This document describes the anatomy of the heart, including: 1. The layers of the pericardium and the pericardial space containing pericardial fluid. 2. The coronary arteries originating from the aortic root including the left and right coronary arteries. 3. The conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. 4. The four chambers of the heart - right and left atria and right and left ventricles - and valves between the chambers.

1. CARDIAC
ANATOMY
DEPARTMENT OF CARDIAC AND VASCULAR
SURGERY
MEDICAL UNIVERSITY PLOVDIV
HRISTO RAHMAN

2. PERICARDIUM
The pericardium consists of two
layers:
1.The fibrous pericardial layer;
2.The serous pericardial layer that is
subdivided into two other layers:
2.1. Visceral pericardium that is tightly
attached to the epicardium;
2.2. Parietal pericardium densely
adherent to the fibrous pericardial layer.
The serous pericardial layers are
covered with mesenchymal cells that
secrete and resorb pericardial fluid.
Approximately 5-10 ml. of pericardial
fluid is present in the pericardial space
(between the visceral and parietal
pericardium).
1.
2.
3.
4.
5.
6.
1. Pericardial space
2. Fibrous pericardium
3. Parietal serous pericardium
4. Visceral serous pericardium
5. Myocardium
6. Endocardium

3. PERICARDIAL SINUSES
• 1. Sinus obliquus
• - Located behind the left
atrium, between the four
pulmonary veins and medially
from the inferior vena cava
(IVC).
• 2. Sinus transversus
• - Located behind the
ascending aorta and the
pulmonary trunk, but above
the superior vena cava (SVC)
and the left atrial appendage.

4. CARDIAC ANATOMY

5. CORONARY
ARTERIES

6. CORONARY
ARTERIESThe arterial coronary vascular system
originates from the aortic root.
It includes the left and right
coronary arteries (LCA and RCA),
as well as their individual/proprietary
branches.
The first branches of the aorta are
the coronary arteries themselves.
The left coronary artery (LCA)
originates from the ostium in the left
coronary sinus of Valsalva in the
aortic root as left main stem or left
main coronary artery (LMCA) which
divides early into: left anterior
descending (LAD), also known as
anterior interventricular artery; and
into circumflex artery (LCx- Left
circumflex artery / branch.

7. CORONARY
ARTERIES
The right coronary artery
(RCA) originates from the right
coronary sinus of Valsalva in the
aortic root, and usually ends up
as posterior descending artery
(PDA), also known as a
posterior interventricular artery,
and posterior left ventricular
artery.
PDA

8. LMCA
Left main coronary artery
- Left main coronary artery (LMCA) originates from the
ostium in the left coronary sinus of Valsalva in the aortic
root.
- LMCA courses in anterior and inferior direction between
the left atrial appendage and the pulmonary trunk.
- LMCA then divides into two major arteries that have
approximately equal diameter: the left anterior descending
artery (LAD) and the circumflex artery (LCx).
- There are usually no branches before the bifurcation of the
left main coronary artery.

9. LMCA
In some patients, the left main
coronary artery (LMCA) instead of
ending normally with bifurcation, ends
with trifurcation in which, in addition
to the typical two arterial branches -
the left anterior descending artery
(LAD) and the circumflex artery (LCx),
there is a third branch - an
intermediate coronary artery / branch
(RIM - ramus intermedius).
The left main coronary artery (LMCA)
is usually 10-40 mm. in length, but in
some patients it may be absent as the
left anterior descending artery (LAD)
and the circumflex artery (LCx)
originate from separate ostia, located
in the sinuses of Valsalva in the aortic
root.

10. LMCA
BIFURCATION VS.
TRIFURCATION

11. LAD
Left anterior descending
The left anterior descending coronary
artery (LAD) courses forward and
inferiorly.
It is located in the anterior interventricular
groove and courses towards the cardiac
apex.
Usually, the left anterior descending
coronary artery (LAD) continues around
the apex of the heart and thus provides
blood supply to a part of the posterior
interventricular groove, and rarely even
terminates as the posterior descending
artery (PDA).
In 4% of patients, the left anterior
descending coronary artery (LAD)
proximally divides and continues as two
parallel-sized coronary vessels situated in
the anterior interventricular groove.

