GII PHU V CC BT THNG CA NG MCH VNH

(Coronary anatomy and anomalies)

Robin Smithuis and Tineke Willems
Radiology department of the Rijnland Hospital Leiderdorp and the University Medical
Centre Groningen, the Netherlands. RADIOLOGY

ASSISTANT

Ngi dch
BS. NGUYN VIT QUANG
Khoa CHA - BVTMAG

1. Tng quan
2. ng mch vnh tri (LCA)
3. Nhnh xung trc tri (LAD)
4. Nhnh m (Cx)
5. ng mch vnh phi (RCA)
6. Cc bt thng ng mch vnh
- Interarterial LCA
- ALCAPA
- Myocardial bridging
- Fistula
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1. TNG QUAN (Overview):

- Hnh bn di l hnh tng quan cc ng mch vnh nhn mt trc.
@ ng mch vnh tri (LCA)
- Nhnh xung trc tri (LAD)
. Cc nhnh cho (diagonal branches) (D1, D2)
. Cc nhnh vch lin tht (septal branches) (Sp).
- Nhnh m (Cx)
. Cc nhnh b (Marginal branches) (M1,M2)
@ ng mch vnh phi (RCA)
. Nhnh b nhn (Acute marginal branch) (AM)
. Nhnh nt nh tht (AV node branch)
. Nhnh xung pha sau (PDA)

Tiu nh phi

Tiu nh tri

- Hnh cc ng mch vnh nhn theo hng chch trc phi (RAO).
@ ng mch vnh tri (LCA)
- Nhnh xung trc tri (LAD)
. Cc nhnh cho (diagonal branches) (D1, D2)
. Cc nhnh vch lin tht (septal branches) (Sp).
- Nhnh m (Cx)
. Cc nhnh b (Marginal branches) (M1,M2)
@ ng mch vnh phi (RCA)
. Nhnh b nhn (Acute marginal branch) (AM)
. Nhnh nt nh tht (AV node branch)
. Nhnh xung pha sau (PDA)

- Hnh cc ng mch vnh nhn ngang.

@ ng mch vnh tri (LCA)
- Nhnh xung trc tri (LAD)
. Cc nhnh cho (diagonal branches) (D1, D2)
. Cc nhnh vch lin tht (septal branches) (Sp).
- Nhnh m (Cx)
. Cc nhnh b (Marginal branches) (M1,M2)
@ ng mch vnh phi (RCA)
. Nhnh b nhn (Acute marginal branch) (AM)
. Nhnh nt nh tht (AV node branch)
. Nhnh xung pha sau (PDA)

2. NG MCH VNH TRI (LCA):

- LCA cn gi l nhnh chnh bn tri.
- LCA xut pht t l vnh tri
- Van ng mch ch c 3 l, l vnh tri (L), l vnh phi (R) v l khng vnh (N)
pha sau.
- Ngay pha trn van ng mch ch c phn dn ra thnh cc xoang (xoang Valsalva).
- ng mch vnh tri (hi nm v pha sau) xut pht t xoang Valsalva (T).
- ng mch vnh phi (hi nm v pha trc) xut pht t xoang Valsalva (P).
- Xoang khng vnh nm v pha sau (P).

- ng mch vnh tri (LCA) sau khi xut pht chia ngay 2 nhnh:
. Nhnh m (Cx).
. Nhnh trc xung (LAD).
- Hnh CT bn di cho thy: LCA chy gia bung thot tht phi (pha
trc) v nh tri (pha sau).

Bung thot
tht phi

Nh tri
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- Hnh di cho thy LCA hay cn gi LM (left main artery) chia 2 nhnh:
. Cx
(Cx cho cc nhnh OM cc nhnh b t).
. LAD
(LAD cho cc nhnh DB nhnh cho).

Hnh CT ti to dng Shaded Surface Display (SSD)

Hnh ti to cho thy: nu mun thy

r LCA th cn phi ly i phn tiu nh
tri.

