Angiology Composition n Cardiovascular system n Lymphatic system

Angiology 脉管学 Composition n Cardiovascular system 心血管系统 n Lymphatic system 淋巴系统

The cardiovascular system心血管系统 Organization n n Heart 心 q A muscle pump to maintain the flow of blood q Consist of four chambers (right and left atria, right and left ventricles) Artery (a. )动脉 carry blood away from the heart Veins ( v. )静脉 carry blood back to the heart Capillary 毛细血管 microscopic vessels, the area of exchange between blood and tissue fluid

The cardiovascular system心血管系统 Blood circulation n Systemic circulation 体循环 left ventricle→aorta and its branches→capillaries of body→superior and inferior vena cava→right atrium n Pulmonary circulation 肺循环right ventricle→pulmonary a. →capillaries of lung → pulmonary v. →left atrium

The cardiovascular system心血管系统 Vascular anastomosis 血管吻合 n n n Anastomosis between a. Anastomosis between v. Arteriolovenular anastomosis 动静脉吻合 n n Collateral vessels 侧副管 Collateral circulation 侧支循环

The Heart

The heart Position n n Lies within the pericardium in middle mediastinum Behind the body of sternum and coastal cartilages 2 to 6 In front of thoracic vertebrae 5 to 8 A third of it lies to the right of median plan and 2/3 to the left

Surfaces of the heart

Surfaces of the heart n n n Pyramidal in shape, somewhat larger than a closed fist One apex One base Two surface Three borders Four sulcuses

Cardiac apex 心尖 n n n Formed by left ventricle Directed downwards, forward, and to the left Lies at the level of the fifth left intercostal space, 1~2 cm medial to the left midclavicular line (9 cm from the midline)

Cardiac base 心底 n n Formed by the left atrium and to a small extent by the right atrium. Faces backward, upward and to the right

Sternocostal surface 胸肋面 n n Formed mainly by the right atrium and right ventricle, and a lesser portion of its left is formed by the left auricle and ventricle Directed forwards and upwards

Diaphragmatic surface 膈面 n n Formed the ventricles－chiefly the left ventricle Directed backwards and downwards, and rest upon the central tendon of the diaphragm

Borders of the heart n Right border 右缘 q q n Left border 左缘 q q n Vertical Formed entirely by right atrium Round Mainly formed by the left ventricle and partly by the left auricle Inferior border 下缘 q q Horizontal Formed by the right ventricle and cardiac apex

Sulcuses of the heart n n Coronary sulcus 冠状沟 (circular sulcus) which marks the division between atria and ventricles, contains the trunks of the coronary vessels and completely encircles the heart Interatrial sulcus 房间沟 －separates the two atria and is hidden by pulmonary trunk and aorta in front

Sulcuses of the heart n Anterior interventricular groove 前室间沟 n Posterior interventricular groove 后室间沟 q Mark the division between ventricles (which separates the RV from the LV) q Cardiac apical incisure 心尖切迹 q Atrioventricular crux 房室交点

Chambers of the heart 心腔

Chambers of the heart 心腔 Consists of four chambers n n Left and right atria 左、右心房 q Left and right auricle 左、右心耳 Left and right ventricles 左、右心室

Right atrium (RA)右心房 n Three inlets q Orifice of superior vena cava 上腔静脉口returns blood to the heart from the upper half of the body q Orifice of inferior vena cava 下腔静脉口 returns blood to the heart from the lower half of the body q Orifice of coronary sinus 冠状窦口 returns blood to the heart from the cardiac muscle n One outlet －right atrioventricular orifice 右房室口

Right atrium (RA) 右心房 n Crista terminalis 界嵴－vertical ridge that from superior vena cave to inferior vena cave n Sulcus terminalis界沟－groove on exterior of heart that corresponds to crista terminalis n Two parts －separated externally by sulcus terminalis and internally by the crista terminalis q Atrium proper 固有心房 q Sinus venarum cavarum 腔静脉窦

Right atrium (RA) 右心房 n Atrium proper 固有心房 q q n In front of the ridge Pectinate muscles in wall Sinus venarum cavarum 腔静脉窦 q q q Smooth walls Fossa ovalis 卵圆窝－ an oval depression, a remnant of the fetal foramen ovale, on the lower part of interatrial septum, the most common location of atrial septal defects (ASD) Aortic mound 主动脉隆凸

Right ventricle (RV) 右心室 　　 n One inlet n －right atrioventricular orifice 右房室口 One outlet 　　 －orifice of pulmonary trunk 肺动脉口

Right ventricle (RV) 右心室 n Supraventricular crest 室上嵴 (a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk ) n Two parts q q Inflow tract 流入道 Outflow tract 流出道

Right ventricle (RV) 右心室 n Inflow tract q q q Trabeculae carneae 肉柱 irregularly arranged bundles of myocardium Septomarginal trabecula 隔缘肉柱－extends from interventricular septum to base of anterior papillary muscle, contains right bundle branch Papillary muscles 乳头肌 n Conical-shaped n Three: anterior, posterior and septal

Right ventricle (RV) 右心室 n Outflow tract —Conus arteriosus 　　　　　　动脉圆锥 q q Cone-shape , smooth area leading upward to orifice of pulmonary trunk Pumps blood through pulmonary orifice to pulmonary trunk

Tricuspid valve 三尖瓣 n Guards right atrioventricular orifice n Three triangular cusps: q q q anterior, posterior and septal Base of cusps are attached to fibrous ring surrounding the atrioventricular orifice. To their free edges and ventricular surfaces are attached chordae tendineae 腱索, which connect the cusps to the papillary muscles.

