摘要
目的:用解剖学的方法研究行标准外科心房颤动射频消融迷宫Ⅳ手术时需要明确的冠状动脉走行问题。方法:选取2020年9月至2021年12月在中国医学科学院阜外医院深圳医院接受心脏移植的16例患者,对切除下的受体心脏进行解剖。观察与标准外科心房颤动射频消融迷宫Ⅳ手术相关的冠状动脉走行、与房室环的毗邻关系以及房室结动脉和窦房结动脉的走行。结果:右冠状动脉沿三尖瓣瓣环走行时,至三尖瓣前叶瓣环处时多数走行于三尖瓣瓣环的心房侧,至后叶瓣环处时平三尖瓣瓣环水平。左回旋支沿二尖瓣瓣环水平走行时,在P1区时多走行于二尖瓣瓣环的心房侧,二尖瓣的P2区瓣环为无血管区,P3区瓣环有右冠状动脉来源的分支血管,但与瓣环的走行关系变异较大。窦房结动脉自右冠状动脉发出时,经常会走行于右心耳与三尖瓣瓣环之间。如果源自左冠状动脉,则经常会走行于主动脉根部后左心房顶处。房室结动脉源自右冠状动脉主干,走行于三尖瓣隔侧瓣环与冠状静脉窦右心房开口之间,走向房室结。结论:冠状动脉在房室沟走行时,与房室环之间的空间毗邻关系是有规律可循的。充分认识并掌握这些规律,可有效避免迷宫Ⅳ手术中消融线路损伤冠状动脉,提高手术的安全性,防止术后并发症的发生。
Objectives:To investigate the anatomical location of the coronary arteries related to the Cox-maze(CM)IV procedure.Methods:Hearts from 16 patients,who underwent heart transplantation from September 2020 to December 2021,were used for analysis in this study.We observed the anatomical relationship of the CM IV procedure-related coronary arteries with the atrioventricular annulus,and the paths of the atrioventricular node artery(AVNA)and sinoatrial nodal artery(SANA).Results:The right coronary artery(RCA)was often located at the atrial side of the anterior tricuspid valve annulus and parallel to the posterior tricuspid valve.The left circumflex coronary artery(LCX)was often located at the atrial side of the P1 area of the mitral annulus.No large coronary arteries were observed in the P2 area of the mitral annulus.Some branches originating from the RCA were located in the P3 area of the mitral annulus,but their anatomic relationship with the mitral annulus varied greatly.The SANA often originated from the RCA or the LCX.The SANA originating from the RCA often travelled through the tissue between the tricuspid annulus and the right atrial appendage.The SANA originating from the LCX often travelled through aortic root and top of the left atrium.AVNA generally originated from the right main coronary artery,travelled through the tissue between the septal tricuspid annulus and the orifice of coronary sinus at right atrium and then to the atrioventricular node.Conclusions:We summarized the running pattern and the spatial relationship between coronary arteries travelling in the atrioventricular groove and the atrioventricular annulus.Fully understanding these anatomic relationships may help to avoid coronary artery injuries during the CM IV procedure,thereby improving the safety of the operation and reducing the complications of the operation.
作者
高进
宋辰
陈枫杰
杨晓涵
王志伟
熊辉
刘盛
樊红光
GAO Jin;SONG Chen;CHEN Fengjie;YANG Xiaohan;WANG Zhiwei;XIONG Hui;LIU Sheng;FAN Hongguang(Department of Adult Cardiac Surgery,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen Hospital,Shenzhen(518000),Guangdong,China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第11期1138-1143,共6页
Chinese Circulation Journal
基金
深圳市南山区技术研发和创意设计项目分项资金(NS2021165)
深圳市医学重点学科建设经费(No.SZXK019)。
关键词
冠状动脉
迷宫Ⅳ手术
心房颤动
解剖
coronary artery
Cox-maze IV
atrial fibrillation
anatomy
