lecture 6 - cardiac anatomy slides

Introduction to RadiologicIntroduction to Radiologic Anatomy of the

Cardiovascular system

Department of Radiology,p gy,Vancouver General Hospital

Dr. Darra MurphyChest Imaging Fellow

Learning Objectives

Be able to identify the following cardiac structures on Chest CT:

P i di l• Pericardial sac• External Cardiac borders, cardiac chambers, valves, muscles:

o Right atrium and right atrial appendageo Right ventriclego Left atrium and left atrial appendageo Left ventricle

• Coronary vessels Right coronary arteryo Right coronary artery

– Posterior descending branch o Left coronary artery

– Circumflex branch– Left anterior descending branch

o Coronary sinus

Learning Objectives

Be able to identify the following cardiac structures on Chest CT:

• Heart valveso Tricuspid valveo Pulmonary valveo Mitral valveo Aortic valve

Cardiovascular System

Knowledge of the borders of the heart help to locate individual structures

• Left heart border: aortic knuckle, aorto-pulmonary window, left atrial appendage, left ventricle

• Right heart border: SVC, right atriumatrium

• Inferior heart border: right ventricle in contact with diaphragmdiaphragm

Basic Anatomy

Left Atrium

Heart Chambers

Looking at the Hila

• Comprised of lobar bronchi,

central/lobar pulmonary arteriescentral/lobar pulmonary arteries,

veins, lymph nodes

• The left hilum is slightly higher

than the right in normal

individuals

• Maybe enlarged by arteries,

masses or enlarged lymph

dnodes

Cardiovascular System Sagittal view

Aortic Arch

Left Pulmonary Veins

Right Ventricle Left Pulmonary Arteries

Left Ventricle

Heart borders (anterior)

A ti t P l t

Superior vena cava

Aortic root Pulmonary artery

Right atrium

Left ventricle

Right ventricle

Left ventricle

Heart borders (right lateral)

Aortic root

Right atriumRight atrial appendage

Right ventricleg

Heart borders (left lateral)

Left atriumLeft atrium

Left ventricle

Diaphragmatic surface of the heart

Right atriumLeft atrium

Posterior i t t i linterventricular

sulcus

Right ventricleLeft ventricle PDA

19

Radiology Anatomy of the Upper Thorax - Axial View

8

27

5

6 4

3

5

1. Sternum2. Arch of the Aorta3. Humerus

6. Trachea7. Azygous Vein8. Superior Vena Cava3. Humerus

4. Esophagus5. Vertebral Body

8. Superior Vena Cava9. Pectoralis Muscles

Radiology Anatomy of the Mid Thorax - Axial View

9 1

28

7

3

46

7

5

1. Ascending Aorta2. Pulmonary Trunk

6. Esophagus7. Right Pulmonary Artery2. Pulmonary Trunk

3. Left Pulmonary Artery4. Bronchi5. Descending Aorta

7. Right Pulmonary Artery8. Superior Vena Cava9. Rib

1

Radiology Anatomy of the Lower Thorax - Axial View

3

2

7

5

7

56

44

1. Right Ventricle2 Pericardium

6. Azygous Vein7 Right Atrium2. Pericardium

3. Left Ventricle4. Descending Aorta5. Esophagus

7. Right Atrium

Radiology Anatomy of the ThoraxAxial View

Aortic Valve

Left atriumLeft atrium

Radiology Anatomy of the ThoraxAxial View

Right Atrium

Left inferiorLeft inferior pulmonary vein

Descending Aorta

Radiology Anatomy of the ThoraxAxial View

Right ventricleg

Left VentricleTricuspid Valve

Left Ventricle

coronary sinus

Radiology Anatomy of the ThoraxAxial View

Moderator Band

Left Ventricle

Radiology Anatomy of the ThoraxCoronal View

Aorta

Pulmonary ArteryAscending

Aorta

Left Ventricle

Right Ventricle

Radiology Anatomy of the ThoraxCoronal View

Trachea

Right Pulmonary Artery

Left Pulmonary Artery

Left Ventricle

y

2 layers of pericardial sac:1. Fibrous pericardium (OUTER)2. Serous pericardium (INNER)