Tricuspid valve 三尖瓣

Tricuspid complex 三尖瓣复合体 n n Tricuspid ring 三尖瓣环 Tricuspid valve 三尖瓣 Chordae tendineae 腱索 Papillary muscles 乳头肌

Chordae tendineae Papillary muscles

n Open during diastole to allow blood to enter ventricles from atria n Closed during systole to prevent regurgitation of blood into atria

Valve of pulmonary trunk 肺动脉瓣 n n Guards the orifice of pulmonary trunk Has three semilunar cusps – each with free border that has central modules called nodules of semilunar valve 半月瓣小结 n Has three pulmonary sinuses 肺 动脉窦—bulges in wall of pulmonary trunk at level of valve that correspond to cusps

Function of pulmonary valves n Opening during systole, with cusps pressed toward wall of vessel as blood is forced upward n Closed during diastole q q Ventricular pressure drops in diastole Floating together of valve cusps, with free borders meeting, thus closing the valve

Left atrium (LA) 左心房 n Four inlets－four orifices of pulmonary veins 肺静脉口 n One outlet－left atrioventricular orifice 左房室口

Left ventricle (LV) 左心室 n One inlet left atrioventricular orifice n n 左房室口 One outlet － aortic orifice 主动脉口 Two parts－divided by anterior cusps of mitral valve q Inflow tract－rough walls q Outflow tract n Aortic vestibule 主动脉前庭 n Smooth area leading to aortic orifice

Mitral valve 二尖瓣 n n Guards left atrioventricular orifice Two triangular cusps－anterior and posterior with commissural cusps between them (posteromedial and anterolateral commissures)

Mirtal complex 二尖瓣复合体 n n Mitral ring 二尖瓣环 Mitral valve 二尖瓣 Chordae tendineae 腱索 Papillary muscles 乳头肌

n Open during diastole to allow blood to enter ventricles from atria n Closed during systole to prevent regurgitation of blood into atria

n n n Guards the aortic orifice Three semilunar cusps (right, left and posterior) Each with free border that has nodules of semilunar valve 半月瓣小 结 n Aortic sinus 主动脉窦 – bulges in aortic wall at level of valve that correspond to cusps q Right－contains opening of right coronary artery q Left－contains opening of left coronary artery q Posterior－no opening

Function of aortic valves n Opening during systole, with cusps pressed toward wall of vessel as blood is forced upward n Closed during diastole q q Ventricular pressure drops in diastole Floating together of valve cusps, with free borders meeting, thus closing the valve

Structures of the heart

Structures of the heart Walls of heart n n n Endocardium 心内膜 q Inner coat of the heart wall q Continuous with the valve flaps Myocardium 心肌 q Arranged spirally q Attached to fibrous rings surrouding the four orifices of heart q The walls of left ventricle are about three times thicker than that of right Epicardium 心外膜 q Outer q Visceral layer of serous pericardium

Structures of the heart n Interatrial septum 房间隔 q q n Interventricular septum 室间隔 q q q n Located between right and left atria Contains fossa ovalis Located between right and left ventricles Has upper membranous part Has thick lower muscular part Atrioventricular septum 房室隔

Membranous part of interventricular septum

Ventricular Septal Defect

Fibrous skeleton of heart 纤维骨骼 n n Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices Left and right fibrous trigones

Conduction system of heart 心传导系统

Conduction system of heart 心传导系统 Composed of specialized myocardial cells n n n Sinuatrial node 窦房结 Internodal tract 结间束 Atrioventricular node 房室结 Atrioventricular bundle 房室束 Right and left bundle branches 左、右束支 Purkinje network 普肯野氏纤维网

Conduction system of heart 心传导系统 Sinuatrial node (SA node)窦房结 n Called the pacemaker cell (P cell) n Located at the upper part of the sulcus terminalis close to the superior vena cava, under the epicardium.