12. LAD
The main branches of the LAD include:
1.Diagonal arteries (RDg - rami diagonales):
There are usually 2-6 in number that originate along the
course of the left anterior descending artery. The
diagonal arteries provide blood supply to the frontal left
surface of the left ventricle;
2.Septal perforators: Usually 3-5 in number. They
branch perpendicularly from the left anterior
descending coronary artery (LAD) and provide the
blood supply to the anterior two-thirds of the
interventricular septum. The first septal perforator
artery is the largest in diameter of the lumen and
courses perpendicularly towards the medial papillary
muscle of the tricuspid valve. The first septal perforator
artery is at risk during the Ross procedure as it lies
immediately underneath the right ventricular outflow
tract (RVOT) and the semilunar pulmonary valve.
3.Right ventricular (RV) branches. They provide
blood supply towards the anterior surface of the right
ventricle (RV) but they are sometimes absent.

13. LAD
The LAD is divided into:
1.Proximal segment (LADp):
Proximal 1/3, which starts from the
bifurcation / trifurcation of the left main
coronary artery, and ends at the level
of origin of the first septal perforator
artery.
2.Medial segment (LADm): Middle
1/3, starting from the first septal
perforator artery and ending at the
level of origin of the last diagonal
artery;
3.Distal segment (LADd): Distal
1/3, which starts from the last diagonal
branch and ends with the termination
of the artery.

14. LCx
Left circumflex artery
The circumflex coronary artery
(LCx) courses along the left
atrioventricular groove and in
85-90% of the patients
terminates before reaching the
posterior interventricular
groove.
In 10-15% of patients, the
circumflex coronary artery (LCx)
continues as a posterior
descending artery (PDA).

15. LCx
The main branches of the circumflex coronary artery
(LCx) are:
1.Obtuse marginal arteries (OM): They provide the blood supply
towards the lateral aspect of the left ventricular wall, and the
anterolateral papillary muscle (ALPM) of the mitral valve;
2.Branches providing blood supply to the left atrium (LA);
3.Sino-atrial nodal artery (SANA): in 45% of the patients;
4.Atrioventricular nodal artery (AVNA): in 10-15% of the
patients;
5.Posterior descending artery (PDA): in 10-15% of the
patients

16. RCA
Right coronary artery
The right coronary artery (RCA) courses forward and laterally
from its origin - the ostium in the right coronary sinus of
Valsalva.
It runs down the right atrioventricular groove and then
reaches the acute margin upon the surface of the right
ventricle.
The right coronary artery (RCA) curves around the inferior
diaphragmatic surface of the heart and, after it has branched
into a posterior descending artery (PDA), it continues and
terminates as the posterior left ventricular artery.

17. RCA
The main branches of the right
coronary artery (RCA) are:
1.Sino-atrial nodal artery (SANA): (in 55%
of patients);
2.Infundibular (conal) branch that courses
anteriorly and over the infundibular
segment of the right ventricle;
3.Acute marginal branches supplying the
acute margin of the right ventricle (RV);
4.Anterior right ventricular branches
supplying the anterior free wall of the
right ventricle (RV);
5.Atrioventricular nodal artery (AVNA):in
85-90% of the patients;
6.Posterior descending artery (PDA): in
85-95% of the patients. It runs in the
posterior interventricular groove and
gives off perpendicularly emerging septal
perforator arteries which provide the
blood supply to the posterior 1/3 of the
interventricular septum;
7.Posterior left ventricular artery: It
provides the blood supply to the posterior
surface of the left ventricle.

