Cardiac Anatomy

Right Ventricle -- overview

Wraps around one-third of the left ventricle (LV)

Muscle fibers continues with those of the LV
Components
o Inferoposterior inflow (sinus)
o Anterosuperior outflow (infundibular)
o 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)
o Inflow component:
Prominent muscle bands:
Moderator
Septal
Parietal
Muscle bundle
Trabeculae carneae

Pulmonary Artery & Peripheral Pulmonary Circulation

Pulmonic valve (a trileaflet valve) separates:

o Right ventricular infundibulum from the main pulmonary artery (PA).
o Trileaflet (right, anterior, left cusps)-- 4 cm2 in area.
o 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:
under the aorta
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)

Pulmonary arteries pulmonary arterioles pulmonary capillaries that

spread over alveolar surfaces between two alveolar endothelial layers.

o Pulmonary vessels size:
Left-to-right shunt:prominent main pulmonary artery and hillar vessels:
prominent.

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:

o Left atrium left ventricle through the mitral valve
o Mitral valve composition: (area = 6-8 cm2)

two major anteromedial and posterolateral leaflets

papillary muscles

chordae tendineae

o Mitral chordae tendineae & papillary muscle: sensitive to reduced blood supply

Left 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:
o interventricular septum

Ventricular layered structures (common to both left and right ventricles)

o inner layer-endocardium covered with endothelium
o muscle layer (myocardium)
o outer layer (epicardium)

Aortic valves

Adjacent to mitral valves within the left ventricle

Cusps-unequal sizes; area = 3-4 cm2.

o right & left (coronary) cusps
o posterior (non-coronary) cusp
o at the level of the valve, the aorta dilates to form the sinuses of Valsalva (location
of the coronary ostia)
o 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.
o

Left image

Right Image
1:

superior vena cava

9:

1:
superior vena cava
9:

chordae tendineae
10:

anterior papillary
muscle
11:

chordae tendineae
10:

anterior papillary
muscle
11:

myocardium

myocardium

12:

pulmonary trunk
13:

ascending aorta
19:

13:

ascending aorta
18:
heart apex

left atrium

aortic valve
20:

left ventricle
21:

22:

pulmonary veins
23:

left ventricle

22:

pulmonary veins
23:

fossa ovalis
left atrium

24:
25:

left atrioventricular
left and bicuspid or
mitral) valve
26:

27:

28:
posterior papillary
muscle

29:

left subclavian artery

30:

descending aorta
31:

left coronary

left atrioventricular
left and bicuspid or
mitral) valve
26:
coronary sinus

coronary sinus

25:

left atrium

24:

fossa ovalis

21:

aortic valve

20:

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. 835865, 1997