CARDIAC ANATOMY (2)

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By: irphan (18 month(s) ago)

hi, I will send it to you by mail. thank you so much

By: heartsurgeon (18 month(s) ago)

Best regards heartsurgeon!

By: heartsurgeon (18 month(s) ago)

I need your presentation. Can you send it to me by e-mail: sonic41@mail.ru

By: heartsurgeon (18 month(s) ago)

I have already registered on this site, but I can not download your presentation. I am a resident of heart surgeon from Kazakhstan.

By: heartsurgeon (18 month(s) ago)

Hello, Dr. Irphan. I �liked your presentation, but I can not download it.

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Dr. Irphan Y. Shammari, DTM(RCSI) CARDIAC ANATOMY

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Surface Anatomy Right atrium anterior and to the right of left atrium Left atrium a midline structure Right ventricle anterior and to the right of left Ventricle. Pulmonary artery anterior and to the left of aorta Coronary arteries on surface follow A-V groove and interventricular septum.

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Cardiac Chambers a) Right atrium Wide based blunt appendage, crista terminalis separates trabeculated from non-trabeculated portion. b) Left atrium Long, narrow appendage, smooth walls. c) Right ventricle Coarsely trabeculated inlet/sinus, outlet portion. d) Left ventricle Fine trabeculations inlet/sinus and outlet portions.

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Right Atrium SVC - IVC Crista terminalis Coronary sinus Tricuspid valve Fossa ovalis Triangle of Koch Tendon of Todaro Inferior isthmus Tendon of Todaro

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Right Ventricle a) Inlet portion supports tricuspid valve b) Trabecular sinus portion (main body of the RV) Moderator band Medial papillary muscle (of conus) c) Outlet portion Infundibular (Conal) septum (separates semilunar valves) Crista supra ventricularis - seperates sinus (chamber) from outlet portion of the ventricle Septal band (trabecula septomarginalis) Parietal band (ventriculo-infundibular fold) Pulmonary valve

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Left Ventricle Thick wall Inlet portion supports mitral valve Anterior and posterior papillary muscles Outlet portion beneath aortic valve

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Conduction System Sinoatrial node - anterolateral RA Interatrial conduction pathways - not well defined and somewhat controversial Atrioventricular node - triangle of Koch Bundle of His - AV node to membranous septum, usually located on the inferior/posterior wall of the membranous septum Left bundle branch - left ventricular septal surface into multiple branches Right bundle branch - below medial papillary muscle via septal and moderator bands to anterior papillary muscle Inferior isthmus (right atrium) Bachman's bundle (left atrium)

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Cardiac Valves Aortic valve wedged between mitral and tricuspid, pulmonary valve separated b) Mitral valve Anterior leaflet wide, short, 1/3 of annular circumference Posterior leaflet narrow, long, 2/3 of annular circumference Papillary muscles and chordae tendineae c) Tricuspid valve Anterior, posterior, septal leaflets d) Aortic and pulmonary valves 3 cusp, semilunar Sinuses of Valsalva Nodulus Aranti and lunulae

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Left Ventricular Outflow Tract Semilunar aortic valve. Fibrous annulus is not a ring. Interleaflet triangles. Aortoventricular junction. Sinuses of Valsalva. Sinotubular junction (sinus rim) = junction of sinus of Valsalva and ascending aorta. Posterior commissure relates to mid point of anterior leaflet of mitral valve.

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Ventricular Band (Torrent-Guasp) Biventricular myocardial band extending from pulmonary artery to aorta Two loops: basal and apical Double helix derived from spiral fold Apex has figure-8 configuration

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Coronary Arteries Right and left coronary arteries Dominant pattern determined by origin of posterior descending Dominance is usually right or balanced; 10-15% prevalence of left dominance. Balanced pattern occurs when there is no particular dominance Septal blood supply 2/3 left anterior descending, 1/3 posterior descending Sinus node artery from RCA - 55%. AV node artery from U bend at crux, just beyond the takeoff of the PDA if circulation is right dominant.