18. DOMINANCE OF THE CORONARY
ARTERY CIRCULATION SYSTEM
The dominance refers to the artery which the posterior descending
artery (PDA) originates from, and not the arterial vessel that provides
the blood supply to the greater absolute myocardial muscle mass.
Dominance of the right coronary artery system (right dominant type)
is observed and found in 80-85% of the patients, whereas the left
dominant type - in the rest 10-15%.
A balanced type of dominance or co-dominence is found in
approximately 5% of the patients.
Left dominant type of coronary circulation is more common in male
and in patients with congenital bicuspid aortic valve (BAV).

19. DOMINANCE OF THE CORONARY
ARTERY CIRCULATION SYSTEM
• 1. RIGHT DOMINANT TYPE: 80 - 85% ( RCA—>PD ).
• 2. LEFT DOMINANT TYPE: 10 - 15% ( LCx—>PD ).
• 3. BALANCED TYPE: 5%

20. CORONARY DRAINAGE
(VENOUS) SYSTEM
The majority of the coronary veins
drain via the coronary sinus into
the right atrium (RA).
The coronary sinus (CS) is a direct
continuation of the great cardiac
vein (vena cardiaca magna), and
the change is denoted by the
valve of Vieussens and entry of
the oblique vein of the left atrium
(Marshall vein).
Several Thebesian veins and
larger anterior veins drain directly
into the right atrium (RA) and thus
they bypass the coronary sinus
(CS).

21. CONDUCTION SYSTEM OF
THE HEART
The conduction system of
the human heart consists
of:
1.Sino-atrial node (SAN);
2.Anterior, middle and
posterior internodal
tracts in the right atrium
(RA) as well as
Bachmann’s bundle in
the left atrium (LA);
3.Atrioventricular node
(AVN);

22. CONDUCTION SYSTEM OF
THE HEART
1.Bundle of His that
penetrates and
passes through the
central fibrous body
to reach the
membranous
septum to lie on the
crest of the
muscular ventricular
septum underneath
the commissure
between the right
and the non-
coronary cusp of the
aortic valve;

23. CONDUCTION SYSTEM OF
THE HEART
1.Bundle branches:
1.1 LBB-left bundle branch, which is divided into anterior and
posterior fascicles. The latter are running sub-endocardially
down the septal surface of the left ventricle to the cardiac apex.
1.2 Right bundle branch (RBB), which runs on the right side
of the interventricular septum in the direction towards the base
the medial papillary muscle of the tricuspid valve. By entering
the papillary muscle, mentioned above, the right bundle branch
courses towards the body of the septo-marginal trabecula and
crosses the cavity of the right ventricle through the moderator
band.
2. Purkinje's fibers.

24. SAN
Sinoatrial node
The sino-atrial node is a sub-epicardial
structure and has either elliptical or horse-
shoe shape.
It is located just lateral to the junction of the
superior vena cava (SVC), and the roof of the
right atrium (RA) at the superior end of the
terminal groove (sulcus terminalis).
The sino-atrial nodal artery (SANA) originates
from the RCA in 55% of patients and the
circumflex coronary artery in 45% of patients.
The sino-atrial nodal artery passes in front of
the junction between the superior vena cava
and the roof of the right atrium in about 60%
of the patients
Behind the junction in 33%
Around the junction in 7%.

25. SAN
ELLIPTICAL VS. “HORSE-SHOE”
CONFIGURATION

26. AVN
Atrioventricular node
The atrioventricular
node (AVN) is located in
the triangle of Koch.
The boundaries of
Koch’s triangle include:
1.The tendon of Todaro;
2.The hinge of the
septal leaflet of the
tricuspid valve to the
fibrous ring;
3.The superior margin
of the coronary sinus
(CS).

27. AVN
The membraneous septum
lies just superior to the
triangle of Koch and is where
the bundle of His penetrates
to enter the muscular septum.
The atrioventricular nodal
artery (AVNA) is the artery
providing the blood supply to
the atrioventricular node
(AVN).
It originates from the right
coronary artery (RCA) in
approximately 85-90% of the
patients with the remaining
10-15% originating from the
circumflex coronary artery
(LCx).

