冠状动脉造影安全解析.pptVIP

左前斜450足位300 左前斜位450 左前斜位130头位250 右前斜300 LAD RCA RCA LCA RCA D1 OM1 PL PD PL PD 左前斜450足位300 后前头位250 后前足位250 左前斜450头位250 D1 D3 D2 OM1 OM2 S1 Ramus LAC PL S2 LCX LAD 右前斜300 右前斜位300 左前斜位450 左前斜100头位250 segments of coronary arteries 冠状动脉病变的定位可直接用各血管支的名称外，仔细区分可选用15段分法来描述。 右冠状动脉分四段：第1段为右冠状动脉的水平段；第2段为垂直段；第3段为后水平段；第4段为分支以后，包括后降支、后侧支和房室结支； 左冠状动脉分11段：第5段为左主干，第6段为前降支的近段，从前降支的开口到分出第一间隔支；第7段为前降支的中段，从第一间隔支到分出第二对角支；第8段为前降支的远段，第二对角支分出以后；第9段为第一对角支；第10段为第二对角支；第11段为回旋支近段；第12段为钝缘支（OM）；第13段为回旋支的远段；第14段为回旋支发出的后降支；第15段为回旋支发出的后侧支。 THANK YOU VERY MUCH * * 35 * * Two types of grafts are used to bypass the coronary arteries: saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts, and free radial artery. Bypass grafts present cannulation difficulties because of their unusual orientation and location. Most catheters are designed for native vessels that come off one of the cusps. These catheters are designed to come over the aortic arch and orient in a specific manner. The SVGs present some unique problems when it comes to engagement. The saphenous vein is removed from the leg and attached proximally to the aorta and distally to the coronary artery beyond the lesion. Because of the short distance between the aortic arch and the origin of the graft, the guide catheter must span the aorta, resting with its secondary curve on the posterior wall and its tip on the anterior wall to provide a stable platform for advancing the balloon catheter. The IMA arises from the left subclavian artery in proximity to the heart. The IMA is dissected away from the chest wall, the distal end is anastomosed directly to the coronary artery distal to the lesion while the proximal end maintains its original takeoff from the subclavian artery. 冠状动脉造影安全性与质量 阜外心血管病医院 冠心病诊疗中心 尤士杰 安全性的要求 适应症选择（患者和介入的条件评估） 如何造影过程顺利（人员和设备以及抢救经验） 怎样减少患者的并发症（各种可能或潜在的风险） 提高处理的任何意外的能力（临床，介入，手术） 制造出图象清晰结果有效的结果（器械与影象的选择） 介入人员的具体标准 应有操作常规指南、良好的操作技术、认真细致的操作过程、及时准确处理各种危险的能力 具有使用X线和其他各种诊断和抢救医疗仪器的技能 具有丰富的常规操作导管经历