Pericardium and Heart Anatomy 2022 PDF

Pericardium and Heart 1 Dr. Rashid Aldahhan Department of Anatomy College of Medicine, IAU Wednesday, March 30, 2022  Learning objectives After participating in this lecture, students should b...

Pericardium and Heart 1 Dr. Rashid Aldahhan Department of Anatomy College of Medicine, IAU Wednesday, March 30, 2022  Learning objectives After participating in this lecture, students should be able to describe: § The divisions of the mediastinum § The boundaries and contents of anterior and middle mediastina § The coronary arteries and conducting system of the heart § The chambers of the heart and their specific features § The structure and function of the pericardium § The proximal parts of the great vessels Wednesday, March 30, 2022 Presentation title Heart and Pericardium  Study guide th Gray's anatomy for students, 4 ed. Contents can be found in Chapter 3 Pericardium & Heart Mediastinum & Pericardium: pp.184 -189 Heart: pp. 190 -215 Wednesday, March 30, 2022 Presentation title  Interesting facts § In the normal human, heart beats approximately 100,000 times per day. § About 2,000 gallons (7,572 liters) of blood travel daily § Through about 60,000 miles (96,560 kilometers) of blood vessels. § An average adult has 4.7 - 5.6 liters of blood. Wednesday, March 30, 2022 Presentation title  Components CVS consists of: 1. The heart, which is a muscular pump 2. A closed system of blood vessels include: § Arteries § Veins § Capillaries McMinn’s & Abraham’s Atlas 7th ed. Wednesday, March 30, 2022 Presentation title  Thoracic cavity http://biology-forums.com/index.php?action=gallery;sa=view;id=8517 Wednesday, March 30, 2022 Presentation title  Mediastinum § The mediastinum is a broad central partition that separates the two laterally placed pleural cavities. It extends: § from the sternum to the bodies of the vertebrae, and § from the superior thoracic aperture to the diaphragm § It is divided into two portions by imaginary line between the sternal angle the junction between the manubrium and the body of the sternum) and intervertebral disc between T4 / T5 Wednesday, March 30, 2022 Presentation title  Division of the mediastinum p Sternal angle p I M II T Mediastinum Superior III mediastinum t IV o Anterior V mediastinum P VI T Inferior VII h mediastinum VIII c Superior Inferior IX c X o m Superior mediastinum –is bounded: XI s XII Middle mediastinum vAnteriorly by the manubrium sterni vPosteriorly by the first four thoracic vertebrae vInferiorly by the sternal angle Posterior mediastinum vSuperiorly by the superior thoracic aperture Gray’s Anatomy for students 4th ed. a s Wednesday, March 30, 2022 Presentation title Heart and Pericardium d  Superior mediastinum Esophagus Contents: 1.Thymus 2.Large veins 3.Large arteries 4.Trachea 5.Esophagus and thoracic duct 6.Sympathetic trunks Netter’s Atlas 7th ed. Wednesday, March 30, 2022 Presentation title  Division of the mediastinum Sternal angle I Mediastinum Superior II III mediastinum IV Anterior V mediastinum VI Inferior VII superior inferior mediastinum VIII It is further IX partitioned by the X pericardial sac into XI the: XII Middle mediastinum anterior middle posterior Posterior mediastinum Between thoracic Between sternum Heart & vertebrae & & pericardium pericardium pericardium Gray’s Anatomy for students 4th ed. Fig. 3.57 Subdivisions of the mediastinum. Heart and Pericardium Its inferior boundary is the diaphragm. Laterally, it is bordered by the mediastinal part of pari- etal pleura on either side. Wednesday, March 30, 2022 Presentation title  Anterior Mediastinum § Contains: 1. Thymus gland : The major structure in the anterior mediastinum is an inferior extension of the thymus gland 2. Fat 3. Connective tissue 4. Mediastinal branches of the internal thoracic vessels 5. Sternopericardial ligaments & 6. Lymph nodes Heart and Pericardium Wednesday, March 30, 2022 Presentation title  Posterior Cricoid cartilage Thyroid gland Right common carotid artery Thyroid cartilage Trachea Left common carotid artery mediastinum Right vagus nerve (CN X) Left vagus nerve (CN X) Anterior scalene muscle Anterior scalene muscle Phrenic nerve Phrenic nerve (cut) Right internal jugular vein Thoracic duct External jugular vein Brachial plexus Brachial plexus Left subclavian artery and vein Right subclavian artery and vein Brachiocephalic trunk Left brachiocephalic vein Contents: Right brachiocephalic vein Internal thoracic