28. CARDIAC CHAMBERS
• ATRIA:
• 1. RIGHT ( RA );
• 2. LEFT ( LA ).
• VENTRICLES:
• 1. RIGHT ( RV);
• 2. LEFT ( LV ).
TRICUSPID VALVE
COMPLEX
Митрален клапен
комплекс

29. RIGHT ATRIUM
The right atrium (RA) consists of three major components:
1.RAA-right atrial appendage;
2.Venous component;
3.Vestibulum.
The right atrial appendage (RAA) has a broad base and a dull tip.
The venous component is confined between the crista terminalis, and
the sulcus interatrialis, which the two venae cavae (SVC and IVC) drain
in.
The vestibulum has smooth walls and ends up with the tricuspid valve.
The presence of parallel pectinati muscles in the right atrial appendage
gives it a trabecular appearance.

30. RIGHT ATRIUM
Crista terminalis separates the trabeculated from the non-
trabeculated portion of the right atrium (RA). At the crista
terminalis, on the outer surface, refers the sulcus terminalis.
At the level of junction of the inferior vena cava (IVC) with the
venous component of the right atrium (RA), a thin Eustachian
valve is present.
The coronary sinus (CS) drains into the inferior portion of the
right atrium.
At the level of opening of the coronary sinus, another thin,
termed Thebesian, valve is also present.

31. RIGHT ATRIUM
The tendon of Todaro
- is a fibrosis structure
that is formed by the
convergent
protuberance of both
Eustachian, and
Thebesian valves.
The triangle of Koch
- is confined between the
septal cusp of the
tricuspid valve, the
coronary sinus, and the
tendon of Todaro.
a. crista terminalis
b. fossa ovalis
c. coronary sinus
d. Thebesian valve
e. Eustachian valve
f. Tendon of Todaro
g. AVN
h. Bundle of His
i. septum atrioventricularis

32. INTERATRIAL SEPTUM
Fossa ovalis is the only contact between
both atria - left and right atrium.
The fossa ovalis is covered by limbus in its
superior, anterior, and posterior marginal
areas.
The superior margin of the limbus is an
invagination of the atrial wall, caused by
the right pulmonary veins. The anterior
margin of the limbus is an atrial wall
invagination, caused by the aortic root.
Septum secundum is located above the
fossa ovalis and is a direct extension of
the crista terminalis.
The sinus septum is located below the
fossa ovalis and separates the ostia of the
inferior vena cava (IVC), and the coronary
sinus.
Septum atrioventricularis is located in
the area of ​​the coronary sinus and the site
where the wall of the right atrium contacts
the left ventricle.

33. TRICUSPID VALVE
COMPLEX
• 1. Fibrous annulus: wave-like configuration
• 2. Valve cusps: 3 ( anterior, posterior, septal )
• SUBVALVULAR APPARATUS
• 3. Chordae tendineae: (
basal, intermediary, marginal )
• 4. Papillary muscles: 3 ( anterior, posterior, septal )
• 5. RV myocardium

34. WAVE-LIKE CONFIGURATION OF THE TRICUSPID
FIBROUS ANNULUS
Lowest points:
а/ anteroseptal commissure;
b/ posteroseptal commissure.
Highest points:
c/ aortic segment of tricuspid fibrous annulus

35. FIBROUS ANNULUS /
RING
• 1. Shape varies during the cardiac cycle (
systole - ovoid shape; diastole - circular shape ).
• 2. Part of the “fibrous skeleton” of the heart.
• 3. Segments:
• - Anterior;
• - Posterior;
• - Septal;
• - Aortic

36. TRICUSPID VALVE
CUSPS
• 1. Differ in size and shape
• - Anterior
• - Posterior
• - Septal
• 2. Commissures: 3
• - anteroposterior; posteroseptal; anteroseptal.

