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 carneaePulmonary Artery & Peripheral Pulmonary Circulation Pulmonic valve (a trileaflet valve) separates: Right ventricular infundibulum from the main pulmonary artery (PA). Trileaflet (right, anterior, left cusps)-- 4 cm2in 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. Path:4. under the aorta4. 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)1. Pulmonary arteries pulmonary arterioles pulmonary capillaries that spread over alveolar surfaces between two alveolar endothelial layers.1. Pulmonary vessels size:6. Left-to-right shunt:prominent main pulmonary artery and hillar vessels: prominent.6. Pulmonary hypertension: main pulmonary artery dilation, followed by tapering of peripheral pulmonary vessels.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 supplyLeft 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)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.

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 muscleRight 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

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