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Gross Anatomy
of the
PERICARDIUM
and
HEART
M1 Gross and Developmental Anatomy
8:00 AM, November 7, 2007
Dr. Milton M. Sholley
Professor of Anatomy and Neurobiology
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Jeff Dupree
Sanger Hall 9-057
828-9536
E-mail: [email protected]
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Left atrium
Right auricle
Right auricle
Right ventricle
Right ventricle
Left ventricle
Opened Chambers
of the
Human Heart
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Mediastinum
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Subdivisions of the Mediastinum
(Mid-sagittal plane drawing from Textbook of Anatomy by W. Henry Hollinshead)
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II. Pericardial sac
Fibrous pericardium
(inferiorly fuses to central
region of diaphragm)
Phrenic nerve:
from cervical spinal
nerves (C3-C5)
Pericardiacophrenic artery
and vein
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Note the opened Pericardial Sac
The pericardial sac is the space
between the parietal and visceral
layers of the serous pericardium.
The sac normally contains only
a thin layer of serous fluid, but
inflammation of the sac
(pericarditis) can cause
a large increase in the
volume of fluid.
The visceral layer
of pericardium (or
epicardium) tightly
adheres to the surface
of the heart
The fibrous layer
of pericardium
is thick and makes
the pericardial
sac tough and
inflexible
The parietal layer
of pericardium
tightly adheres to
the inside of the
fibrous pericardium
Grant’s Atlas,
12th Ed.,7
Fig. 1.21, p. 25
Cut edge of fused
fibrous (outside) + parietal (inside)
layers of pericardium
Fibrous pericardium
Pericardial sac
Parietal layer
Serous pericardium
Visceral layer
Pericardial sac
Diagrammatic Coronal Section
Grant’s Atlas,
11th Ed., 8
Fig. 1.57B, p. 63
Superior View of Diaphragm
The fibrous pericardium
is fused to the superior
surface of the diaphragm.
Thus, the heart moves
up and down with the
diaphragm during
respiration.
Pericardial sac
Inferior vena cava
R
L
Esophagus
Aorta
Grant’s Atlas,
12th Ed., 9
Fig. 1.70A, p. 73
Layers of the Heart Wall (page 266)
Fibrous pericardium:
(inferiorly fuses to central
region of diaphragm)
Epicardium:
Visceral pericardium
Fat and blood vessels
Myocardium:
heart muscle
Endocardium:
innermost endothelial
layer)
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II. Pericardial Sinuses (page 266)
Transverse pericardial sinus
Oblique pericardial sinus
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Transverse Pericardial Sinus
Transverse pericardial sinus:
Between pericardial
attachments to pulmonary
veins and SVC and the aorta
and pulmonary trunk
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Oblique and Transverse Pericardial Sinuses
Pulmonary trunk
Superior vena cava
Transverse pericardial sinus
Right superior pulmonary vein
Left superior pulmonary vein
Right inferior pulmonary vein
Left inferior pulmonary vein
The base of the heart sits
here, forming the opposite
(anterior) wall of the oblique
pericardial sinus. The
line of junction between the
parietal and visceral layers
of serous pericardium
surrounds the six great
veins and creates a cul-desac known as the oblique
pericardial sinus.
Inferior vena cava
Posterior wall of opened pericardial sac – heart removed
Grant’s Atlas,
12th Ed., 13
Fig. 1.44B, p. 51
The Esophagus and Thoracic Aorta lie
behind the
Oblique Pericardial Sinus
Esophagus
Grant’s Atlas,
12th Ed.,
Fig. 1.44B, p. 51
Aorta
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The Esophagus and Thoracic Aorta lie
behind the
Oblique Pericardial Sinus
Esophagus
Grant’s Atlas,
12th Ed.,
Fig. 1.44B, p. 51
Aorta
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16
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AA = Ascending aorta
AR = Aortic arch
DA = Descending aorta
BT = Brachiocephalic trunk
RS = Right subclavian a.
RC = Right common carotid a.
LC = Left common carotid a.
LS = Left subclavian a.
R
C
L
C
RS
BT
LS
AR
AA
DA
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III. External form of the Heart
Coronary (or
atrioventricular)
sulcus
Anterior
interventricular
sulcus
Sternocostal surface
Anterior view
Base
Diaphragmatic
surface
Posterior
interventricular
sulcus
Posterior view
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Sulci of the Heart
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IV. Blood Supply of the Heart
Right coronary a.
SA nodal branch
Conus
Right marginal
AV nodal branch
Posterior interventricular
Left coronary a.
Anterior interventricular
Diagonal branches
Circumflex
Posterior ventricular
Left marginal
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Coronary Arteries
SA nodal branch
Left coronary artery
(main stem)
Circumflex branch
Right coronary artery
Left anterior descending
branch (LAD)
Left marginal branch
Diagonal branch of LAD
Conus branch
Note: LAD is also called
the anterior Interventricular
branch
Right marginal branch
Anterior view
Grant’s Atlas,
12th Ed., 22
Fig. 1.45A, p. 52
Coronary Arteries
Note: The crux of the heart is the area
of junction of the atrioventricular and
posterior interventricular sulci. If the
right coronary artery gives off the
posterior Interventricular (as here) the
pattern is “right dominant”. If the circumflex
branch of the left coronary reaches the
crux and gives off the posterior
interventricular the pattern is”left dominant”.