37. ПОДКЛАПЕН АПАРАТ
• Chordae tendineae
• Свързват клапните платна с папиларните мускули
• 1. Базални:
• - захващат се за основата на клапните платна
• 2. Интермедиерни ( вторични ):
• - захващат се по долната ( камерната ) повърхност към
средната част на платната
• 3. Маргинални:
• - захващат се за свободния ръб на клапните платна

38. SUBVALVULAR
APPARATUS
• Chordae tendineae
• Attach the valve cusps to the papillary
muscles
• 3 types:
• - 1. Basal - attach to the base of the
valve cusp;
• - 2. Intermediary ( secondary ) -
attach to the midportion onto the
ventricular surface of the valve cusp;
• - 3. Marginal ( primary ) - to the free
margin (co-apting) of the valve cusp

39. SUBVALVULAR
APPARATUS
• Papillary muscles
• 1. Anterior papillary
muscle ( largest )
• 2. Posterior papillary
muscle ( smallest )
• 3. Septal group of
papillary muscles
( Muscle of Lancisi )

40. RIGHT VENTRICLE
• The 3 papillary muscles are situated in the
RV, which consists of the following 3 major
components:
• 1. INLET PORTION:
• - around tricuspid valve complex;
• 2. APICAL TRABECULAR PORTION:
• - expands towards the cardiac apex and has
thin walls;
• 3. OUTLET PORTION / RVOT -
right ventricular outflow tract
• - A.K.A, “infundibulum”;
• - supports the pulmonic valve
• - entirely muscular tissue

41. RIGHT VENTRICLE
The muscular elements, involved in the
formation and composition of the outlet of
the right ventricle (RVOT) are different from
those, involved in the composition and
configuration of the left ventricular outflow
tract (LVOT).
Crista supraventricularis (parietal band)
is a muscular protuberance separating the
tricuspid from the pulmonary valve
complex.The right coronary artery (RCA)
courses over the crista supraventricularis.
Trabecula septomarginalis (septal band)
is a prominent muscle bundle that in its
upper segment divides itself into anterior
and posterior branches, whereas with its
lower segment reaches the heart's apex.
- The anterior branch of the trabecula
septomarginalis goes up and participates in
the pulmonary valve support apparatus.
- The posterior branch is dorsal and gives
rise to the medial papillary muscle.
- The moderator band and the anterior
papillary muscle of the tricuspid valve
originate from the lower segment of the
trabecula septomarginalis.

42. PULMONIC VALVE
The pulmonary valve is a
semilunar type valve and in
concordant ventriculo-arterial
connection, it is situated
between the right ventricle (RV)
and the pulmonary trunk.
The pulmonary valve consists of
three semilunar leaflets/cusps:
1.Right cusp;
2.Left cusp;
3.Anterior cusp.
The competency of the
pulmonary valve is maintained
by similar to the aortic valve
structures.

43. LEFT ATRIUM
The left atrium (LA) consists of the following three
major components, analogical to those of the
right atrium (RA):
1. LAA - left atrial appendage;
2. Venous component: It contains 2 pairs of
pulmonary veins: superior and inferior right
pulmonary veins - (RSPV, RIPV) as well as
superior and inferior left pulmonary veins -
(LSPV, LIPV);
3. Vestibulum.
The left atrial appendage (LAA), compared to the
right, is narrow and long.
There are four morphological types of the left
atrial appendage:
1.“Cactus";
2."Chicken wing”;
3.“Windsock”;
4.“Cauliflower".
The walls of the left atrium (LA), compared to the
walls of the RA, are smooth.