artery Phrenic nerve and Arch of aorta pericardiacophrenic artery and vein (cut) Vagus nerve (CN X) Superior vena cava Left recurrent laryngeal nerve Right superior lobar Esophagus and its (eparterial) Ligamentum bronchus arteriosum Right pulmonary Left artery pulmonary artery associated nerve plexus Pulmonary trunk Left Right pulmonary pulmonary veins veins Mediastinal part of Mediastinal parietal pleura part of (cut edge) Thoracic aorta and its parietal pleura (cut edge) Costal part of parietal pleura Costal part of (cut edge) parietal pleura (cut edge) Phrenic nerve branches (cut) Diaphragmatic part of Diaphragmatic parietal pleura part of parietal pleura and cut edge Phrenic nerve (cut) Left main bronchus Azygos vein Pericardium (cut edge) Thoracic duct Respiratory diaphragm Inferior vena cava Esophagus and esophageal plexus Azygos system of veins Plate 210 Lun mebooksfree.com Thoracic duct and associated lymph nodes Sympathetic trunks Thoracic splanchnic nerves Netter’s Atlas 7th ed. Wednesday, March 30, 2022 Presentation title x al afferents in the vagus nerves relay information brachiocephalic trunk. It descends in a posterior direction Mediast ntral nervous system about normal physiological toward the trachea (Fig. 3.94), crosses the lateral surface Mediastinum and reflex activities. They do not transmit pain of the trachea, and passes posteriorly toLeftthe superior root of the intercostal vein of the aortic arch, lateral to the left vagus nerve n. right lung to reach the esophagus. Just before the esopha- The left superior intercostal vein receives the second, medial to the left phrenic nerve, before entering th gus, it is crossed by the arch of the azygos vein. gus nerve third, and sometimes the fourth posterior intercostal brachiocephalic vein (Fig. 3.89). Inferiorly, it may co As the right vagus nerve passes through the superior veins, usually the left bronchial veins, and sometimes the with the accessory hemiazygos vein (superior he t vagus nerve enters the superior mediastinum mediastinum, it gives branches to the esophagus, cardiac left pericardiacophrenic vein. It passes over the left side zygos vein). between the right brachiocephalic vein and the plexus, and pulmonary plexus. Esophagus Esophagus Rib I Brachiocephalic trunk Right brachiocephalic vein Left subclavian artery Trachea Left brachiocephalic vein Left brachiocephalic vein Right vagus nerve Left phrenic nerve Left superior intercostal vein Superior vena cava Azygos vein Left vagus nerve Bronchus Accessory hemiazygos vein Right phrenic nerve Esophagus Thoracic aorta Esophageal plexus Diaphragm Diaphragm Right vagus nerve passing through the superior mediastinum. Gray’s Anatomy for students 4th ed. Fig. 3.89 Left superior intercostal vein. Wednesday, March 30, 2022 Presentation title  Middle Mediastinum § Contains: 1. The heart & the pericardium 2. Roots of great blood vessels 3. Various nerves 4. Smaller vessels Heart and Pericardium Wednesday, March 30, 2022 Presentation title  Junction between fibrous pericardium and adventitia Pericardium of great vessels Visceral layer of serous pericardium § Fibroserous sac (epicardium) Pericardial cavity § Covers the heart and the root of the great vessels § Consists of two components: Parietal layer 1. Fibrous pericardium: a tough CT outer layer of serous pericardium Fibrous that define the boundaries of the middle pericardium Fig. 3.59 Sagittal section of the pericardium. mediastinum 186 2. Serous pericardium: thin and consists of two layers: A. The parietal layer B. The visceral layer Gray’s Anatomy for students 4th ed. Wednesday, March 30, 2022 Presentation title  Fibrous pericardium v A cone-shaped bag with its base on the diaphragm and its apex continuous with the of outer coats of the great vessels. v Superiorly: it fuses with the tunica adventitia (perivascular connective tissue) of the great blood vessels passing through it, the aorta, the pulmonary trunk, the superior and inferior venae cavae (SVC & IVC), and the pulmonary veins v Inferiorly: the base is attached to the central tendon of the diaphragm by the pericardiacophrenic ligament and to a small muscular area of the diaphragm on the left side. v Anteriorly: it is attached to the posterior surface of the sternum by sternopericardial ligaments. v These attachments help to maintain the heart in its position in the thoracic cavity. v The sac also prevents cardiac distention. Wednesday, March 30, 2022 