About 60% of hearts are “right dominant”.
AV nodal branch
Circumflex branch
Crux of heart
Posterior interventricular
(posterior descending) branch
Posterior view
Grant’s Atlas,
12th Ed., 23
Fig. 1.45B, p. 52
Sinuatrial nodal a.
Left coronary a.
Circumflex a.
Right Coronary a.
Marginal a.
Anterior Interventricular a.
Right marginlal a.
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Sinuatrial nodal a.
Circumflex a.
Left marginal a.
Posterior ventricular a.
Right Coronary a.
Right marginal a.
Posterior interventricular a.
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Right dominant coronary circulation
(what we studied just studied)
~60% of cases
Left dominant coronary circulation
~40% of cases
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Anomalous Origins of Coronary Arteries
Single coronary artery
(bad news if it becomes blocked)
Circumflex artery
arising from right coronary sinus
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LIMA Graft Provides an Artery to Artery
Bypass around a Blocked LAD
LIMA
LAD
Fibrous
pericardium
The left internal mammary artery (LIMA) lies very close (just outside
the pericardial sac) to the left anterior descending artery (LAD). It can
be diverted and anastomosed to the LAD to bypass a blockage in
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this important arterial supply to the left ventricle and interventrticular
septum.
Cardiac veins
Great cardiac
Middle cardiac
Small cardiac
Anterior cardiac
Least cardiac
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Cardiac veins
Anterior cardiac veins
Great cardiac vein
Oblique vein of
left atrium
Middle cardiac vein
Coronary sinus
Small cardiac vein
Anterior view
Grant’s Atlas,
12th Ed., 30
Fig. 1.46A, p. 53
Cardiac veins
Oblique vein of
left atrium
Great cardiac vein
Coronary sinus
Left marginal vein
Middle cardiac vein
Left posterior
ventricular vein
Small cardiac vein
Grant’s Atlas,
12th Ed., 31
Fig. 1.46D, p. 53
Posterior view
Left atrium
Right auricle
Right auricle
Right ventricle
Right ventricle
Left ventricle
Opened Chambers
of the
Human Heart
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Right Atrium Opened
Pectinate muscles
(rough part
of wall)
Fossa ovalis
SVC
Crista
terminalis
Orifice of
coronary sinus
Valve of IVC
IVC
Right atrioventricular
orifice
Grant’s Atlas,
12th Ed.,
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Figs. 1.49 A&B, p. 56
Right Ventricle Opened
Orifice of pulmonary valve
Septal papillary muscles
Conus
arteriosus
Septal cusp
Chordae
tendineae
Posterior papillary
muscle
Moderator band
Anterior cusp
Anterior papillary muscle
Grant’s Atlas,
12th Ed., 35
Figs. 1.50 A, p. 57
Posterior cusp
Left auricle
Left superior pulmonary v.
Valve of foramen ovale
Right pulmonary v.
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Left Ventricle Opened
Posterior sinus of
aortic valve
Posterior (non-coronary)
cusp of aortic valve
Orifice of right
coronary artery
Orifice of left
coronary artery
Right aortic sinus
Left aortic sinus
Right cusp of
aortic valve
Left cusp of
aortic valve
Membranous
interventricular septum
Anterior cusp of
mitral valve
Chordae
tendineae
Posterior cusp of
mitral valve
Anterior papillary
muscle
Trabeculae
carneae
Posterior papillary
muscle
Grant’s Atlas,
12th Ed., 37
Figs. 1.52A, p. 59
Detail of the Aortic Semilunar Valve
Orifice of the right
coronary artery
Lunule
Nodule
Nodules meet when
the valve cusps
close
Orifice of the left
coronary artery
Aortic sinus
RC
PC
LC
Orifice of a
coronary
artery
Right coronary artery
Left coronary artery
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Aortic and Pulmonary Semilunar Valves
Aortic valve
P
L
R
L
R
A
Pulmonary valve
Grant’s Atlas,
12th Ed.,
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Figs. 1.53 & 1.54C, p. 60
Superior view
Cardiac Conduction System
Superior vena cava
Location of SA node
SA node
AV node
Crista terminalis
Orifice of
coronary
sinus
AV bundle
Orifice of
coronary
sinus
Right
bundle branch
Left
bundle branch
Interventricular septum
Location of AV node
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This diagram shows the cardiac nerves and the locations of the superficial (a) and deep (b) cardiac
plexuses. Vagal branches are shown as dashed lines and sympathetic branches are shown as dotted
lines. The thoracic cardiac nerves from the upper thoracic sympathetic trunks are not shown. (From
Textbook of Anatomy by W. Henry Hollinshead)
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Auscultation Sites for the 4 Heart Valves
Actual locations of the 4 heart valves
projected onto the anterior thoracic wall.
The actual locations do not correspond to
the sites of auscultation. The sites of
auscultation are where the chamber distal
(in terms of blood flow) to the valve lies
closest to the body surface.
P=Pulmonary valve, A=Aortic valve,
M=Mitral valve, and T=Tricuspid valve.
(From Textbook of Anatomy by W. Henry
Hollinshead)
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