44. MITRAL VALVE
COMPLEX
• 1. Mitral fibrous annulus: saddle-shaped configuration
• 2. Valve cusps: 2 ( anterior: AML, posterior: PML )
• SUBVALVULAR APPARATUS
• 3. Chordae tendineae:
( basal, intermediary, marginal )
• 4. Papillary muscles: 2 (
anterolateral-ALPM,posteromedial-PMPM )
• 5. LV myocardium

45. MITRAL FIBROUS
ANNULUS / RING
• 1. Shape varies during the cardiac cycle
( systole - kidney shape; diastole - circular shape
).
• 2. Part of the “fibrous skeleton” of the heart.
• - 2,1. Anterolateral trigone;
• - 2,2. Posteromedial trigone
• 3. Important anatomical markers in close
proximity:
• - 3,1. Circumflex coronary artery ( LCx );
• - 3,2. Venous coronary sinus ( CS );
• - 3,3. Bundle of His;
• - 3,4. Non-coronary and left coronary cusp of the
aortic valve

46. MITRAL VALVE
LEAFLETSThe mitral valve is the atrioventricular valve, situated
between the left atrium (LA), and the left ventricle
(LV), in concordant atrioventricular connection, and
consists of two leaflets:
1.Anterior mitral leaflet (AML);
2.Posterior (mural) mitral leaflet (PML)
The anterior (AML) and posterior (PML) leaflets are
subdivided by clefts into scallops, known as
A1,A2,A3,P1,P2, and P3, respectively.
The mitral valve native, fibrous ring (annulus) has the
shape of a kidney.
The posterior mitral valve annulus takes up 2/3 of the
circumference, whereas the anterior mitral valve
annulus takes up the remaining 1/3 of the whole
circumference of the fibrous mitral ring.
The AML takes up approximately 2/3 of the cross-
sectional area of the mitral valve orifice, whereas the
PML takes up the remaining 1/3, and so the line of
apposition between both cusps tend to be closer to
the posterior mitral valve annulus.

47. ПОДКЛАПЕН АПАРАТ
• Chordae tendineae
• Свързват клапните платна с папиларните мускули
• 1. Базални:
• - захващат се за основата на клапните платна
• 2. Интермедиерни ( вторични ):
• - захващат се по долната ( камерната ) повърхност към
средната част на платната
• 3. Маргинални:
• - захващат се за свободния ръб на клапните платна

48. MITRAL VALVE
LEAFLETS
• Commissures:
• - 1. Anterolateral ( AC
): higher to:
• - 2. Posteromedial (
PC )

49. ПОДКЛАПЕН АПАРАТ
• Chordae tendineae
• Свързват клапните платна с папиларните мускули
• 1. Базални:
• - захващат се за основата на клапните платна
• 2. Интермедиерни ( вторични ):
• - захващат се по долната ( камерната ) повърхност към
средната част на платната
• 3. Маргинални:
• - захващат се за свободния ръб на клапните платна

50. SUBVALVULAR
APPARATUS
• Chordae tendineae
• Attach the valve cusps to the
papillary muscles
• 3 types:
• - 1. Basal - attach to the base of the
valve cusp;
• - 2. Intermediary ( secondary ) -
attach to the midportion onto the
ventricular surface of the valve cusp;
• - 3. Marginal ( primary ) - to the free
margin (co-apting) of the valve cusp

51. SUBVALVULAR
APPARATUS
Papillary muscles:
1. Anterolateral papillary muscle
(ALPM - anterolateral papillary
muscle):
- The ALPM has a single head and
receives its blood supply from the
circumflex coronary artery (LCx);
2. Postromedial papillary muscle
(PMPM):
- The PMPM usually has multiple
(usually 3) and receives its blood
supply from the right coronary
artery (RCA).