Tiu nh tri

- C 15% nhnh th 3 xut pht gia

LAD v Cx. Nhnh ny gi l nhnh
trung gian (ramus intermedius or
intermediate branch).
- Intermediate branche c v nh l
nhnh b ca Cx.

1. Tng quan
2. ng mch vnh tri (LCA)
3. Nhnh xung trc tri (LAD)
4. Nhnh m (Cx)
5. ng mch vnh phi (RCA)
6. Cc bt thng ng mch vnh
- Interarterial LCA
- ALCAPA
- Myocardial bridging
- Fistula
10

3. Left Anterior Descending (LAD):

- LAD chy trong rnh nh tht trc v lin tc ti mm tim.
- LAD cung cp mu cho phn trc ca vch lin tht bng cc nhnh vch (septal
branches - sp) v thnh trc tht tri bng cc nhnh cho (diagonal branches DB
hay D).
- LAD cung cp mu cho hu ht tht tri (LV) v b nh tht (AV-bundle).
* Ghi nh: Diagonal branches xut pht t LAD.

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Tiu nh tri nm
pha trc LM.

- Cc nhnh D (DB) xut pht t LAD v chy sang bn cung cp mu cho thnh trc
bn ca tht tri.
- Nhnh D u tin c xem nh l ranh gii gia on gn ca LAD (LAD 1) v on
xa ca LAD (LAD 2).
- C th c nhiu nhnh D1, D2

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1. Tng quan
2. ng mch vnh tri (LCA)
3. Nhnh xung trc tri (LAD)
4. Nhnh m (Cx)
5. ng mch vnh phi (RCA)
6. Cc bt thng ng mch vnh
- Interarterial LCA
- ALCAPA
- Myocardial bridging
- Fistula
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4. Circumflex (Cx):
- Cx i trong rnh nh tht tri gia nh tri v tht tri v cung cp mu cho thnh
bn ca tht tri.
- Cc nhnh ca Cx gi l cc nhnh b t (are known as obtuse marginals) (M1,
M2...), v chng cung cp mu cho b ngoi tht tri v xut pht vi mt gc > 90
.
- a s cc trng hp Cx c nhnh tn l nhnh b t (M).
- 10% bnh nhn c tun hon u th bn tri (left dominant circulation) th nhnh Cx
cung cp mu cho nhnh xung pha sau ( posterior descending artery - PDA).
* Ghi ch: Marginal branches xut pht t Cx v cung cp mu cho b ngoi tht tri.

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RCA, LAD and LCx in Anterior projection

RCA c 6 nhnh (ch )

- RCA xut pht t xoang Valsalva trc,

i trong rnh nh tht phi (gia nh phi
v tht phi) n phn di ca vch lin
tht.
- (50 60)% nhnh u tin ca RCA l
nhnh conus (nn) nh, cung cp mu
cho bung thot tht phi.
- (20 -30)% nhnh conus xut pht trc
tip t ng mch ch.
- 60% nhnh nt xoang l nhnh th hai
ca RCA, chy vng ra sau n nt
xoang. (40% nhnh nt xoang xut pht
t ng mch m Cx).
- Cc nhnh k tip l cc nhnh cho
(diagonals) chy ra trc v cung cp
mu cho thnh trc tht phi.

- Nhnh ln l nhnh b nhn (acute marginal branch - AM) xut pht t RCA theo
mt gc nhn, chy dc theo b tht phi n pha trn vm honh.
- RCA tip tc chy trong rnh nh tht ra pha sau v cho nhnh nt nh tht (branch
to the AV node).
- 65% trng hp nhnh xung pha sau (PDA) l nhnh ca RCA (tun hon u th
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bn phi - right dominant circulation).
- PDA cung cp mu cho thnh di tht tri v phn di ca vch lin tht.

- Hnh trn tri cho thy trng hp thng gp nht l RCA

xut pht t xoang Valsalva phi v nhnh conus xut pht t
RCA mc thp hn (khng c hnh minh ha).
- Hnh trn phi cho thy nhnh conus xut pht trc tip t
ng mch ch.
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Nhnh PDA

Nhnh AM

- Nhnh AM cung cp mu cho thnh bn tht phi.