Presentation title  Serous pericardium ² Closed sac lies within fibrous pericardium ² Parietal layer lines the inner surface of the fibrous pericardium ² Visceral layer (epicardium) adheres to the heart and forms its outer covering ² The slitlike space between the parietal and visceralFigure 5.27 Different layers of the pericardium. layers is referred to as the pericardial cavity. ² Normally, the cavity contains a small amount of tissue fluid (~ 50 mL) à the pericardial fluid. ² The pericardial fluid acts as a lubricant to facilitate (frictionless) movements of the heart. Snell’s Clinical Anatomy by regions 10th ed. Wednesday, March 30, 2022 Presentation title  sinus lies posterior to the ascending aorta and the pulmo- somatic afferent fibers in the phrenic nerves. For this nary trunk, anterior to the superior vena cava, and superior reason, “pain” related to a pericardial problem may be to the left atrium. referred to the supraclavicular region of the shoulder or When the pericardium is opened anteriorly during lateral neck area dermatomes for spinal cord segments surgery, a finger placed in the transverse sinus separates C3, C4, and C5. Pericardial sinuses Superior vena cava Ascending aorta Arch of aorta Transverse pericardial sinus (separates arteries from veins) Ø Spaces posterior to the heart formed by Left pulmonary artery Branch of right pulmonary artery the reflections of the serous pericardium Left pulmonary veins around the great vessels Right pulmonary veins Ø The reflection around the large veins Oblique pericardial sinus (formed by reflection onto the pulmonary veins of heart) forms an inverted U/J-shaped cul-de- Cut edge of pericardium sac/recess àthe oblique sinus Inferior vena cava Ø This runs along the long axis of the heart, Thoracic aorta 188 Gray’s Anatomy for students 4th ed. Fig. 3.61 Posterior portion of pericardial sac showing reflections of serous pericardium. from the apex to the ascending aorta. Ø The relatively short horizontal space between the reflection of the serous pericardium around the aorta and pulmonary trunk and the reflection around the large veins à the transverse sinus Wednesday, March 30, 2022 Presentation title  Arterial supply Venous drainage § Internal thoracic artery branches: z Pericardiophrenic veins Ø Pericardiophrenic artery z Veins of azygous system Ø Musculophrenic artery § Branches of thoracic aorta: Ø Bronchial Ø Esophageal Ø Superior phrenic arteries § Coronary arteries (visceral layer of serous pericardium) Wednesday, March 30, 2022 Presentation title  Innervation § Fibrous and parietal serous pericardium: ¤ Phrenic nerves (C3, C4, and C5) § Visceral serous pericardium: ² Vagus nerve ² Sympathetic trunk Wednesday, March 30, 2022 Presentation title  Clinical anatomy àPericarditis Ø An inflammation of pericardium Ø Clinical presentations: – Continuous central chest pain – Friction between opposing layers of serous pericardium (pericardial friction rub) – Possible pericardial effusion à excessive fluid in the pericardial cavity. medical emergency that – Pericardial effusion can compress the thin-walled atria and takes place when abnormal interfere with the filling of the heart during diastole and amounts of fluid reduces cardiac output. accumulate in the pericardial sac – Such compression of the heart is called cardiac tamponade compressing the heart and leading to a decrease in Wednesday, March 30, 2022 Presentation title cardiac output and shock.  Pericardiocentesis a procedure performed to remove pericardial fluid from the pericardial sac. § Aspiration of fluid from the pericardial cavity § To relieve cardiac tamponade § Performed with a needle at the left infrasternal angle through the cardiac notch of the left lung. Wednesday, March 30, 2022 Presentation title  l Anatomy Immunology Aorta Superior vena cava Ligamentum arteriosum The Heart Pharmacology Biochemistry Right pulmonary Left pulmonary artery Pulmonary trunk artery Left atrium Physiology Medical Genetics Right § A muscular organ that pumps pulmonary veins Left pulmonary veins blood around the body by Pathology Behavioral Science/Social Sciences Left ventricle (Left border) Right atrium circulating it through the Microbiology (Right border) Right ventricle circulatory system. Inferior vena cava Apex § Consists of four chambers Figure II-2-33. Sternocostal SternocostalView Viewofofthe theHeart Heart ² Two atria (inflow chambers) ² Two ventricles (outflow) Th e t Wednesday, March 