系统解剖 脉管学 英文版.Heart.ppt

Angiology脉管学,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动脉bloodvesselscarringbloodawayfromtheheartVein静脉bloodvesselscarringbloodtowardstheheartCapillary毛细血管smallestbloodvessels，exchangesiteofsubstancesbetweenbloodandsurroundingtissues,TheHardWorkingHeart,LVSV70ml/beatHMO70 x70=5000mlHHO70 x70 x60=300000mlHDO70 x70 x60 x24=7200000mlHAO70 x70 x60 x24x365=2600000000mlHLO70 x70 x60 x24x365x70=210,000,000,000ml,210,000/50/50=84,Trains,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,Heart,丁兆习山东大学医学院人体解剖教研室Office:1205dingzhaoxi,Positionoftheheart,PositionoftheheartLieswithinthepericardiuminmiddlemediastinumBehindthebodyofsternumandcoastalcartilages2to6InfrontandatthelevelofT5-8Athirdofitliestotherightofmedianplanand2/3totheleft,Surfacesoftheheart,Pyramidalinshape,somewhatlargerthanaclosedfistOneapex-CardiacapexOnebase-CardiacbaseTwosurfaceSternocostalsurfaceDiaphragmaticsurfaceThreebordersRightborderLeftborderInferiorborderFoursulcusesCoronarysulcusAnteriorinterventriculargroovePosteriorinterventriculargrooveInteratrialsulcus,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VerticalFormedentirelybyrightatriumLeftborder左缘RoundMainlyformedbytheleftventricleandpartlybytheleftauricleInferiorborder下缘HorizontalFormedbytherightventricleandcardiacapex,Surfacesoftheheart,SulcioftheheartCoronarysulcus冠状沟(circularsulcus)whichmarksthedivisionbetweenatriaandventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartInteratrialsulcus房间沟Separatesthetwoatriaandishiddenbypulmonarytrunkandaortainfront,Surfacesoftheheart,SulcioftheheartAnteriorinterventriculargroove前室间沟Posteriorinterventriculargroove后室间沟Markthedivisionbetweenventricles(whichseparatestheRVfromtheLV)Cardiacapicalincisure心尖切迹Atrioventricularcrux房室交点,Chambersoftheheart心腔,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VerticalridgethatfromsuperiorvenacavetoinferiorvenacaveSulcusterminalis界沟GrooveonexteriorofheartthatcorrespondstocristaterminalisTwopartsSeparatedexternallybysulcusterminalisandinternallybythecristaterminalisAtriumproper固有心房InfrontofthecristaterminalisSinusvenarumcavarum腔静脉窦,Rightatrium(RA)右心房,Atriumproper固有心房Rightauricle-心外科最常用手术入路之一PectinatemusclesinwallSinusvenarumcavarum腔静脉窦Fossaovalis卵圆窝Anovaldepression,aremnantofthefetalforamenovaleLiesonthelowerpartofinteratrialseptumThemostcommonlocationofatrialseptaldefects(ASD)Limbusfossaeovalis卵圆窝缘Aorticmound主动脉隆凸KochtriangleKoch三角,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(conusarteriosus动脉圆锥),Rightventricle(RV)右心室,InflowtractTricuspidvalve三尖瓣GuardsrightatrioventricularorificeThreetriangularcusps:anterior,posteriorandseptalBaseofcuspsareattachedtofibrousTricuspidringsurroundingtheatrioventricularorificeChordaetendineae腱索fibrousbandthatConnectthefreeedgesandventricularsurfacesofcuspstothepapillarymusclesPapillarymuscles乳头肌Conical-shapedThree:anterior,posteriorandseptal,Trabeculaecarneae肉柱irregularlyarrangedbundlesofmyocardiumSeptomarginaltrabecula隔缘肉柱/morderatorband节制索extendsfrominterventricularseptumtobaseofanteriorpapillarymuscle,containsrightbundlebranch,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Function:preventthereflowofbloodfromtherightventricleintorightatrium,Rightventricle(RV)右心室,diastole,systole,Ant.,Post.,septal,Tricuspidvalve三尖瓣,Rightventricle(RV)右心室,Chordaetendineae,Papillarymuscles,Rightventricle(RV)右心室,FunctionoftricuspidcomplexVentriclesrelax,bloodreturningtotheheartfillsatria,puttingpressureagainstatrioventricularvalves,atrioventricularvalesforcedopen.,diastole,Rightventricle(RV)右心室,FunctionoftricuspidcomplexVentriclescontract,forcingbloodagainstatrioventricularvalvecusps.Atrioventricularvalvesclosed.Papillarymusclescontractandchordaetendineaetighten,preventingvalveflapsfromevertingintoatria.,systole,Rightventricle(RV)右心室,Outflowtract-Conusarteriosus动脉圆锥Cone-shape,smootharealeadingupwardtoorificeofpulmonarytrunkPumpsbloodthroughpulmonaryorificetopulmonarytrunkorificeofpulmonarytrunk肺动脉口valveofpulmonarytrunk肺动脉瓣,Rightventricle(RV)右心室,PulmonaryValve肺动脉瓣GuardstheorificeofpulmonarytrunkThreesemilunarcuspseachwithfreeborderthathascentralnodulescallednodulesofsemilunarvalve半月瓣小结Pulmonarysinuses肺动脉窦BulgesinwallofpulmonarytrunkatlevelofvalvethatcorrespondtocuspsFunctionPreventthereflowofbloodfromthepulmonarytrunktorightventricle,Rightventricle(RV)右心室,FunctionofpulmonaryvalvesAsventriclescontractandintraventricularpressurerises,bloodispushedupagainstsemilunarvalves,forcingthemopen,Rightventricle(RV)右心室,FunctionofpulmonaryvalvesAsventriclesrelaxandintraventricularpressurefalls,bloodflowbackfromarteries,fillingthecuspsofsemilunarvalvesandforcingthemtoclose,Leftatrium(LA)左心房,左心耳Leftauricles-心外科最常用手术入路之一左心房窦leftatrialsinusFourinlets:orificesofpulmonaryveins肺静脉口Oneoutlet:leftatrioventricularorifice左房室口,Leftventricle(LV)左心室,Oneinlet:leftatrioventricularorifice左房室口Oneoutlet:Aorticorifice主动脉口Twoparts:DividedbyanteriorcuspsofmitralvalveInflowtractroughwallsOutflowtractAorticvestibule主动脉前庭Smootharealeadingtoaorticorifice,Mitralvalve二尖瓣GuardsleftatrioventricularorificeTwotriangularcusps:AnteriorandposteriorFunction:preventthereflowofbloodfromtheleftventricleintoleftatrium,Leftventricle(LV)左心室,Mirtalcomplex二尖瓣复合体Mitralring二尖瓣环Mitralvalve二尖瓣Chordaetendineae腱索Papillarymuscles乳头肌Function：preventthereflowofbloodfromleftventricleintoleftatrium,Leftventricle(LV)左心室,Leftventricle(LV)左心室,FunctionofmitralcomplexOpenduringdiastoletoallowbloodtoenterventriclesfromatriaClosedduringsystoletopreventregurgitationofbloodintoatria,Leftventricle(LV)左心室,Aorticvalve主动脉瓣GuardstheaorticorificeThreesemilunarcusps(right,leftandposterior)Eachwithfreeborderthathasnodulesofsemilunarvalve半月瓣小结Aorticsinus主动脉窦BulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRightcontainsopeningofrightcoronaryarteryLeftcontainsopeningofleftcoronaryarteryPosteriornoopeningFunction：preventthereflowofbloodfromaortaintoleftventricle,L,R,P,Leftventricle(LV)左心室,FunctionofaorticvalvesOpenedduringsystole,withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastoleVentricularpressuredropsindiastoleFloatingtogetherofvalvecusps,withfreebordersmeeting,thusclosingthevalve,Structuresoftheheart,Endocardium心内膜Myocardium心肌Epicardium心外膜,Wallsoftheheart,Endocardium心内膜InnercoatoftheheartwallContinuouswiththevalveflapsMyocardium心肌ArrangedspirallyAttachedtofibrousringssurroundingthefourorificesofheartThewallsofleftventricleareaboutthreetimesthickerthanthatofrightEpicardium心外膜OuterViscerallayerofserouspericardium,Structuresoftheheart,Interatrialseptum房间隔LocatedbetweenrightandleftatriaContainsfossaovalisASD(AtrialSeptalDefect)Interventricularseptum室间隔LocatedbetweenrightandleftventriclesHasuppermembranouspartHasthicklowermuscularpartVSD(VentricularSeptalDefect)Atrioventricularseptum房室隔,Membranouspartofinterventricularseptum,Muscularpartofinterventricularseptum,VentricularSeptalDefect,Fibrousskeletonofheart纤维骨骼,Fibrousringsthatsurroundtheatrioventricular,pulmonary,andaorticorificesLeftandrightfibroustrigones,Fibrousskeletonofheart纤维骨骼,Conductionsystemofheart心传导系统,Conductionsystemofheart心传导系统,窦房结,房室结,房室束,左、右束支,Purkinje纤维,ComposedofspecializedmyocardialcellsComponentsSinoatrialnode窦房结(pacemaker)Internodaltracts结间束Atrioventricularnode房室结Atrioventricularbundle房室束Rightandleftbundlebranches左、右束支Purkinjefibers(network)普肯野氏纤维网,Conductionsystemofheart心传导系统,Sinuatrialnode(SAnode)窦房结Calledthepacemaker(Pcell)(60-100pulses/min)Locatedattheupperpartofthesulcusterminalisclosetothesuperiorvenacava,undertheepicardium,窦房结,Clinicaltip:窦性心动过速sinustachycardia窦性心动过缓sinusbradycardia,Conductionsystemofheart心传导系统,Atrioventricularnode(AVnode)房室结LocatedintheKochtriangleUndertheendocardiumLowerpartrelatedtomembranouspartofinterventricularseptum,房室结,Conductionsystemofheart心传导系统,Atrioventricularbundle(AVbundle)房室束PassesforwardthroughrightfibroustrigonetoreachinferiorborderofmembranouspartofinterventricularseptumDividesintorightandleftbundlebranchesatupperborderofmuscularpartofinterventricularseptum,房室束,Conductionsystemofheart心传导系统,Rightandleftbundlebranches左、右束支Rightbundlebranchpassesdownonrightsideofinterventricularseptumtoreachtheseptomarginaltrabecularandintothebaseofanteriorpapillarymuscle.HereitbecomescontinuouswiththefibersofPurkinjefibresLeftbundlebranchpassesdownonleftsideofinterventricularseptumbeneaththeendocardiumItusuallydividesintotwobranches,whicheventuallybecomecontinuouswiththePurkinjefibersPurkinjenetwork普肯野氏纤维网Continuouswithmyocardium,左、右束支,Purkinjenetwork,Conductionsystemofheart心传导系统,Arterialsupplyoftheheart,Arteries：leftcoronaryarteryrightcoronaryartery,Arterialsupplyoftheheart,Leftcoronaryartery左冠状动脉CourseArisesfromleftaorticsinusRunsbetweenpulmonarytrunkandleftauricleintocoronarysulcusBranchesAnteriorinterventricularbranch前室间支RunsdownwardinanteriorinterventriculargroovearoundinferiormarginofhearttoposteriorinterventriculargrooveCircumflexbranch旋支Travelstoleftincoronarysulcustoposterioraspect,Distributionsuppliesleftatriumandventricle,lesserportionofanteriorwallofrightventricle,andanterior2/3ofinterventricularseptum,Arterialsupplyoftheheart,Rightcoronaryartery右冠状动脉CourseArisesfromtherightaorticsinusRunsforwardbetweenrightauricleandpulmonarytrunkintocoronarysulcusBranchesBranchofsinoatrialnode窦房结支Rightmarginalbranch右缘支travelsalonginferiorborderPosterorinterventricularbranch后室间支travelsdownwardinposteriorinterventriculargrooveitanastomosisesneartheapexwiththeanteriorinterventricularbranchoftheleftcoronaryartery,Distributionsuppliesrightatriumandventricle,posterioinferior1/3ofinterventricularseptum,posteriorwallofleftventricle,thesinuatrialnodeandatrioventricularnode,Arterialsupplyoftheheart,ThrombusinCoronaryArteryAngiogram冠状动脉造影显示动脉血栓,Arterialsupplyoftheheart,Stentinanartery,Precutaneoustranslaminalcoronaryangioplasty(PTCA),Coronaryarterybypassgrafting(CABG),Venousdrainageoftheheart,Coronarysinus冠状窦Greatcardiacvein心大静脉Middlecardiacvein心中静脉Smallcardiacvein心小静脉Anteriorcardiacveins心前静脉Smallestcardiacveins心最小静脉,Venousdrainageoftheheart,Coronarysinus冠状窦LiesinposteriorpartofcoronarysulcusCarriesmostofvenousbloodfrommyocardiumtorightatriumTributariesGreatcardiacvein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,Fibrouspericardium纤维心包Serouspericardium浆膜心包Pericardialcavity心包腔,Pericardium心包,Fibrouspericardium纤维心包AttachedtocentraltendonofdiaphragminferiorlyBlendswithoutercoatofgreatvesselssuperiorlySerouspericardium浆膜心包Viscerallayer(epicardium)ParietallayerPericardialcavity心包腔Potentialspacebetweenvisceralandparieta