibrat.

Aspectul EKG in IMA corelat cu datele angiografice.

Aspectul EKG in IMA corelat cu datele angiografice.

Aspectul EKG corelat cu datele angiografice.

Anomalii de origine a ACD(1%). Anomalous origin of the right coronary artery from the left coronary sinus.

Anomalii de origine a ADA(0,15%). Four possible pathways of the anomalous left coronary artery arising from the right coronary sinus (R): A, Interarterial (between the aorta and the pulmonary artery [PA]); B, retroaortic; C, prepulmonic; and D, septal (beneath the right ventricular outflow tract). L = left coronary sinus, N = non-coronary sinus.The right coronary artery has a normal origin from the right coronary sinus (curved arrow) but the left anterior descending artery arises from the right coronary cusp and courses beneath the pulmonary artery (straight arrow). F, The left anterior descending artery arising from the right coronary sinus and taking a septal (subpulmonic) course.

Origine a ACS din artera pulmonara(0,002%). Anomalous origin of the left coronary artery (LCA) from the pulmonary artery. A to C, The thoracic aortogram shows a large right coronary artery (RCA) and no antegrade filling of the LCA. The LCA fills primarily through extensive collaterals from the RCA to the LADA (straight arrows). The anomalous origin of the LCA from the pulmonary artery is demonstrated in late phases of the aortogram (C, curved arrow).

Anomalii de origine a ACX (0,67%) Anomalous origin of the left circumflex coronary artery from the right coronary sinus.

Artera coronara unica(0,066%).

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