30, 2022 Presentation title  Wall of the heart Made of three layers: 1. External layer à epicardium 2. Middle muscular layer à myocardium 3. Inner layer àendocardium Wednesday, March 30, 2022 Presentation title  Thorax Heart l Surfaces and margins Cardiac orientation Anterior surface The general shape and orientation of the heart are that of a pyramid that has fallen over and is resting on one of its sides. Placed in the thoracic cavity, the apex of this pyramid Apex Margins: projects forward, downward, and to the left, whereas the Base base is opposite the apex and faces in a posterior direction Left pulmonary Base 1. Obtuse (Fig. 3.63). The sides of the pyramid consist of: surface a diaphragmatic (inferior) surface on which the Surfaces: pyramid rests, 2. Inferior an anterior (sternocostal) surface oriented anteriorly, 1. Anterior a right pulmonary surface, and a left pulmonary surface. 3. Right Obtuse margin (Sternocostal) 4. Left Right pulmonary surface Apex Base (posterior surface) and apex 2. Inferior The base of the heart is quadrilateral and directed pos- Inferior (acute) margin (diaphragmatic) teriorly. It consists of: Rib 2 Upper Left Diaphragmatic surface the left atrium, Rib 3 3. Right pulmonary a small portion of the rightUpper Right atrium, and Fig. the proximal parts of the great veins (superior and infe- Rib 3.63 5 Schematic illustration of the heart showing orientation, surfaces, and margins. rior venae cavae and the pulmonary veins) (Fig. 3.64). 4. Left pulmonary Lower Right Rib 6 Apex Gray’sArch Anatomy of aorta for students 4th ed. Left pulmonary artery Figure II-2-35. Surface Projections of the Heart Surface Projections of the Heart Wednesday, March 30, 2022 Superior vena cava  Arch of aorta Pulmonary trunk Borders Inferior vena cava Left auricle Important to recognize for radiological evaluation of the heart Ø Superior (atria, auricles) Ø Inferior (right and left ventricles) Ø Left (left auricle, left ventricle) Ø Right (right atrium) A Right atrium Apex of heart Superior vena cava Left ventricle Wednesday, March 30, 2022 Gray’s Anatomy for students 4th ed. Fig. 3.67 Chest radiographs. A. Standard posteroanterior view of the chest  Arch of aorta Left pulmonary artery Superior vena cava Base Right pulmonary artery Left pulmonary veins Right pulmonary veins § Quadrilateral and directed posteriorly Left atrium Right atrium Coronary sinus § It consists of: Inferior vena cava 1. The left atrium (primarily) Left ventricle Marginal branch of right coronary artery Posterior interventricular Right ventricle 2. A small portion of the right atrium branch of right coronary artery Middle cardiac vein 3. The proximal parts of the great veins Apex Posterior interventricular groove 192 Fig. 3.66 Diaphragmatic surface of the heart. (SVC, IVC and the pulmonary veins) Apex ² Formed by the inferolateral part* of the left ventricle ² Positioned deep to the left fifth intercostal space ~ 9 cm from the midsternal line Gray’s Anatomy for students 4th ed. Wednesday, March 30, 2022  Surfaces Thorax Surfaces of the heart The right pulmonary surface faces the right The anterior surface faces anteriorly and consists is broad and convex, and consists of the right a mostly of the right ventricle, with some of the right (Fig. 3.66). Ø The anterior (sternocostal) surface consists of: atrium on the right and some of the left ventricle on the left (Fig. 3.65). The heart in the anatomical position rests on the dia- Margins and borders Some general descriptions of cardiac orientation re phragmatic surface, which consists of the left ventricle right, left, inferior (acute), and obtuse margins: and a small portion of the right ventricle separated by the posterior interventricular groove (Fig. 3.66). This surface The right and left margins are the same as the faces inferiorly, rests on the diaphragm, is separated from and left pulmonary surfaces of the heart. ⌘ Mainly the right ventricle the base of the heart by the coronary sinus, and extends The inferior margin is defined as the sharp from the base to the apex of the heart. between the anterior and diaphragmatic surfaces The left pulmonary surface faces the left lung, is heart (Figs 3.63 and 3.65)—it is formed mostly b broad and convex, and consists of the left ventricle and a right ventricle and a small portion of the left ven portion of the left atrium (Fig. 3.66). near the apex. ⌘ Some of the right atrium on the right and ⌘ Some of the left