Download Cardiac and Coronary Anatomy Cardiac Chambers

7/29/2011
Cardiac and Coronary
Anatomy
Disclosure
Speaking honorarium - GE
Healthcare
Smita Patel, M.B.B.S., M.R.C.P., F.R.C.R.
Associate Professor, University of Michigan
Ann Arbor, MI
Objectives
• Review anatomy of the cardiac
chambers
• Review normal coronary artery anatomy
Cardiac Chambers
• Review cardiac vein anatomy
RV
Moderator
Band
RV
RV
RV
RA
RA
MV
AV
LV
LAA
LA
LV
LA
LA
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RV
RV
RA
MV
LV
RA
LV
Coronary Arteries
LA
Papillary
Muscle
Coronary Sinus
Coronary Arteries
Normal Coronary Arteries: Origin & Course
• Right Coronary Artery (RCA)
RCA
RVOT
• Left Main Coronary Artery (LM)
LAD
• Left Anterior Descending Artery (LAD)
Ao
LMCA
• Left Circumflex Artery (LCX)
Right Coronary Artery
• Arises from the right sinus of Valsalva
• Origin is below that of the LM
• Runs rightward and anteriorly and
inferiorly in the right AV groove
towards the interventricular septum
LCx
RCA
Branch to the
SA Node
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Right Coronary Artery
Branches
Coronary Artery Axial Anatomy
• Conus Branch (1st branch in 50%)
• SA nodal branch (60%)
• Anterior branches supplying the free
wall of the RV
• Acute Marginal Branches
• AV nodal branch
• PDA
• Posterolateral branch
RCA
Posterolateral
branch
Acute
Marginal
PDA
LCA - Branches
• LAD runs anterior and inferiorly in
the anterior inter-ventricular groove
to the apex of the heart
– Septal perforators
Left Coronary Artery
• LM – could be short or long
• Divides into LAD and LCX
• Occasionally trifurcates
– LAD, LCX & RI
• Ramus intermedius supplies
the anterior wall of the LV similar
to the 1st diagonal
• Left coronary is dominant in 8-10%
of cases
RCA, LAD, Ramus I & Cx
LAD
RCA
LAD
– Diagonal branches
• LCX runs posteriorly into the
posterior inter-ventricular groove
LM
CX
RI
– Obtuse marginal branches
– PDA and PLB (Left dominant)
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LAD
Circumflex
Septal
Obtuse
Marginal
Diagonals
Right dominant
Left dominant
Standard Cardiac Viewing Planes
Left Ventricular Segmental
Anatomy for LV Functional
Analysis
Short
axis
long
axis
Three
chamber
Four
chamber
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Coronary Artery Territories
Short axis views
Base
Mid body
Coronary Artery Territories
Long Axis Views
Apex
LAD
LAD
RCA
RCA
LCX
Wall Motion
Short Axis
Basal
Mid-Cavity
LCX
Horizontal long axis
Vertical long axis
Wall Motion
Long Axis – 4 chamber
Apex
Aortic Valve
Valves
• Located between the left ventricle
and the aorta
• Three leaflets
• Valve leaflets open during systole
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Mitral Valve
Aortic Valve
• One way valve between the left atrium
and left ventricle
• Opens during ventricular diastole
• Two leaflets – anterior and posterior
• Chordae tendinae attach the ventricular
surface of the MV leaflets to the papillary
muscles
Mitral Valve
Cardiac Veins
Cardiac Veins
• Coronary sinus and its tributaries
– Return blood from almost the entire heart
• Anterior cardiac veins
– Drain anterior regions of the RC and
right cardiac border
• Thebesian veins
– Open directly into any of the four chambers
Left Cardiac Veins
•
•
•
•
•
•
Great cardiac vein
Middle cardiac vein
Small cardiac vein
Left obtuse marginal vein
Left posterior ventricular vein
Coronary Sinus
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Cardiac Veins
Cardiac Veins
Coronary
Sinus
Great
cardiac
vein
Posterior left
ventricular vein
Cardiac Veins
Great
Cardiac
Vein
Anterior
interventricular
vein
Middle
cardiac vein
Posterior
LV Cardiac
Vein
Coronary Sinus
Middle
Cardiac
Vein
References
Anterior
Interventricular
Vein
• Cademartiri F, La Grutta L, Malagò R, et al. Eur
Radiology 2008; 18:781-791.
• Patel S. Seminars in Roent 2008; 43:100-112.
• Kini S, Bis KG, Weaver L. AJR, 2007; 188:1665-1674.
• Austen WG, Edwards JE, Frye RL, et al. Circulation
1975; 51:5-40.
• Cerqueira MD, Weissman NJ, Dilsizian V, et al.
Circulation 2002; 105:539-542.
• Van de Veire NR, Schuijf JD, De Sutter J, et al. JACC
2006; 48:1832-1838.
• Edwards WD, Tajik AJ, Seward JB. Mayo Clinic
Proceedings 1981; 56:479-497.
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Thank you!
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