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Right and Left coronary arteries originate from proximal aorta via respective ostia. Common branches from main coronary arteries · Left main-- diagonal branches · Left anterior descending-- septal and diagonal arteries · Circumflex-- marginal arteries (and PDA in left dominant hearts) · Right coronary artery-- acute marginal, AV nodal, sinus node arteries (and PDA in right dominant hearts)

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. Descriptive Variables Situs of thoracic viscera and atria This is best identified from the bronchial anatomy (3 bronchi on the right, 2 on the left) Solitus, inversus, ambiguous Situs of ventricles Usual, concordant, D-loop, right-handedness Inverted, discordant, L-loop, left-handedness Dominance of ventricles Balanced (usual), right (left small), left (right small)

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The Fibrous Skeleton of the Heart In addition to cardiac muscle tissue, the heart wall also contains a dense connective tissue network forming the fibrous skeleton of the heart that reinforces the myocardium internally and anchors the cardiac muscle fibers. This network of collagen and elastin fibers is thicker in some areas than others. The fibrous skeleton consists of four dense connective tissue rings surrounding all the four cardiac valves like handcuffs. This skeleton has four important functions: a. anchors the valve cusps b. prevents overdialation of the valve openings c. provides the point of insertion for the bundles of heart muscle d. blocks the direct spread of electrical impulses from atrial to ventricular muscles.

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Fibrous Trigones: T hickened area of tissue between the aortic ring and the Atrioventricular ring. The right fibrous trigone is between the aortic ring and the right Atrioventricular ring. The left fibrous trigone is between the aortic ring and the left Atrioventricular ring.

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Cardiovascular Silhouette The cardiovascular silhouette is the radiodensity apparent on a standard PA chest radiograph due to the contrast of the blood-filled heart and great vessels against the surrounding air-filled lungs. It has prominences on each border which occur in a regular sequence and represent cardiovascular structures: right border, from superior to inferior: superior vena cava right atrium inferior vena cava left border, from superior to inferior: arch of aorta - this prominence is termed the aortic knob pulmonary trunk left auricle left ventricle Inferiorly, the heart shadow merges with that of the diaphragm.

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The overall shape of the cardiovascular silhouette is dependent on the phase of breathing due to the attachments of fibrous pericardium to the diaphragm inferiorly. The pericardium is relatively fixed by the great vessels to the roots of the lungs superiorly, so descent of the diaphragm during inspiration tends to make the silhouette look thinner and longer. Hence, standardly chest films are taken in inspiration. Conversely, the normal variation within the population of the shape of the heart results both in extremes of very thin and broad silhouettes. The former are more common in the obese and pregnant ladies; the latter are more common in thin individuals. Lateral radiographs reveal a radiolucent space posterior to the heart and anterior to the vertebral column; this is the retrocardiac space. It contains the oesophagus and descending aorta. Mediastinal Border · Right atrium · Superior vena cava b) Left Border · Aortic arch · Pulmonary trunk · Left atrial appendage · Left ventricle

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Anderson, RH and Ho, SY. What is a ventricle?. Ann Thorac Surg 1998 Aug;66(2):616-20. Review. The components of normal and abnormal ventricles are reviewed.Anderson, RH and Wilcox, BR. Understanding cardiac anatomy: The prerequisite for optimal cardiac surgery. Annals of Thoracic Surgery. A current update on important landmarks in the heart. The article expands on the concepts of the single ventricle, the septal components, and cardiac valve structure. Sutton, JP III; Ho, SY, and Anderson, RH. The forgotten interleaflet triangles: A review of the surgical anatomy of the aortic valve. Annals of Thoracic Surgery 1995;59:419-27 This article focuses on a particularly difficult area of the heart - the aortic root. Interesting points include discussion of the dynamic characteristics of the valve and definitions of some common and not-so-common terms. Zimmerman, J. The functional and surgical anatomy of the heart. Annals of the Royal College of Surgeons of England 1966;39(6):348-66. A thorough review of cardiac anatomy, including embryologic development with plenty of illustrations and photographs to help visualize the topic. Sources for further reading Textbook Chapters Chapter 1: Anatomy, Dimensions, and Terminology. Cardiac Surgery (Kirklin and Barratt-Boyes), 2nd ed., 3-284.Chapter 95: Surgical Anatomy of the Heart. Glenn's Thoracic and Cardiovascular Surgery (Baue, Geha, Hammond, Laks, and Naunheim), 6th ed., 1535-1548. Chapter 1: The Thorax. Clinically Oriented Anatomy (Moore), 3rd ed., 87-106. http://www.ctsnet.org http://www.gpnotebook.co.uk References

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