ventricle on the left Arch of aorta Left pulmonary artery Ø The heart in the anatomical position rests on the inferior Superior vena cava Right pulmonary artery (diaphragmatic) surface Left pulmonary veins Right pulmonary veins Left atrium Right atrium o It is formed of: Coronary sinus Inferior vena cava Left ventricle § The left ventricle Marginal branch of right coronary artery Posterior interventricular Right ventricle branch of right coronary artery § A small portion of the right ventricle Apex Middle cardiac vein Posterior interventricular groove 192 Fig. 3.66 Diaphragmatic surface of the heart. Ø This surface faces inferiorly, rests on the diaphragm, and extends from the base to the apex of the heart. Gray’s Anatomy for students 4th ed. Wednesday, March 30, 2022 Presentation title  Surfaces The left pulmonary surface faces the left Thorax Surfaces of the heart The right pulmonary surface faces the right lu lung, is broad and convex, and consists of The anterior surface faces anteriorly and consists is broad and convex, and consists of the right atri mostly of the right ventricle, with some of the right (Fig. 3.66). atrium on the right and some of the left ventricle on the left (Fig. 3.65). Margins and borders The heart in the anatomical position rests on the dia- Some general descriptions of cardiac orientation refe the left ventricle and a portion of the left phragmatic surface, which consists of the left ventricle right, left, inferior (acute), and obtuse margins: and a small portion of the right ventricle separated by the posterior interventricular groove (Fig. 3.66). This surface The right and left margins are the same as the ri faces inferiorly, rests on the diaphragm, is separated from and left pulmonary surfaces of the heart. the base of the heart by the coronary sinus, and extends The inferior margin is defined as the sharp e atrium from the base to the apex of the heart. between the anterior and diaphragmatic surfaces of The left pulmonary surface faces the left lung, is heart (Figs 3.63 and 3.65)—it is formed mostly by broad and convex, and consists of the left ventricle and a right ventricle and a small portion of the left ventr portion of the left atrium (Fig. 3.66). near the apex. Arch of aorta Left pulmonary artery Superior vena cava Right pulmonary artery The right pulmonary surface faces the right Left pulmonary veins Right pulmonary veins Left atrium Right atrium lung, is broad and convex, and consists of Coronary sinus Inferior vena cava the right atrium Left ventricle Marginal branch of right coronary artery Posterior interventricular Right ventricle branch of right coronary artery Middle cardiac vein Apex Posterior interventricular groove 192 Fig. 3.66 Diaphragmatic surface of the heart. Wednesday, March 30, 2022 Presentation title  External features Great cardiac vein Coronary sulcus § Atrioventricular groove (coronary sulcus) Right coronary artery § Interatrial groove Anterior interventricular s § Anterior interventricular bra Interventricular groove A Small cardiac vein of left coronary artery rax § Auricles – extensions of each atria Great cardiac vein Interatrial Great cardiac vein groove Circumflex branch of left coronary artery Coronary sulcus Coronary sulcus Small cardiac vein Coronary sinus Right coronary artery Right coronary artery Anterior interventricular sulcus Anterior interventricular branch Middle cardiac vein Posterior interventricular sulcus Small cardiac vein of left coronary artery Posterior interventricular branch A B of right coronary artery Fig. 3.68 Sulci of the heart. A. Anterior surface of the heart. B. Diaphragmatic surface and base of the heart. Wednesday, March 30, 2022  Right atrium Microbiology v Receives venous blood from the whole body Aorta Superior Crista v Blood returning to the right atrium enters through vena cava terminalis four vessels: Tricuspid valve Ø SVC & IVCà together deliver blood to the heart Sinus venarum from the body Pectinate muscles Fossa ovalis Ø The coronary sinus and the smallest cardiac veins Coronary Tricuspid valve àreturns blood from the walls of the heart itself sinus Inferior vena cava v From the right atrium, blood passes into the right ventricle Figure II-2-36. Inside Inside the the Right RightAtrium Atrium through the right atrioventricular orifice à faces forward eft Th e gs: d and medially and is closed during ventricular contraction by the tricuspid valve. v The crista terminalis is the vertical