52. LEFT VENTRICLE
The left ventricle (LV) consists of the following three
major components, similar to those, referring to the
general configuration of the right ventricle (RV):
1. Inlet portion;
2. Apical trabecular portion;
3. Outlet / LVOT - left ventricular outflow tract.
The endocardial surface of the left ventricle is
delicately trabecular, compared to the rough
trabeculation of the right ventricular endocardium.
The inlet portion is located around the mitral valve
complex (valve leaflets and fibrous mitral annulus).
The apical trabecular portion of the LV reaches the
apex of the heart and has relatively thick walls, in
contrast with the thin walls of the apical trabecular
portion of the RV.
The outlet supports the aortic valve complex and is
composed of muscular and fibrous elements: a part
of the membranous septum, and the aorto-mitral
valvular continuity.
The muscular elements, involved in the left
ventricular outflow tract composition and
configuration are different from those, involved in the
construction of the RVOT.

53. INTERVENTRICULAR
SEPTUM
• 1. Concave LV surface (
higher LV pressure)
• 2. Convex RV surface. (
lower RV pressure)
• 3. Muscular septum:
• - located between LV and RV;
• 4. Membranous septum:
• - fibrous structure, located
between the LVOT and
portions of the RA and RV.
• 5. Atrioventricular
septum:
• - located between the LV and
RA

54. AORTIC VALVE
The aortic valve is a semilunar type valve and
in concordant ventriculo-arterial connection, it
is situated between the left ventricle (LV) and
the aorta.
The aortic valve consists of three semilunar
leaflets/cusps:
1. Right coronary cusp;
2. Left coronary cusp;
3. Non-coronary (posterior) cusp
The aortic valve leaflets are composed of a
fibrous core, covered by endothelium.
The fibrous core is thickened at the free edge
of the cusp, especially centrally. This
thickening is known as the nodule of Arantius.
The aortic valve cusps coapt at the free edge
of their ventricular surface with three zones of
apposition.
The commissures are the areas of contact
between the cusps and the aortic wall.

55. АОРТНА КЛАПА
Coapting surfaces with adjacent aortic valve cusps are called lunulae. They are fibrous structures with a maximum size /
height (h) of 2-3 mm. The nodule of Arantius is a small fibrous structure located in the middle of the free edge of each of
the three aortic valve leaflets.These nodules complete the surface of coaptation and contribute to the supporting of the
competence of the aortic valve. By shape and size, the three aortic valve leaflets are not completely identical. Despite the
minimal differences, each aortic valve cusp has a constant ratio between the height (H) and the length (L) of the free edge.
There is also a constant ratio between the height of the lunulae (h) and the height of the leaflets (H). There is another
constant ratio between the length of the free edge (L) and the attachment area of the aortic leaflet onto the valve annulus
(C), valid for each one of the three aortic valve cusps.

56. AORTIC ROOT
The competence of the aortic valve is
supported by several different
components of aortic root, working in
harmony:
1.Aortic valve leaflets/cusps;
2. Three sinuses of Valsalva: They
allow the aortic valve cusps to fall
back during ventricular systole and
thus enabling a column of blood to
pass unobstructed (as long as there
is no pathological process, involving
the aortic valve,
e.g.: (calcific aortic stenosis) from
the LVOT into the systemic
circulation. The sinuses of Valsalva
are:
2.1. Right coronary;
2.2. Left coronary;
2.3. Non-coronary

57. AORTIC ROOT
3. Anatomical and
physiological junctions in
the aortic root:
3.1. Sinotubular junction
(STJ): between the distal
part of the sinuses of
Valsalva and the proximal
part of the ascending aorta;
3.2. Anatomical ventricular-
arterial junction: between
the ventricular myocardium
and the aortic sinuses;
3.3. Basal ring: combines
the lower aspect of the
aortic valve cusps.

58. THORACIC AORTA
• 1. ASCENDING AORTA (
Aorta ascendens )
• 2. AORTIC ARCH (
Arcus aortae ):
• - SUPRA-ARCH BRANCHES:
• - 2,1. Brachiocephalic trunk /
Innominate artery;
• - 2,2. Left common carotid artery. (
LCCA );
• - 2,3. Left subclavian artery ( LScA )
• 3. AORTA DESCENDENS (
Descending aorta )