I parietal pericardium (fused to fibrous pericardium)I. parietal pericardium (fused to fibrous pericardium)II. visceral pericardium (part of the epicardium)

Normal Pericardium

Pericardial Effusion

YELLOW arrows outline the parietal andYELLOW arrows outline the parietal and visceral layers of the pericardium

Cardiac Valves

Cardiac Valves

Valvular Anatomy: Tricuspid Valve

• Separates right atrium and ventricle

• Consists of three leaflets o Leaflets are attached by chordae tendinae to papillary muscles to keep valves

closed during systole

Valvular Anatomy: Tricuspid Valve

Valvular Anatomy: Pulmonary Valve

• Separates the right ventricular outflow tract and pulmonary trunk

• Consists of three semilunar cusps

Valvular Anatomy: Pulmonary Valve

Valvular Anatomy: Mitral Valve

• Separates left atrium and ventricle

• Consists of two leafletso Leaflets are attached by chordae tendinae to papillary muscles to keep

valves closed during systole

Mitral valve

Tricuspid + Mitral valves

Mitral valve in fibrous continuity with the aortic valve

Valvular Anatomy: Aortic Valve

• Separates left ventricular outflow tract from ascending aorta

C i t f th il• Consists of three semilunarcusps

• Right and left coronary arteries• Right and left coronary arteries originate from the right and left aortic sinuses

Valvular Anatomy: Aortic Valve

Origin of left Coronary Artery

Coronary Circulation

Arterial blood supply to the myocardium arises from two coronary arteriesArterial blood supply to the myocardium arises from two coronary arteries• Coronary arteries arise from the sinuses of the aortic valve • Encircle the heart and branches converge towards the apex

Volume rendered – heart (anterior)

A ti tAortic root

Right coronary arteryLeft anterior descending

coronary arteryRight coronary artery y y

Volume rendered – lateral

Aortic root

Right coronaryRight coronary artery

Left anterior descending

coronary artery

Volume rendered - Left lateral

Left Circumflex

LAD coronary artery

Volume rendered - posterior

Posterior descending artery

Left Anterior Descending Artery Occlusion

Right Coronary Artery

• Arises from the aortic sinus of the right aortic valve

• Courses anteriorly and descends between right atrium and ventricle along the A- V groove and bifurcates at the crux into the PDA and PL - right dominance 85% of people85% of people

RCA

Right coronary artery

Left Coronary Artery

• Left main coronary artery arises from the sinus of the left aortic valve

Co rses posterior to p lmonar tr nk and di ides into t o branches• Courses posterior to pulmonary trunk and divides into two brancheso Left anterior descending artery: descends towards apexo Circumflex artery: turns towards posterior surface

Origins of coronary arteries

Right coronary artery

Ascending aorta

Left main coronary artery

Left coronary artery branches

Left main coronary Left anterior

descending arteryartery

Circumflex arteryy

Left coronary artery branches

Circumflex artery

Left coronary artery branches

Left anterior descending artery

TracheaTrachea

Superior vena cava

Aortic archcava

Left main bronchusRight main bronchus

Aortopulmonary window

Left hilumRight hilum

Pulmonary trunk

Left

Right atrium

Left atrial appendage

ventricle

RightRight hemidiaphragm

Costophrenic angle

Right ventricle

TracheaTracheaTracheaTrachea

Superior vena cavaSuperior vena cava

Aortic archAortic arch

L ftL ft

Left main bronchusLeft main bronchusRight main bronchusRight main bronchus

Aortopulmonary windowAortopulmonary window

Left hilumLeft hilumRight

hilumRight hilum

Pulmonary trunkPulmonary trunk

Left Left

Right atriumRight atrium

Left atrial appendageLeft atrial appendage

ventricleventricle

Right Right Costophrenic Costophrenic hemidiaphragmhemidiaphragm

pangle

pangle

Right ventricleRight ventricle

Right upper lobe bronchus

SternumLeft main

lobe bronchus

Th i

Left upper lobe

pulmonary arteryThoracic aorta

Right mainpulmonary artery

bronchus

Left atrium

pulmonary artery

Pulmonary trunk

Left ventricle

Right ventricle

Inferior vena

Vertebral body

cava