Tuesday, October 6, 2009

Anatomy V -- external features of the heart

Coronary (atrioventricular) sulcus -- separates atria and ventricles
Anterior (or posterior) interventricular sulcus

Some pretty useless surface terms:
Sternocostal surface (anterior) -- right ventricle
Diaphragmatic surface (inferior) -- left ventricle, small part right ventricle
Pulmonary surface (left) -- left ventricle, forms the cardiac impression on left lung

Right auricle and left auricle -- earlobe like extensions to the atria

The cardiac veins and arteries are located below the visceral pericardium. The veins are superficial to the arteries.

Coronary sinus, dilated, 2-2.5cm in length, opens into right atrium in groove between SVC and tricuspid valve, just above the tricuspid in the right auricle. Coronary sinus runs superiorly in coronary sulcus to receive great cardiac vein, which upon reaching the sternocostal surface runs down the anterior interventricular sulcus. The coronary sinus gives off the middle cardiac vein at the posterior interventricular sulcus. The small cardiac vein runs inferiorly down the coronary groove from the coronary sinus and then left along the inferior border of the heart.

While most veins connect with coronary sinus, the anterior cardiac veins do not. They cross the atrioventricular sulcus, draining the anterior surface of the right ventricle into the right atrium. They are superficial to the right coronary artery.

The aortic valve has three semilunar cusps: left, right, and posterior. Behind each cusp is an aortic sinus (left, right, and posterior). The left aortic sinus gives rise to the left coronary artery, which courses down to split at the junction of the coronary sulcus and interventricular sulcus to form the anterior interventricular branch (left anterior descending artery) and the circumflex branch, which wraps posterior around the coronary sulcus to supply the posterior wall of the left ventricle. The right aortic sinus gives rise to the right coronary artery, which courses down the coronary sulcus around the heart to the diaphragmatic surface. It gives off several tributaries: the anterior right atrial branch, which itself has a sinuatrial nodal branch (spelled correctly) to supply the SA node; the marginal branch, running along with the small cardiac vein along the inferior surface toward, but not reaching, the left ventricle; the artery to the atrioventricular node, on the diaphragmatic surface at the coronary sulcus and interventricular juncture; the posterior interventricular branch, which also comes off at that juncture (in 15% of hearts, comes off the left coronary artery). There are anastomoses between the left circumflex and right coronary artery on the posterior surface, and between the posterior interventricular branch and the left anterior descending artery (anterior interventricular branch) at the apex of the heart.


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