ridge that separates the smooth portion (sinus venarum) from the rough portion (atrium proper) of the right atrium v It extends longitudinally from the SVC to the IVC Wednesday, March 30, 2022 USMLE Step 1 Anatomy.indb 82 Presentation title 10/25  coronary sinus enter the lower posterior portion of the cavae and is derived embryologically from the rig right atrium. of the sinus venosus. This component of the righ From the right atrium, blood passes into the right ven- has smooth, thin walls, and both venae cavae em tricle through the right atrioventricular orifice. This this space. Right atrium Arch of aorta z Sinus venarum: Superior vena cava Right auricle ª Posterior to the crista Limbus of fossa ovalis Crista terminalis Right ventricle ª Smooth, thin walls, and both venae cavae empty into Musculi pectinati this space. It developed from the sinus venosus. Fossa ovalis z Atrium proper Inferior vena cava Valve of inferior vena cava Opening of coronary sinus « Anterior to the crista, including the right auricle Valve of coronary sinus Fig. 3.70 Internal view of right atrium. 196 « Named on basis of its origin from the embryonic primitive atrium. « Its walls are covered by ridges called the pectinate muscles, which fan out from the crista like the “teeth of a comb.” « These ridges are also found in the right auricle, which is an ear-like, conical, muscular pouch Wednesday, March 30, 2022 Presentation title Netter’s Atlas 7th ed.  coronary sinus enter the lower posterior portion of the cavae and is derived embryologically from the rig right atrium. of the sinus venosus. This component of the righ From the right atrium, blood passes into the right ven- has smooth, thin walls, and both venae cavae em tricle through the right atrioventricular orifice. This this space. Arch of aorta Septal part of the right atrium Superior vena cava Right auricle Limbus of fossa ovalis o The interatrial septum separates the right atrium from Crista terminalis Right ventricle the left atrium Musculi pectinati o Faces forward and to the right because the left atrium Fossa ovalis Inferior vena cava lies posteriorly and to the left of the right atrium. Valve of inferior vena cava Opening of coronary sinus Valve of coronary sinus Fig. 3.70 Internal view of right atrium. 196 o Fossa ovalis: a depression is clearly visible in the septum just above the orifice of IVC v Its prominent margin à the limbus fossa ovalis v Marks the location of the embryonic foramen ovale, which is an important part of fetal circulation v Allows O2 blood entering the right atrium through the IVC to pass directly to the left atrium and so bypass the lungs, which are nonfunctional before birth v Closes after birth Gray’s Anatomy for students 4th ed. Wednesday, March 30, 2022 Presentation title  Thorax Left atrium Arch of aorta ² The left atrium forms most of the base of the heart. Left auricle ² As with the right atrium, the left atrium is derived Pulmonary arteries embryologically from two structures. Pulmonary veins u Smooth posterior portion: most of the interior Valve of foramen ovale and receives the four pulmonary veins Left atrium Mitral valve u Rough anterior portion: continuous with the A Left ventricle left auricle Ascending aorta Right ventricle ² Unlike the crista terminalis in the right atrium, no distinct structure separates Right pulmonary vein Left atrium Esophagus Left pulmonary vein the two components of the left atrium. Thoracic aorta ² Presence of the valve of the foramen ovale that prevents blood from passing B Fig. 3.73 Left atrium. A. Internal view. B. Axial computed tomography image showing the pulmonary veins entering the left atrium. from the left atrium to the right atrium Gray’s Anatomy for students 4th ed. Wednesday, March 30, 2022 Presentation title 200  in the anterior wall of the atrium at the upper end of the crista terminalis, just below the opening of the superior vena cava. The atrioventricular node (AV node, 8) is embedded in the Right ventricle interatrial septum, just above and to the left of the opening of the coronary sinus (6). D Right ventricle from the front 9 ² In general, the walls of the ventricles are much thicker 1 Anterior cusp of tricuspid valve 13 4 2 Anterior papillary muscle than those of the atria. 