- Trong trng hp ny c tun hon tri bn phi bi v nhnh
PDA xut pht t RCA.
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1. Tng quan
2. ng mch vnh tri (LCA)
3. Nhnh xung trc tri (LAD)
4. Nhnh m (Cx)
5. ng mch vnh phi (RCA)
6. Cc bt thng ng mch vnh
- Interarterial LCA
- ALCAPA
- Myocardial bridging
- Fistula
18

@ CC BT THNG NG MNH
VNH:
- Cc bt thng ng mch vnh t gp
vi t xut lu hnh (prevalence) 1%.
- Pht hin & nh gi sm cc bt
thng ng mch vnh rt quan trng
v chng c th gy thiu mu c tim v
t t.
CC BT THNG NG MCH VNH
1.

Bt thng ngun gc:

- MV xut pht t ng mch phi
- MV duy nht
- Xut pht t xoang (l) khng vnh

2. Bt thng ng i:
- Myocardial brigging

- Ngy nay chp CT tim cng nhiu nn

pht hin cc bt thng mch vnh
ngy cng nhiu.
- Cc bt thng mch vnh chia thnh
cc nhm:
1. Bt thng ngun gc
2. Bt thng ng i
3. Bt thng kt thc

- Nhn i
3. Bt thng kt thc:
- D ng mch vnh (fistula)
- MV kt thc ngoi tim

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** CC HNH NH MINH HA BT THNG NG MCH VNH:

1. LCA i gia 2 ng mch
2. ALCAPA
3. ng mch vnh i di c tim (Myocardial bridging)
4. D ng mch vnh (Fistula)

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- Trn hnh minh ha, bt

thng trn tri (c mi tn
vng) l thng gp nht v l
bt thng kh nng.
- LCA xut pht t xoang
Valsalva phi v i gia ng
mch ch v ng mch phi.
ng i ca LCA (mi tn
vng) gia 2 ng mch nn rt
d b chn p gy thiu mu c
tim.
- Cc bt thng khc ca hnh
bn t trm trng v mt huyt
ng.

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** LCA i gia 2 ng mch:

- Hnh trn l bt thng v ngun gc ca LCA t xoang
Valsalva phi v i gia 2 ng mch.
- Kh nng t t c th xy ra trn nhng bnh nhn ny.

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** ALCAPA
- L ng mch vnh tri xut pht t ng mch phi. (Anomalous origin of the LCA
from the pulmonary artery).
- Trong ALCAPA, c tht tri c ti mu ngho oxy v p lc thp nn dn n
thiu mu c tim.
- ALCAPA him gp, chim (0.25-0.5)% cc loi tim bm sinh.
- Khong 85% bnh nhn b ALCAPA c suy tim huyt (CHF) trong 1 2 thng u
sau sinh.
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** ng mch vnh i di c tim (Myocardial bridging

bc ngang c tim):
- Myocardial bridging thng gp nht nhnh LAD (hnh
minh ha).
- Mch mu i bn di c tim. di on i ny cng ln
th kh nng nh hng n huyt ng cng nhiu.
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- C nhiu tranh lun xung quanh vn ny.

Shunt tri sang phi: nhnh vch ca LAD kt thc tht phi.

** D ng mch vnh (Fistula):

- Hnh trn cho thy nhnh LAD cho mt nhnh vch ln (a
large septal branch) nhnh ny kt thc tht phi. (mi tn
xanh).

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Introduction to cardiothoracic imagingby Carl Jaffe and Patrick J. Lynch

Cardiology Siteby M. Abdulla
This site includes instructional movies, 3-D animation, panoramic views, online quiz,
interactive video-clips, interactive heart sounds & murmurs and interactive
echocardiograms.
Visualization of Anomalous Coronary Arteries on Dual Source Computed Tomographyby
G.J. de Jonge et al
European Radiology, Volume 18, Number 11 / November, 2008, 2425-2432

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