Cardiac Anatomy

 Right Ventricle -- overview

  • Wraps around one-third of the left ventricle (LV)

  • Muscle fibers continues with those of the LV

  • Components

    •  Inferoposterior inflow (sinus)

    •  Anterosuperior outflow (infundibular)

    •  Inflow and outflow components divided by the crista supraventricularis (definition: a ridge on the inner wall of the right ventricle, marking off the conus arteriosus: supraventricularis also called supraventricular crest)

      •  Crista supraventricularis:  joins interventricular septum and LV to the right ventricular free wall (may assist left and right ventricular function integration)

    • Inflow component:

      •  prominent muscle bands:

        • moderator

        • septal

        • parietal

      •  muscle bundle

        • trabeculae carneae

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Pulmonary Artery & Peripheral Pulmonary Circulation

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  • Pulmonic valve (a trileaflet valve) separates:

    •  Right ventricular infundibulum from the main pulmonary artery (PA).

    •  Trileaflet (right, anterior, left cusps)-- 4 cm2 in area.

    •  Origination -- superior portion of the right ventricle

      • 11: anterior semilunar cusp (pulmonic valve)

      • 12: left semilunar cusp (pulmonic valve)

      • 13: right semilunar cusp (pulmonic valve)

      • 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

       

    •  Path:

      1. under the aorta

      2. bifurcation into the right & left pulmonary artery (upper part of bifurcation is attached to the inferior aortic surface by the ligimentum arteriosum - a remnant of the ductus arteriosus)

    •  Pulmonary arteries  pulmonary arterioles  pulmonary capillaries that spread over alveolar surfaces between two alveolar endothelial layers

  •   Pulmonary vessels size:
    •  Left-to-right shunt:prominent main pulmonary artery & hillar vessels: prominent
    •  Pulmonary hypertension: main pulmonary artery dilation, followed by tapering of peripheral pulmonary vessels

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Left Atrium  

  • Larger than right atrium
  • Receives one or two pulmonary veins on left side
  • Receives two or three pulmonary veins  on right side
  • Blood flow path:
    • Left atrium left ventricle through the mitral valve
    • Mitral valve composition:  (area = 6-8 cm2)
      • two major anteromedial and posterolateral leaflets
      • papillary muscles
      • chordae tendineae
    • Mitral chordae tendineae & papillary muscle: sensitive to reduced blood supply  

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Left Ventricle (LV)

  • Thicker (8-15 mm) > right ventricle
  • Internal dimension (4.5 cm) > right ventricle (3.5 cm)
  • Division of right ventricle from left ventricle:
    • interventricular septum
  • Ventricular layered structures (common to both left and right ventricles)
    •  inner layer-endocardium covered with endothelium
    •  muscle layer (myocardium)
    •  outer layer (epicardium)

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Aortic valves

  • Adjacent to mitral valves within the left ventricle
  • Cusps-unequal sizes; area = 3-4 cm2.
    •  right & left (coronary) cusps
    •  posterior (non-coronary) cusp
    •  at the level of the valve, the aorta dilates to form the sinuses of Valsalva (location of the coronary ostia)
    • 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
Left image
  • 1: superior vena cava
  • 9: chordae tendineae
  • 10: anterior papillary muscle
  • 11: myocardium
  • 12: pulmonary trunk
  • 13: ascending aorta
  • 19: left atrium
  • 20: aortic valve
  • 21: left ventricle
  • 22: pulmonary veins
  • 23: fossa ovalis
  • 24: left atrium
  • 25: left atrioventricular left and bicuspid or mitral) valve
  • 26: coronary sinus
  • 27: left coronary
  • 28: posterior papillary muscle

Right Image

  • 1: superior vena cava

  • 9: chordae tendineae

  • 10: anterior papillary muscle

  • 11: myocardium

  • 13: ascending aorta

  • 18: heart apex

  • 20: aortic valve

  • 21: left ventricle

  • 22: pulmonary veins

  • 23: fossa ovalis

  • 24: left atrium

  • 25: left atrioventricular left and bicuspid or mitral) valve

  • 26: coronary sinus

  • 29: left subclavian artery

  • 30: descending aorta

  • 31: left pulmonary artery

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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