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Gross Anatomy
of the
Jeff Dupree
PERICARDIUM
and
HEART
Sanger Hall 9-057
828-9536
E-mail: [email protected]
M1 Gross and Developmental Anatomy
8:00 AM, November 7, 2007
Dr. Milton M. Sholley
Professor of Anatomy and Neurobiology
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Left atrium
Right auricle
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Mediastinum
Right auricle
Right ventricle
Right ventricle
Left ventricle
Opened Chambers
of the
Human Heart
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4
II. Pericardial sac
Fibrous pericardium
(inferiorly fuses to central
region of diaphragm)
Phrenic nerve:
from cervical spinal
nerves (C3-C5)
Pericardiacophrenic artery
and vein
Subdivisions of the Mediastinum
(Mid-sagittal plane drawing from Textbook of Anatomy by W. Henry Hollinshead)
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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.
Fibrous pericardium
The visceral layer
of pericardium (or
epicardium) tightly
adheres to the surface
of the heart
Pericardial sac
Parietal layer
Serous pericardium
Visceral layer
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
Cut edge of fused
fibrous (outside) + parietal (inside)
layers of pericardium
Grant’s Atlas,
12th Ed.,7
Fig. 1.21, p. 25
Pericardial sac
Grant’s Atlas,
11th Ed., 8
Fig. 1.57B, p. 63
Diagrammatic Coronal Section
Superior View of Diaphragm
Layers of the Heart Wall (page 266)
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
Fibrous pericardium:
(inferiorly fuses to central
region of diaphragm)
Inferior vena cava
Epicardium:
Visceral pericardium
Fat and blood vessels
R
L
Myocardium:
heart muscle
Endocardium:
innermost endothelial
layer)
Esophagus
Aorta
Grant’s Atlas,
12th Ed., 9
Fig. 1.70A, p. 73
II. Pericardial Sinuses (page 266)
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Transverse Pericardial Sinus
Transverse pericardial sinus:
Between pericardial
attachments to pulmonary
veins and SVC and the aorta
and pulmonary trunk
Transverse pericardial sinus
Oblique pericardial sinus
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Oblique and Transverse Pericardial Sinuses
The Esophagus and Thoracic Aorta lie
behind the
Oblique Pericardial Sinus
Pulmonary trunk
Superior vena cava
Esophagus
Aorta
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
Grant’s Atlas,
12th Ed.,
Fig. 1.44B, p. 51
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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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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
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DA
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III. External form of the Heart
Sulci of the Heart
Coronary (or
atrioventricular)
sulcus
Anterior
interventricular
sulcus
Sternocostal surface
Base
Diaphragmatic
surface
Posterior
interventricular
sulcus
Anterior view
Posterior view
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Coronary Arteries
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
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
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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”.
Sinuatrial nodal a.
Left coronary a.
Circumflex a.
Right Coronary a.
AV nodal branch
Marginal a.
Anterior Interventricular a.
Circumflex branch
Crux of heart
Posterior interventricular
(posterior descending) branch
Posterior view
Grant’s Atlas,
12th Ed., 23
Fig. 1.45B, p. 52
Right marginlal a.
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Right dominant coronary circulation
(what we studied just studied)
~60% of cases
Sinuatrial nodal a.
Left dominant coronary circulation
~40% of cases
Circumflex a.
Left marginal a.
Right Coronary a.
Posterior ventricular a.
Right marginal a.
Posterior interventricular a.
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LIMA Graft Provides an Artery to Artery
Bypass around a Blocked LAD
Anomalous Origins of Coronary Arteries
Single coronary artery
(bad news if it becomes blocked)
Circumflex artery
arising from right coronary sinus
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.
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Cardiac veins
Cardiac veins
Great cardiac
Middle cardiac
Small cardiac
Anterior cardiac veins
Anterior cardiac
Least cardiac
Great cardiac vein
Oblique vein of
left atrium
Middle cardiac vein
Coronary sinus
Small cardiac vein
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Anterior view
Grant’s Atlas,
12th Ed., 30
Fig. 1.46A, p. 53
Left atrium
Cardiac veins
Right auricle
Right auricle
Oblique vein of
left atrium
Great cardiac vein
Right ventricle
Coronary sinus
Right ventricle
Left marginal vein
Left ventricle
Middle cardiac vein
Left posterior
ventricular vein
Small cardiac vein
Opened Chambers
of the
Human Heart
Grant’s Atlas,
12th Ed., 31
Fig. 1.46D, p. 53
Posterior view
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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
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Grant’s Atlas,
12th Ed.,
34
Figs. 1.49 A&B, p. 56
Right atrioventricular
orifice
Right Ventricle Opened
Orifice of pulmonary valve
Left auricle
Septal papillary muscles
Conus
arteriosus
Chordae
tendineae
Septal cusp
Posterior papillary
muscle
Left superior pulmonary v.
Valve of foramen ovale
Right pulmonary v.
Moderator band
Anterior cusp
Anterior papillary muscle
Posterior cusp
Grant’s Atlas,
12th Ed., 35
Figs. 1.50 A, p. 57
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Left Ventricle Opened
Posterior sinus of
aortic valve
Detail of the Aortic Semilunar Valve
Posterior (non-coronary)
cusp of aortic valve
Orifice of right
coronary artery
Orifice of left
coronary artery
Right aortic sinus
Orifice of the right
coronary artery
Lunule
Nodule
Orifice of the left
coronary artery
Left aortic sinus
Right cusp of
aortic valve
Nodules meet when
the valve cusps
close
Left cusp of
aortic valve
Membranous
interventricular septum
Aortic sinus
Anterior cusp of
mitral valve
Chordae
tendineae
Posterior cusp of
mitral valve
RC
PC
Orifice of a
coronary
artery
LC
Anterior papillary
muscle
Trabeculae
carneae
Posterior papillary
muscle
Right coronary artery
Grant’s Atlas,
12th Ed., 37
Figs. 1.52A, p. 59
Left coronary artery
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Aortic and Pulmonary Semilunar Valves
Cardiac Conduction System
Superior vena cava
Location of SA node
Aortic valve
SA node
AV node
P
L
R
R
Crista terminalis
Orifice of
coronary
sinus
L
A
AV bundle
Orifice of
coronary
sinus
Pulmonary valve
Right
bundle branch
Superior view
Grant’s Atlas,
12th Ed.,
39
Figs. 1.53 & 1.54C, p. 60
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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