Conduction system of heart 心传导系统 Atrioventricular node (AV node) 房室结 n n n Located in the lower part of interatrial septum, near orifice of coronary sinus and base of tricuspid valve Under the endocardium Lower part related to membranous part of interventricular septum

Conduction system of heart 心传导系统 Atrioventricular bundle (AV n n bundle)房室束 Passes forward through right fibrous trigon to reach inferior border of membranous part Divides into right and left bundle branches at upper border of muscular part of interventricular septum

Conduction system of heart 心传导系统 n Right and left bundle branches 左、右束支 q Right bundle branch－passes down q n on right side of interventricular septum to reach the septomarginal trabecular and into the base of anterior papillary muscle. Here it becomes continuous with the fibers of Purkinje fibres Left bundle branch－passes down on left side of interventricular septum beneath the endocardium. It usually divides into two branches, which eventually become continuous with the Purkinje fibers Purkinje network 普肯野氏纤维网 continuous with myocardium

★心传导系统 Sinuatrial node Atrioventricular bundle Right and left bundle branches Purkinje network

Arterial supply of the heart

Arterial supply of the heart Left coronary artery 左冠状动脉 n Course q q n n Arises from left aortic sinus Runs between pulmonary trunk and left auricle into coronary sulcus Branches q Anterior interventricular branch 前室间支 －runs downward in anterior interventricular groove around inferior margin of heart to posterior interventricular groove q Circumflex branch 旋支－travels to left in coronary sulcus to posterior aspect Distribution－supplies left atrium and ventricle, lesser portion of anterior wall of right ventricle, and anterior 2/3 of interventricular septum

Arterial supply of the heart Right coronary artery 右冠状动脉 n n n Course q Arises from the right aortic sinus q Runs forward between right auricle and pulmonary trunk into coronary sulcus Branches q Right marginal branch 右缘支 travels along inferior border q Posteror interventricular branch 后室间支－ travels downward in posterior interventricular groove, it anastomosises near the apex with the anterior interventricular branch of the left coronary artery Distribution: supplies right atrium and ventricle, posterioinferior 1/3 of interventricular septum, posterior wall of left ventricle, the sinuatrial node and atrioventricular node

Thrombus in Coronary Artery Angiogram 冠状动脉造影显示动脉血栓

Coronary artery bypass grafting (CABG) Precutaneous translaminal coronary angioplasty (PTCA) Stent in an artery

Venous drainage of the heart

Venous drainage of the heart Coronary sinus 冠状窦 n n n Lies in posterior part of coronary sulcus Carries most of venous blood from myocardium to right atrium Tributaries q Great cardiac vein 心大静脉 q Middle cardiac vein 心中静脉 q Small cardiac vein 心小静脉

Venous drainage of heart n Anterior cardiac veins 心前静脉－3~4 small vessels, drain into right atrium n Smallest cardiac veins 心最小静脉－drain into all chambers, mainly atria

Pericardium 心包

Pericardium 心包 n Fibrous pericardium 纤维心包 q q n Serous pericardium 浆膜心包 q q n Attached to central tendon of diaphragm inferiorly Blends with outer coat of great vessels superiorly Visceral layer (epicardium) Parietal layer Pericardial cavity 心包腔 q q Potential space between visceral and parietal layes Contains film of pericardium fluid as a lubricant to facilitate cardiac movements

Pericardium 心包 Pericardium sinus n n Formed by reflection of serous pericardium Transverse sinus of pericardium 心包横窦 q q Posterior to ascending aorta and pulmonary trunk Anterior to superior vena cava and left atrium.

Pericardium sinus n n Oblique sinus of pericardium 心包斜窦－cul-de-sac , posterior to heart, bounded by pulmonary veins on either side Anterior inferior sinus of pericardium 心包前下窦

Surface markings of heart

Surface markings of heart n n R. superior point－ lies on the upper border of right third costal cartilage ± 1. 2 cm from the margin of sternum R. inferior point － lies on the sixth sternocostal joint L. superior point － lies on lower border of left second costal cartilage ± 1. 2 cm from sternal margin Cardiac apex－in the fifth left intercostal space 7~9 cm from the midline

Surface markings of heart n n Right border－corresponds to a line running from the upper border of right third costal cartilage ± 1. 2 cm from the margin of sternum, downwards to sixth sternocostal joint Apex－in the fifth left intercostal space 7~9 cm from the midline Left border－represented by a line running from apex upwards and medially to a point on lower border of left second costal cartilage ± 1. 2 cm from sternal margin Lower border－represented by a line joint the lower end of right border to apex

Cardiac anatomy shown by transthoracic echocardiography. Four-chamber view.

Cardiac anatomy shown by transthoracic echocardiography. Short-axis view at aortic valve level.

Dissection of the heart

★You must identify follow structures！ Shape of heart n Cardiac apex n Cardiac base n Coronary sulcus n Anterior interventricular groove n Posterior interventricular groove n Cardiac apical incisure n Atrioventricular crux n Right and left auricle n Pulmonary trunk Vessels of heart n Left coronary artery n Anterior interventricular branch n Right coronary artery n Posteror interventricular branch n coronary sinus Right atrium n Orifice of superior vena cava n Orifice of inferior vena cava n Orifice of coronary sinus n Sulcus terminalis n Fossa ovalis n Pectinate muscles

★You must identify follow structures！ Right ventricle n Right atrioventricular orifice n Tricuspid valve n Chordae tendineae n Papillary muscles n Supraventricular crest n Trabeculae carneae n Septomarginal trabecula n Conus arteriosus n Valve of pulmonary trunk Left atrium Orifices of pulmonary veins n Left atrioventricular orifice Left ventricle n Aortic vestibule n Mitral valve n Aortic vavle n Aortic sinus n