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Transcript
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 1 7/29/2011 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 2 7/29/2011 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) 3 7/29/2011 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 4 7/29/2011 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 5 7/29/2011 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 6 7/29/2011 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. 7 7/29/2011 Thank you! 8