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  • The morphologic characteristics and function of the aortic valve are interrelated to the aortic root and are best described as a single functional unit. The diameter of the aortic annulus is 15% to 20% larger than the diameter of the sinotubular junction. The lenghts of the free margins of the leaflets areslightly larger than the diameter of the sinotubular junction <br />
  • Vd lavoro di T David su Current Problem (pag 431-432): scambiare immagini <br />

Heart anatomy written  copy Heart anatomy written copy Presentation Transcript

  • ANATOMY OF THE HEART Moderator: Dr. Ravi Narayan, Consultant Paediatric Cardiologist, Presented by, Dr. Agilan M., I year, PGDCC, M.S. Ramaiah- Narayana Hrudayalaya.
  • Heart in pericardial cavity 4 Figure 18.1
  • Pericardium • Pericardial cavity is lined by the pericardium. • Pericardium – a double-walled sac around the heart composed of: 1. A superficial fibrous pericardium 2. A deep two-layer serous pericardium a. The parietal layer lines the internal surface of the fibrous pericardium b. The visceral layer or epicardium lines the surface of the heart They are separated by the fluid-filled pericardial cavity. Pericardial fluid acts as a lubricant reducing friction.
  • The Function of the Pericardium: Protects and anchors the heart Prevents overfilling of the heart with blood Allows for the heart to work in a relatively friction-free environment The clear tissue being Lifted up by the scalpel Is the pericardium
  • Applied anatomy- Pericarditis • Various pathogens may infect the pericardium. • The inflamed pericardial surfaces rub against one another. • Makes a distinct scratching sound. • Cardiac tamponade could occur due to the increased pericardial fluid in the pericardial cavity. This condition restricts the movement of the heart.
  • Cardiac Tamponade Black looking structure is the heart bulging from the pericardial sac.Not only pathogens can cause a cardiac tamponade, but blunt force trauma can also cause it.
  • External Heart: Anterior View Chapter 18, Cardiovascular System 10 Figure 18.4b
  • Gross Anatomy • A conical hollow muscular organ approximately the size of your fist • Location : Middle mediastinum behind sternum, costal cartilages of 3,4,5 ribs Superior surface of diaphragm Left of the midline Anterior to the vertebral column, • Directed forward and to left . • Anterior most is the apex. • Average measurement: 12cm X9cm • Weight: 325±75 g in men 275± 75 g in women
  • External features • Sulci: 1.Coronary (atrioventicular) sulcia) anterior b) posterior 1.Interterial groove visible posteriorly 2.Interventricular sulci/ groove 3.Crux is the posterior basal surface at juction of coronary and posterior interventricular sulci and internally atrial septum joins the venticular septum
  • Surfaces • Diaphragmatic or inferior • Anterior of sternocostal • Left surface Borders • Right- SVC and RA • Left- LV and La • Inferior- RV and laterally LV
  • External Heart: Vessels that Supply/Drain the Heart (Posterior View) • Arteries – right coronary artery (in atrioventricular groove) and the posterior interventricular artery (in interventricular groove) • Veins – great cardiac vein, posterior vein to left ventricle, coronary sinus, and middle cardiac vein
  • The anterior and posterior interventricular sulci are shallower depressions that mark the boundary line between the left and right ventricles. These areas usually contain a large amount of fat. The sulci contain the arteries and veins that feed the heart. The heart has an attached base and a free apex. The inferior tip is called the apex. In a typical adult the heart measures approximately 12.5 cm from the base to the tip. The apex reaches to the fifth intercostal space, 7.5 cm to the left of the midline.
  • 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.
