《脉管系统和心》PPT课件.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Leftventricle aortaanditsbranches capillariesofbody superiorandinferiorvenacava rightatriumPulmonarycirculation肺循环Rightventricle pulmonarya capillariesoflung pulmonaryv 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Formedtheventricles chieflytheleftventricleDirectedbackwardsanddownwards 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TwopartsDividedbyanteriorcuspsofmitralvalveInflowtract roughwallsOutflowtractAorticvestibule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BulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRight containsopeningofrightcoronaryarteryLeft containsopeningofleftcoronaryarteryPosterior noopening 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3 4smallvessels 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 superiorpointLiesontheupperborderofrightthirdcostalcartilage 1 0cmfromthemarginofsternumR inferiorpointLiesonthe7thsternocostaljointL superiorpointLiesonlowerborderofleftsecondcostalcartilage 1 2cmfromsternalmarginCardiacapexInthefifthleftintercostalspace7 9cmfromthemidline SurfacemarkingsoftheHeartValves TricuspidvalveLiesbehindtherighthalfofthesternumoppositesthefourthinterxostalspaceMitralvalveLiesbehindthelefthalfofthesternumoppositethefourthcostalcartilagePulmonar