Anatomia Coronariana

Dr. Mihai Lazar

.
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
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).

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,
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
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Sistem coronarian cu dominanta dreapta
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Sistem coronarian cu dominanta stanga .
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Sistem coronarian echilibrat.
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Aspectul EKG in IMA corelat cu datele
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angiografice. Outline
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Aspectul EKG in IMA corelat cu datele

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Aspectul EKG corelat cu datele
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angiografice. Level
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Anomalii de origine a ACD(1%).
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Anomalous origin of the right coronary artery from the left
coronary sinus.  Fifth level
 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%).
Va multumesc