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Anatomia Coronariana

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 : - A rtera descendenta anterioara(ADA)

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Anatomia Coronariana

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  1. Anatomia Coronariana • Dr Olariu Ioan

  2. . 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 treiramuri:ADA, ACX si un ram intermediar. 2. Arteracoronaradreapta.

  3. ADA(aprox 130mm lungimesidiametrul proximal de aprox 3-4mm) • Parcurgesantulinterventricular anterior catre apex pe care ilinconjoarasi se continua cu 1-2 cm in santulinterventricular posterior(arterarecurenta) . • Daurmatoareleramuri: - arterelediagonale: irigaperetele anterior al VS si o parte din muschiulpapilarantero-lateral. - artereleseptaleanteriore: iriga 2/3 anterioare ale SIV, ramuradreptasistanga a fasciculului HIS. -ramuriseptaleposterioare(din arterarecurenta): iriga 1/3 posterioara a SIV. -ramuriventricularedrepteanteriore(arterastanga a conuluipulmonarei). Se imparte in 3 segmente: Segmentul I (proximal): intre TACS si prima diagonala(candaceastalipsestepana la prima septala). Segmentul II (mediu): intre prima diagonalasi a douadiagonala. Segmentul III(distal): distal de origineacelei de-a douadiagonale.

  4. ACX(aprox 90mm lungimesidiametrul proximal de aprox 3mm) • Inconjoaracordulprinsegmentulstang al santuluicoronar, se terminavariabil la stangasau la dreaptafata de crux cordiscelmaiadeseadupaceda 2-3 ramuripentruperetele lateral al VS (arterelemarginale) siramuriposterolaterale pt peretele posterior VS, saucoboara in santulinterventricular posterior ca arteradescendentaposteriora(dominantastangasaucodominanta). • Ramuricolaterale: - Ramuriventricularestangi(OMI, OMII) -Arteraatriuluistang cu arteranoduluisinusal(45%). - ADP si SLP (15% din cazuri) • Se imparte in douasegmente: -Segmentul proximal (de la originepana la emergenta OMI) -Segmentul distal (de la emergenta OMI pana distal). Irigaperetele lateral si posterior al VS si o parte din muschiulpapilarantero-lateral.

  5. Principaleleincidenteangiografice pt TACS, ADA si ACX.

  6. ACD(aprox 110mm lungimesi 4mm diametru in segmentul proximal) • Origine in sinusulcoronardrept, strabatejumatateadreapta a santuluicoronar. Traiectul de ansamblu al ACD este general simetriccontralateral cu traiectul ACX realizandimpreuna un cerc frontal. In tipul de dominantadreapta ACD la nivelul crux cordis se continua cu ADP si SLP. • Ramurilecolateralesunt: -Arteraconului(participa la inelulluiVieussensimpreuna cu ramurileventricularedrepte din ADA)(20-30% din cazuri are origine separata direct din Ao) - Arteranoduluisinusal(55%) -Arteramarginaladreapta(iriga VD siapexul ). -Arteranoduluiatrioventricular (iriga NAV). -Arteradescendentaposterioara(iriga 1/3 posteriora a SIV, ) -Sistemulpostero-lateral. In dominantadreapta ACD iriga: peretele inferior al VS, SIV inferior, NAV, ramuldreptsiportiuneaposteriora al ramuluistang al fasciculului HIS, muschiulpapilarpostero-medial. Angiografic se imparte in 3 segmente: -Segmentul I (de la originepana la prima curbura). -Segmentul II (de la prima curburapana la a douacurbura) - Segmentul III (de la cea de-a douacurburapana la crux cordis)

  7. Principaleleincidenteangiografice pentru ACD

  8. Anatomia coronariana

  9. Anatomia coronariana in plan atrioventricular si interventricular.

  10. 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.

  11. Dominanta coronariana

  12. Sistemcoronarian cu dominantadreapta

  13. Sistemcoronarian cu dominantastanga .

  14. Sistemcoronarianechilibrat.

  15. Aspectul EKG in IMA corelat cu datele angiografice.

  16. Aspectul EKG in IMA corelat cu datele angiografice.

  17. Aspectul EKG corelat cu datele angiografice.

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

  19. 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.

  20. Origine a ACS din arterapulmonara(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).

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

  22. Arteracoronaraunica(0,066%).

  23. Va multumesc

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