  • External Heart: Major Vessels of the Heart (Anterior View) • • Vessels returning blood to the heart include: 1. Superior and inferior venae cavae 2. Right and left pulmonary veins Vessels conveying blood away from the heart include: 1. Pulmonary trunk, which splits into right and left pulmonary arteries 2. Ascending aorta (three branches) – a. Brachiocephalic b. Left common carotid c. Subclavian arteries 17
  • External Heart: Vessels that Supply/Drain the Heart (Anterior View) • Arteries – right and left coronary (in atrioventricular groove), marginal, circumflex, and anterior interventricular arteries • Veins – small cardiac, anterior cardiac, and great cardiac veins
  • External Heart: Posterior View Chapter 18, Cardiovascular System 19
  • External Heart: Major Vessels of the Heart (Posterior View) • Vessels returning blood to the heart include: 1. Right and left pulmonary veins 2. Superior and inferior venae cavae • Vessels conveying blood away from the heart include: 1. Aorta 2. Right and left pulmonary arteries
  • Anatomical position of the heart from Grays Anatomy
  • Anomalous-Anatomical position of the heart
  • OVERVIEW OF THE CARDIOVASCULAR SYSTEM • Pulmonary circuit • Systemic circuit • Arteries (Including the coronary arteries) • Veins (Including the coronary veins) • Capillaries (Arterioles & Venules) • Four chambers of the heart
  • Pathway of Blood Through the Heart and Lungs • Right atrium  tricuspid valve  right ventricle • Right ventricle  pulmonary semilunar valve  pulmonary arteries  lungs • Lungs  pulmonary veins  left atrium • Left atrium  bicuspid valve  left ventricle • Left ventricle  aortic semilunar valve  aorta • Aorta  systemic circulation 25
  • Heart Wall • Epicardium – visceral layer of the serous pericardium • Myocardium – cardiac muscle layer forming the bulk of the heart • Fibrous skeleton of the heart – crisscrossing, interlacing layer of connective tissue • Endocardium – endothelial layer of the inner myocardial surface
  • Walls of the Heart
  • Myocardial Thickness and Function Thickness of myocardium varies according to the function of the chamber Atria are thin walled, deliver blood to adjacent ventricles Ventricle walls are much thicker and stronger – right ventricle supplies blood to the lungs (little flow resistance) – left ventricle wall is the thickest to supply systemic circulation
  • Thickness of Cardiac Walls Myocardium of left ventricle is much thicker than the right.
  • Chambers of the heart • Right atrium RA • Right ventricle RV • Left Atrium LA • Left Ventricle LV • When not filled with blood, the outer portion of each atrium deflates and becomes a lumpy, wrinkled flap. • This extension is called the auricle (looks like an external ear).
  • 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.
  • Gross Anatomy of chambers: Frontal Section Chapter 18, Cardiovascular System 35 Figure 18.4e
  • Atria of the Heart • Atria are the receiving chambers of the heart • Each atrium has a protruding auricle • Pectinate muscles mark atrial walls • Blood enters right atria from superior and inferior venae cavae and coronary sinus • Blood enters left atria from pulmonary veins
  • Right Atrium • - SVC IVC Crista terminalis Coronary sinus Tricuspid valve Fossa ovalis Triangle of Koch Tendon of Todaro Inferior isthmus
  • Ventricles of the Heart • Ventricles are the discharging chambers of the heart • Papillary muscles and trabeculae carneae muscles mark ventricular walls • Right ventricle pumps blood into the pulmonary trunk • Left ventricle pumps blood into the aorta 41
  • View from the right side of the heart.
  • 1 2 3 Chordae tendineae Papillary muscle
  • Ventricular Differences • The anatomical differences between the right and left ventricles are as follows: • The right ventricle is relaetively thin. The left ventricle has a massive muscular wall.
  • Interventricular septum
  • Interatrial Septum. Lateral view
  • The pectinate muscles are prominent muscular ridges found in the atrial walls
  • Left Ventricle Heart Wall Right Ventricle Heart Wall
  • Fibrous Skeleton Of The Heart
  • Heart Valves • Heart valves ensure unidirectional blood flow through the heart • Atrioventricular (AV) valves lie between the atria and the ventricles – AV valves prevent backflow into the atria when ventricles contract • Chordae tendineae anchor AV valves to papillary muscles 52
  • Atrioventricular Valves • Prevent backflow of blood from the ventricles back into the atria. • Chordae tendineae and papillary muscles play an important role in this process. • Ventricular diastole the ventricles relax and the ventricles refill. • The chordae tendineae are loose and offer no resistance to the flow of blood.
  • Heart Valves 54
  • Heart Valves
  • During ventricular systole the ventricles begin to contract blood moving back towards the atria swings the cusps together closing the valves. The chordae tendineae and papillary muscles stops the cusps from swinging into the atria. If those two structures are cut or damaged the valves act as swinging doors, and there is backflow, or regurgitation. Mitral valve damage can especially occur in women after pregnancy.
  • Mitral valve -Anatomy
  • Anatomic Classification Schema: Mitral Valve Segments Duran Classification Ann Thorac Surg 1998: 65:1025-1031. J Heart Valve Dis 1995; 4:70-75. Cardiol Clin. 2000; 18: 731-50.
  • Am Heart J. 2000;139: 378-87.