3 Ascending aorta 3 7 4 Auricle of right atrium 5 Chordae tendineae 6 Inferior vena cava 7 Infundibulum of right ventricle (conus 12 arteriosus) ² Numerous muscular, irregular structures 8 9 10 Posterior papillary muscle Pulmonary trunk Right atrium 11 Septomarginal trabeculation (moderator 10 àtrabeculae carneae 12 13 band) Septal papillary muscle (of conus) Superior vena cava 11 1 5 Ø Characteristic features of the ventricular walls and The septomarginal trabeculum (11), which conducts part of the right limb of the 2 atrioventricular bundle from the interventricular septum (13) to the anterior papillary muscle (2), was formerly known as 6 give the walls a sponge-like appearance. the moderator band. 8 The chordae tendineae (5) connect the cusps of the tricuspid valve to the papillary muscles. Ø Three types: McMinn’s & Abraham’s Atlas 7th ed. 1. Papillary muscles: project inward and attach by Artificial cardiac pacemaker, cardiac pacemaker, left ventricular enlargement, see pages 215–216. their bases to the ventricular wall and their apices connect by fibrous chords (chordae tendineae) to the cusps of the tricuspid valve 2. Bridges: attaches at the ends to the ventricular wall and are free in the middle, e.g. Septomarginal trabecula (moderator band): crosses the ventricular cavity from the septal to the anterior wall 3. Prominent ridges Wednesday, March 30, 2022 Presentation title  (thebesian) Fossa ovalis of coronary sinus Valve (eustachian) of inferior vena cava Inferior vena cava Right atrioventricular Opened right atrium: right lateral view Pulmonary trunk Pericardial reflection Transverse pericardial sinus orifice Aorta Nonadjacent semilunar leaflet (anterior semilunar cusp) Transverse Right adjacent semilunar Pulmonary pericardial sinus leaflet (cusp) valve Superior vena cava Left adjacent semilunar leaflet (cusp) ² Closed during ventricular Right auricle (atrial appendage) Conus arteriosus Right atrium Supraventricular crest contraction by the tricuspid valve Septal Membranous part of papillary muscle interventricular septum Interventricular septum Anterosuperior (muscular part) leaflet (anterior Right cusp) ² Named because it usually consists atrioventricular Septal leaflet (tricuspid) (cusp) Heart 189 valve Septomarginal trabecula Inferior leaflet (posterior cusp) B Heart Tricuspid valve Netter’s Atlas of three cusps (leaflets):C C Chordae tendineae coronal section of the ventricles from the right atrium Inferior (posterior) papillary muscle 7th ed. 9 Superoposterior The atrium has been opened by incising the anterior wall (anterior) papillary muscle 3 (2) and turning the flap outwards so that the atrial surface Opened right ventricle: anterior view Anterior of the atrioventricular Apical trabeculations orifice is seen, guarded by the three 1. 4 cusps of the tricuspid valve – anterior (1), posterior (7) and septal (8). 6 1 Anterior cusp of tricuspid valve 6 Pectinate muscles 2 Anterior wall of right atrium 7 Posterior cusp of tricuspid Plate 3224 Heart Septal Auricle of right atrium valve 2. 2 4 Crista terminalis 8 Septal cusp of tricuspid valve 5 1 5 Interatrial septum mebooksfree.com 9 Superior vena cava 8 The posterior cusp (7) of the tricuspid valve is the smallest. 3. Posterior (inferior) 7 D McMinn’s & Abraham’s Atlas 7th ed. 12 D Pulmonary, aortic and 2 15 mitral valves from above ² The base of each cusp is secured to the fibrous ring of 7 3 8 The pulmonary trunk (12) and ascending aorta (3) have been cut off immediately above the three cusps of the pulmonary and aortic valves (7, 2 and 15, and 14, 10 and 9 6 14 the heart skeleton that surrounds the atrioventricular 4 6). The upper part of the left atrium (5) has been removed 10 to show the upper surface of the mitral valve cusps (11 and 1). 1 1 Anterior cusp of mitral valve 9 Ostium of left coronary orifice 2 Anterior cusp of pulmonary artery 11 valve 10 Posterior cusp of aortic valve 3 Ascending aorta 11 Posterior cusp of mitral valve 16 4 Auricle of right atrium 12 Pulmonary trunk 13 5 Left atrium 13 Right atrium 5 6 Left cusp of aortic valve 14 Right cusp of aortic valve 7 Left cusp of pulmonary valve 15 Right cusp of pulmonary ² The free edges are attached to the chordae tendineae 8 Marker in ostium of right valve coronary artery 16 Superior vena cava E 2 13 E Heart fibrous framework Wednesday, March 30, 2022 7 Presentation titleThe heart is seen from the right and behind after removing  (thebesian) Fossa ovalis of coronary sinus Valve (eustachian) of inferior vena cava Inferior vena cava Opened right atrium: right lateral view Pulmonary trunk Pericardial reflection Transverse pericardial sinus