脉管系统和心.ppt

Angiology脉管学,山东大学医学院解剖教研室,Angiology脉管学,CompositionCardiovascularsystem心血管系统Lymphaticsystem淋巴系统,Thecardiovascularsystem心血管系统,OrganizationHeart心AmusclepumptomaintaintheflowofbloodConsistoffourchambers(rightandleftatria,rightandleftventricles)Artery(a.)动脉CarrybloodawayfromtheheartVein(v.)静脉CarrybloodbacktotheheartCapillary毛细血管Microscopicvessels,theareaofexchangebetweenbloodandtissuefluid,Thecardiovascularsystem心血管系统,BloodcirculationSystemiccirculation体循环LeftventricleaortaanditsbranchescapillariesofbodysuperiorandinferiorvenacavarightatriumPulmonarycirculation肺循环Rightventriclepulmonarya.capillariesoflungpulmonaryv.leftatrium,Thecardiovascularsystem心血管系统,Vascularanastomosis血管吻合Anastomosisbetweena.Anastomosisbetweenv.Arteriolovenularanastomosis动静脉吻合Collateralvessels侧副管Collateralcirculation侧支循环,Positionoftheheart,LieswithinthepericardiuminmiddlemediastinumBehindthebodyofsternumandcoastalcartilages2to6Infrontofthoracicvertebrae5to8Athirdofitliestotherightofmedianplanand2/3totheleft,Surfacesoftheheart,Pyramidalinshape,somewhatlargerthanaclosedfistOneapexOnebaseTwosurfaceThreebordersFoursulcuses,Cardiacapex心尖FormedbyleftventricleDirecteddownwards,forward,andtotheleftLiesatthelevelofthefifthleftintercostalspace,1-2cmmedialtotheleftmidclavicularline(9cmfromthemidline),Surfacesoftheheart,Surfacesoftheheart,Cardiacbase心底FormedbytheleftatriumandtoasmallextentbytherightatriumFacesbackward,upwardandtotherightContinuouswiththelargevessels,Surfacesoftheheart,Sternocostalsurface胸肋面Formedmainlybytherightatriumandrightventricle,andalesserportionofitsleftisformedbytheleftauricleandventricleDirectedforwardsandupwardsLeftandrightauricles左、右心耳,Surfacesoftheheart,Diaphragmaticsurface膈面FormedtheventricleschieflytheleftventricleDirectedbackwardsanddownwards,andrestuponthecentraltendonofthediaphragm,Surfacesoftheheart,BordersoftheheartRightborder右缘VerticalandroundFormedentirelybyrightatriumLeftborder左缘RoundMainlyformedbytheleftventricleandpartlybytheleftauricleInferiorborder下缘HorizontalandsharpFormedbytherightventricleandcardiacapex,Surfacesoftheheart,SulcusesoftheheartCoronarysulcus冠状沟(circularsulcus)whichmarksthedivisionbetweenatriaandventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartPosteriorinteratrialsulcus后房间沟Separatesthetwoatriaandmarkstheposteriorborderofinteratrialseptum,Surfacesoftheheart,SulcusesoftheheartAnteriorinterventriculargroove前室间沟Posteriorinterventriculargroove后室间沟Markthedivisionbetweenventricles(whichseparatestheRVfromtheLV)Cardiacapicalincisure心尖切迹Atrioventricularcrux房室交点junctionoftheposteriorinterventriculargroove，coronarysulcusandInteratrialsulcus.,Chambersoftheheart心腔,ConsistsoffourchambersLeftandrightatria左、右心房Leftandrightventricles左、右心室,Rightatrium(RA)右心房,ThreeinletsOrificeofsuperiorvenacava上腔静脉口returnsbloodtotheheartfromtheupperhalfofthebodyOrificeofinferiorvenacava下腔静脉口returnsbloodtotheheartfromthelowerhalfofthebodyOrificeofcoronarysinus冠状窦口returnsbloodtotheheartfromthecardiacmuscleOneoutletRightatrioventricularorifice右房室口,Rightatrium(RA)右心房,Cristaterminalis界嵴verticalridgethatfromorificeofsuperiorvenacavatoorificeofinferiorvenacavaSulcusterminalis界沟GrooveonexteriorofheartthatcorrespondstocristaterminalisTwopartsSeparatedexternallybysulcusterminalisandinternallybythecristaterminalisAtriumproper固有心房Sinusvenarumcavarum腔静脉窦,Rightatrium(RA)右心房,Atriumproper固有心房InfrontoftheridgePectinatemusclesinwallSinusvenarumcavarum腔静脉窦SmoothwallsFossaovalis卵圆窝Anovaldepression,aremnantofthefetalforamenovaleLiesonthelowerpartofinteratrialseptumThemostcommonlocationofatrialseptaldefects(ASD)Limbusfossaeovalis卵圆窝缘Aorticmound主动脉隆凸KochtriangleKoch三角,下界：三尖瓣膈侧尖附着处上界：todaro腱后界：冠状窦口前内侧缘，,Rightventricle(RV)右心室,OneinletRightatrioventricularorifice右房室口Oneoutletorificeofpulmonarytrunk肺动脉口,Rightventricle(RV)右心室,Supraventricularcrest室上嵴AmuscularridgebetweenrightatrioventricularorificeandorificeofpulmonarytrunkTwopartsInflowtract流入道Outflowtract流出道,Rightventricle(RV)右心室,InflowtractTrabeculaecarneae肉柱irregularlyarrangedbundlesofmyocardiumSeptomarginaltrabecula隔缘肉柱extendsfrominterventricularseptumtobaseofanteriorpapillarymuscle,containsrightbundlebranch右束支Papillarymuscles乳头肌Conical-shapedThree:anterior,posteriorandseptal,Tricuspidvalve三尖瓣GuardsrightatrioventricularorificeThreetriangularcusps:anterior,posteriorandseptalBaseofcuspsareattachedtofibrousringsurroundingtheatrioventricularorificeTheirfreeedgesandventricularsurfacesareattachedchordaetendineae腱索,whichconnectthecuspstothepapillarymusclesrightfibrousring右纤维环(三尖瓣环tricuspidannulus),Rightventricle(RV)右心室,Tricuspidcomplex三尖瓣复合体Tricuspidring三尖瓣环Tricuspidvalve三尖瓣Chordaetendineae腱索Papillarymuscles乳头肌,Rightventricle(RV)右心室,Rightventricle(RV)右心室,FunctionoftricuspidcomplexBloodreturningtotheheartfillsatria,puttingpressureagainstatrioventricularvalves,atrioventricularvalesforcedopen.,Rightventricle(RV)右心室,FunctionoftricuspidcomplexVentriclescontract,forcingbloodagainstatrioventricularvalvecusps.Atrioventricularvalvesclose.Papillarymusclescontractandchordaetendineaetighten,preventingvalveflapsfromevertingintoatria.,Rightventricle(RV)右心室,OutflowtractConusarteriosus动脉圆锥Cone-shape,smootharealeadingupwardtoorificeofpulmonarytrunkPumpsbloodthroughpulmonaryorificetopulmonarytrunk,Rightventricle(RV)右心室,Valveofpulmonarytrunk肺动脉瓣GuardstheorificeofpulmonarytrunkThreesemilunarcuspseachwithfreeborderthathascentralnodulescallednodulesofsemilunarvalve半月瓣小结Pulmonarysinuses肺动脉窦BulgesinwallofpulmonarytrunkatlevelofvalvethatcorrespondtocuspsAnnulusofpulmonaryvalve肺动脉瓣环,Rightventricle(RV)右心室,FunctionofpulmonaryvalvesAsventriclescontractandintraventricularpressurerises,bloodispushedupagainstsemilunarvalves,forcingthemopen,Rightventricle(RV)右心室,FunctionofpulmonaryvalvesAsventriclesrelaxandintraventricularpressurefalls,bloodflowbackfromarteries,fillingthecuspsofsemilunarvalvesandforcingthemtoclose,Leftatrium(LA)左心房,Leftauricle左心耳projectingtotheright,pectinatemusclesinwallFourinletsFourorificesofpulmonaryveins肺静脉口OneoutletLeftatrioventricularorifice左房室口,Leftventricle(LV)左心室,Oneinletleftatrioventricularorifice左房室口OneoutletAorticorifice主动脉口TwopartsDividedbyanteriorcuspsofmitralvalveInflowtractroughwallsOutflowtractAorticvestibule主动脉前庭Smootharealeadingtoaorticorifice,Mitralvalve二尖瓣GuardsleftatrioventricularorificeTwotriangularcuspsAnteriorandposteriorwithcommissuralcuspsbetweenthem(posteromedialandanterolateralcommissures)rightfibrousring右纤维环(mitralannulus二尖瓣环）,Ant.,Post.,Leftventricle(LV)左心室,Posteriorcusp,Anteriorpapillarymuscle,Posteriorpapillarymuscle,Anteriorcusp,Mirtalcomplex二尖瓣复合体Mitralring二尖瓣环Mitralvalve二尖瓣Chordaetendineae腱索Papillarymuscles乳头肌,Leftventricle(LV)左心室,Leftventricle(LV)左心室,FunctionofmitralcomplexOpenduringdiastole舒张(期)toallowbloodtoenterventriclesfromatriaClosedduringsystole收缩(期)topreventregurgitationofbloodintoatria,SimilarfunctionsforrightandleftatriventricularvalvesOpenduringdiastole舒张(期)ofventriclestoallowbloodtoenterventriclesfromatriaClosedduringsystole收缩(期)ofventriclestopreventregurgitation(reflow)ofbloodintoatria,Leftventricle(LV)左心室,Aorticvalve主动脉瓣GuardstheaorticorificeThreesemilunarcusps(right,leftandposterior)Eachwithfreeborderthathasnodulesofsemilunarvalve半月瓣小结Annulusofaorticvalve主动脉瓣环Aorticsinus主动脉窦BulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRightcontainsopeningofrightcoronaryarteryLeftcontainsopeningofleftcoronaryarteryPosteriornoopening,L,R,P,Anteriorcusp,Leftventricle(LV)左心室,FunctionofaorticvalvesOpeningduringsystole,withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastoleVentricularpressuredropsindiastoleFloatingtogetherofvalvecusps,withfreebordersmeeting,thusclosingthevalve,SimilarfunctionsforpulmonaryandaorticvalvesOpeningduringsystole收缩(期),withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastole舒张(期)Ventricularpressuredropsindiastolepreventregurgitation反流ofbloodintoventricle,Structuresoftheheart,Wallsoftheheart,Endocardium心内膜InnercoatoftheheartwallContinuouswiththevalveflapsMyocardium心肌ArrangedspirallyAttachedtofibrousringssurroundingthefourorificesofheartThewallsofleftventricleareaboutthreetimesthickerthanthatofrightEpicardium心外膜OuterViscerallayerofserouspericardium,Structuresoftheheart,Interatrialseptum房间隔LocatedbetweenrightandleftatriaContainsfossaovalisInterventricularseptum室间隔LocatedbetweenrightandleftventriclesHasuppermembranouspartHasthicklowermuscularpartAtrioventricularseptum房室隔,Fibrousskeletonofheart纤维骨骼,Fibrousringsthatsurroundtheatrioventricular,pulmonary,andaorticorificesLeftandrightfibroustrigones,Heatindiastole,Heatinsystole,Conductionsystemofheart心传导系统,Conductionsystemofheart心传导系统,ComposedofspecializedmyocardialcellsCompositionSinuatrialnode窦房结Internodaltract结间束Atrioventricularnode房室结Atrioventricularbundle房室束Rightandleftbundlebranches左、右束支Purkinjenetwork普肯野氏纤维网,Conductionsystemofheart心传导系统,Sinuatrialnode(SAnode)窦房结Calledthepacemakercell(Pcell)Locatedattheupperpartofthesulcusterminalisclosetothesuperiorvenacava,undertheepicardium,Conductionsystemofheart心传导系统,Atrioventricularnode(AVnode)房室结LocatedintheKochtriangleUndertheendocardiumLowerpartrelatedtomembranouspartofinterventricularseptum,Conductionsystemofheart心传导系统,Atrioventricularbundle(AVbundle)房室束PassesforwardthroughrightfibroustrigonetoreachinferiorborderofmembranouspartofinterventricularseptumDividesintorightandleftbundlebranchesatupperborderofmuscularpartofinterventricularseptum,Conductionsystemofheart心传导系统,Rightandleftbundlebranches左、右束支Rightbundlebranchpassesdownonrightsideofinterventricularseptumtoreachtheseptomarginaltrabecularandintothebaseofanteriorpapillarymuscle.HereitbecomescontinuouswiththefibersofPurkinjefibresLeftbundlebranchpassesdownonleftsideofinterventricularseptumbeneaththeendocardiumItusuallydividesintotwobranches,whicheventuallybecomecontinuouswiththePurkinjefibersPurkinjenetwork普肯野氏纤维网Continuouswithmyocardium,Conductionsystemofheart心传导系统,Sinuatrialnode,Atrioventricularnode,Atrioventricularbundle,Rightandleftbundlebranches,Purkinjenetwork,Arterialsupplyoftheheart,Leftcoronaryartery左冠状动脉,CourseArisesfromleftaorticsinusRunsbetweenpulmonarytrunkandleftauricleintocoronarysulcusBranchesAnteriorinterventricularbranch前室间支RunsdownwardinanteriorinterventriculargroovearoundinferiormarginofhearttoposteriorinterventriculargrooveCircumflexbranch旋支TravelstoleftincoronarysulcustoposterioraspectDistributionsuppliesleftatriumandventricle,lesserportionofanteriorwallofrightventricle,andanterior2/3ofinterventricularseptum,thesinuatrialnode(40)andatrioventricularnode(7),Rightcoronaryartery右冠状动脉,CourseArisesfromtherightaorticsinusRunsforwardbetweenrightauricleandpulmonarytrunkintocoronarysulcusBranchesBranchofsinuatrialnode窦房结支Rightmarginalbranch右缘支travelsalonginferiorborderPosteriorinterventricularbranch后室间支travelsdownwardinposteriorinterventriculargrooveitanastomosisesneartheapexwiththeanteriorinterventricularbranchoftheleftcoronaryarteryRightcircumflexbranch右旋支Distributionsuppliesrightatriumandventricle,posterioinferior1/3ofinterventricularseptum,posteriorwallofleftventricle,thesinuatrialnodeandatrioventricularnode,Stentinanartery,Precutaneoustranslaminalcoronaryangioplasty(PTCA),Coronaryarterybypassgrafting(CABG),Venousdrainageoftheheart,Venousdrainageoftheheart,Coronarysinus冠状窦LiesinposteriorpartofcoronarysulcusCarriesmostofvenousbloodfrommyocardiumtorightatriumTributaries属支Greatcardiacvein心大静脉Middlecardiacvein心中静脉Smallcardiacvein心小静脉,Venousdrainageofheart,Anteriorcardiacveins心前静脉34smallvessels,drainintorightatriumSmallestcardiacveins心最小静脉Drainintoallchambers,mainlyatria,Pericardium心包,Pericardium心包,Fibrouspericardium纤维心包AttachedtocentraltendonofdiaphragminferiorlyBlendswithoutercoatofgreatvesselssuperiorlySerouspericardium浆膜心包Viscerallayer(epicardium)ParietallayerPericardialcavity心包腔PotentialspacebetweenvisceralandparietallayersContainsfilmofpericardiumfluidasalubricanttofacilitatecardiacmovements,Pericardium心包,Pericardiumsinus心包窦FormedbyreflectionofserouspericardiumTransversesinusofpericardium心包横窦PosteriortoascendingaortaandpulmonarytrunkAnteriortosuperiorvenacavaandleftatrium,Pericardium心包,Obliquesinusofpericardium心包斜窦Cul-de-sac,posteriortoheart,boundedbypulmonaryveinsoneithersideAnteriorinferiorsinusofpericardium心包前下窦,Surfacemarkingsofheart,Surfacemarkingsofheart,R.superiorpointLiesontheupperborderofrightthirdcostalcartilage1.0cmfromthemarginofsternumR.inferiorpointLiesonthe7thsternocostaljointL.superiorpointLiesonlowerborderofleftsecondcostalcartilage1.2cmfromsternalmarginCardiacapexInthefifthleftintercostalspace7-9cmfromthemidline,SurfacemarkingsoftheHeartValves,TricuspidvalveLiesbehindtherighthalfofthesternumoppositesthefourthinterxostalspaceMitralvalveLiesbehindthelefthalfofthesternumoppositethefourthcostalcartilagePulmonaryvalveL