  • Mitral Valve Prolapse
  • Tricuspid Valve
  • Semilunar Heart Valves • Semilunar valves prevent backflow of blood into the ventricles • Aortic semilunar valve lies between the left ventricle and the aorta • Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk 64
  • Atrioventricular Valve Function Chapter 18, Cardiovascular System 65 Figure 18.9
  • Semilunar Valve Function Chapter 18, Cardiovascular System 66 Figure 18.10
  • Aortic valve – Anatomy
  • Aortic Root - Anatomy The AORTIC ROOT has four anatomic components: • The aortic annulus or aortoventricular junction • The leaflets SINGLE • The aortic sinuses or sinuses of Valsalva FUNCTIONAL UNIT • The sinotubular junction
  • Aortic Annulus (aortoventricular junction N L Fibrous tissue Anterior leaflet of the mitral valve Membranous septum Normal: Marfan/Bicuspid aortic valve: R Myocardium 55% 65% Histology: The aortic root is in fibrous continuity with the anterior leaflet of the mitral valve and the membranous septum; connective tissue (fibrous strands) unites the aortic root to the interventricular septum. 45% 35% Sinotubular Junctinon
  • Valve Leaflets They are attached to the aortic root in a semilunar fashion The triangular space underneath the leaflet (trigone) is part of the left ventricle. The highest point of the trigone where the leaflets meet is called the commissure. The commissures are localised immediately below the Sinotubular Junction. The 2 trigones underneath the commissures of the noncoronary leaflet are fibrous structures, whereas the other underneath the commissure between the right and the left leaflets is mostly a muscular structure.
  • Sinuses of Valsalva The segment of the arterial wall of the aortic root delineated by a leaflet proximally and by the sinotubular junction distally is called the aortic sinus or sinus of Valsalva. They are 3 elliptical inlets that have a very important role in the dynamics of circulation : • Guaranteeing coronary artery perfusion during systole; •Creating eddies to close the aortic leaflets during diastole
  • Sinotubular Junction It represents the terminal edge of the aortic root and it is constituted by the imaginary line that connects together the 3 commissures. Young adults AA>STJ Adults AA = STJ BASE = Aortic Annulus (AA) Elderly AA<STJ
  • aortic valve calcification aortic stenosis AORTIC VALVE PATHOLOGY aortic valve fibrosis
  • AR due to Abnormalities of the Leaflets Infective endocarditis Trauma Iatrogenic cause Cusp perforation
  • AR due to Abnormalities of the Leaflets • • • Excess of tissue Disrupted commissure Commissural malposition Cusp prolapse
  • AR due to Abnormalities of the Leaflets Fibrous thickening Restrictive motion
  • AR - Abnormalities of the Aortic SinotubularWall dilatation junction Dilatation of the sinotubular junction displaces the commissures outward and prevents the aortic leaflets from coapting, with resulting central aortic insufficiency
  • AR - Abnormalities of the Aortic Wall • • Marfan syndrome • Connective tissue diseases • Ventricular dilatation • Chronic hypertension Annular dilatation
  • AI due to Abnormalities of the Aortic Wall Aortic root aneurysm: ST junction dilatation + Sinuses of Valsalva aneurysm
  • Conduction System • Sinoatrial node - anterolateral RA • Interatrial conduction pathways - not well defined and somewhat controversial • Inferior isthmus (right atrium) anterior Bachman's bundle (left atrium), middle Wenkebachs, posterior Thorel • 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
  • Heart Blood Supply • Coronary circulation demands high oxygen and nutrients for the cardiac muscle cells. • Coronary arteries originate at the base of the ascending aorta. • Interconnections between arteries called anastomoses ensure a constant blood supply.
  • Coronary Circulation: Arterial Supply
  • Coronary Circulation: Venous Supply Chapter 18, Cardiovascular System 94 Figure 18.7b
  • Great, Posterior, small, Anterior, Middle Cardiac Veins carry blood from The coronary capillaries To the coronary sinus. Left coronary artery supplies The left ventricle. Circulflex Curves left meeting with The right coronary artery. Left anterior decending Supplies the posterior Decending artery (interventricular).
  • Microscopic Anatomy of Heart Muscle • Cardiac muscle is striated, short, fat, branched, and interconnected • The connective tissue endomysium acts as both tendon and insertion • Intercalated discs anchor cardiac cells together and allow free passage of ions • Heart muscle behaves as a functional syncytium InterActive Physiology®: Cardiovascular System: Anatomy Review: The Heart 96
  • Microscopic Anatomy of Heart Muscle Chapter 18, Cardiovascular System 97 Figure 18.11
  • Extrinsic Innervation of the Heart • Heart is stimulated by the sympathetic cardioaccelerator y center • Heart is inhibited by the parasympathetic cardioinhibitory center
  • Thank