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Cardiovascular Anatomy

 

 

 

Cardiac Anatomy

  • Overview:

    • 4 cardiac chambers

    • 4 valves

    • Great vessels

  • Observable by several imaging modalities-- e.g.,ultrasound, computer-aided tomography (CAT-Scan), magnetic resonance imaging (MRI)

courtesy of vesalius (http://www.vesalius.com), used with permission

Right Atrium: Anatomy & blood entry

  • Synonym = right auricle: larger than the left atrium, but with thinner walls (about 2 mm); blood capacity about 60 mls

  • Blood enters the right atrium through the:

    •  Superior vena cava (SVC): opens into the upper & back part of the atrium {orifice direction downward & forward, towards the atrioventricular orifice}: no valve associated with the opening

    •  Inferior vena cava (IVC): opens into the lowest part of the atrium, near the atrial septum;{orifice direction upward & backward, towards the atrial septum 

    •  Coronary sinus- opens between the inferior vena cava orifice and the atrioventricular opening  (definition: atrioventricular opening= major communication between atrium and ventricle, tricuspid orifice)

  • Details:

    1. Inferior vena cava ostium: protected by the eustachian valve-- in the adult, it may remain however mostly it is small and sometimes lacking {in the fetus the eustachian valve is important and serves to direct the blood from the inferior vena cava, by way of the foramen ovale, into the left atrium}

    2.  Coronary sinus ostium: protected by the thebesian valve, a semicircular valve, also known as the valve of the coronary sinus

  • Right & Left atria: separated by: 

    1. Interatrial septum (central ovoid component)

    2. Fossa ovalis: Definition = oval depression on the atrial septal wall (foramen ovale in the fetus); Located at the lower part of the septum, above and left of the inferior vena cava orifice

    3. Remnant of the fetal foramen ovale

  • Right atrial outflow tract:

    •  Through the tricuspid valve (blood direction: anteriorly inferiorly-- towards the right ventricular outflow tract)

      • Aperture about 4 cm in diameter {surrounded by fibrous ring and covered by the cardiac lining membrane}; significantly larger then be communication aperture between the left atrium and left ventricle

    •  Tricuspid valve: composition-- three leaflets -- (area 8-11 cm2)

"Right atrioventricular (tricuspid) valve:{anterior aspect after removal of the  anterior wall the right  ventricle)"
  1. Right atrium

  2. Anterior cusp of the tricuspid valve

  3. Chordae tendineae

  4. Trabeculae carneae

  5. Interventricular septum

  6. Septal cusp of the tricuspid valve

  7. Anterior papillary muscle

  8. Myocardium of the right ventricle

 Reference: Rohen, J.W. and Yokochi, C.,Color Atlas of Anatomy: Photographic Study of the Human Body, third edition, Ikaku-Shoin, New York, Tokyo, p. 240, 1993 Permission Pending

  •  Anterior or infundibular cusp (largest)-- interposed between the atrioventricular orifice of the conus arteriosus

    • Attached to the crystal supraventricularis

    • Controlled by the anterior papillary muscle

  •  Posterior or marginal cusp

  •  Medial or septal cusp

  •  Tricuspid valve cusp bases are attached to a fibrous ring surrounding the atrioventricular orifice and join each other, forming a continuous annular membrane -- their apices projecting into the ventricular cavity

  •  Atrial surfaces: (towards the atrium)--smooth

  •  Ventricular surfaces: (towards the ventricle) -- irregular & rough surfaces -- attachment points for some of the tendinous cords making up the chordae tendineae

 
  1. Superior vena cava

  2. Crista terminalis

  3. Fossa ovalis

  4. Inferior vena cava opening

  5. Carotid sinus opening

  6. Right atrium

  7. Right coronary artery & coronary sulcus

  8. Anterior cusp of tricuspid valve

  9. Chordae tendineae

  1. Anterior papillary muscle

  2. Myocardium

  3. Pulmonary trunk

  4. Ascending aorta

  5. Pulmonic valve

  6. Conus arteriosus (interventricular septum)

  7. Septal papillary muscles

  8. Septomarginal or moderator band

  9. Heart apex

 

Reference: Rohen, J.W. and Yokochi, C.,Color Atlas of Anatomy:  Photographic Study of the Human Body, third edition, Ikaku-Shoin, New York, Tokyo, p. 240, 1993.

 

 
 
 
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  • Primary Reference: Lake, C.L. Cardiovascular Anatomy and Physiology, Third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 805-835, 1997
  • Primary Reference:  Ross, AF, Gomez, MN. and Tinker, JH Anesthesia for Adult Cardiac Procedures in  Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 1659-1698, 1998.
  • Primary Reference: Shanewise, JS and Hug, Jr., CC, Anesthesia for Adult Cardiac Surgery, in Anesthesia, 5th edition,vol 2, (Miller, R.D, editor; consulting editors, Cucchiara, RF, Miller, Jr.,ED, Reves, JG, Roizen, MF and Savarese, JJ) Churchill Livingston, a Division of Harcourt Brace & Company, Philadelphia, pp. 1753-1799, 2000.
  • Primary Reference: Wray Roth, DL, Rothstein, P and Thomas, SJ Anesthesia for Cardiac Surgery, in Clinical Anesthesia, third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 835-865, 1997