The Heart.ppt

TheHeart,山东大学医学院解剖教研室李振华,PositionLieswithinthepericardiuminmiddlemediastinumBehindthebodyofsternumandcoastalcartilages2to6Infrontofthoracicvertebrae5to8Athirdofitliestotherightofmedianplanand2/3totheleft,Externalcharacteristicsahollowmuscularorgan,pyramidalinshape,somewhatlargerthanaclosedfist;consistsoffourchanbers(rightandleftatria,rightandleftventricles)Cardiacapexisformedbyleftventricleandisdirecteddownwardsandforwardstotheleft.Itliesatthelevelofthefifthleftintercostalspace,12cmmedialtotheleftmidclavicularline(9cmfromthemidline)Cardiacbaseisformedbytheleftatriumandtoasmallextentbytherightatrium.Itfacesbackward,upwardandtotheright,TwosurfaceSternocostalsurfaceisformedmainlybytherightatriumandrightventricle,andalesserportionofitsleftisformedbytheleftauricleandventricle.ItisdirectedforwardsandupwardsDiaphragmaticsurfaceisformedtheventricleschieflytheleftventricle,directedbackwardsanddownwards,andrestuponthecentraltendonofthediaphragm,ThreebordersRightbordervertical,isformedentirelybyrightatriumLeftborderround,ismainlyformedbytheleftventricleandpartlybytheleftauricleInferiorborderhorizontal,isformedbytherightventricleandcardiacapex,FourgroovesCoronarysulcus冠状沟(circularsulcus)whichmarksthedivisionbetweenatriaandventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartInteratrialsulcus房间沟separatesthetwoatriaandishiddenbypulmonarytrunkandaortainfrontInterventriculargrooves室间沟anteriorandposterior,markthedivisionbetweenventricles(whichseparatestheRVfromtheLV),thetwogroovesextendfromthebaseoftheventricularpotiontoanotchcalled:thecardiacapicalincisure心尖切迹Atrioventricularcrux房室交点ajunctionoftheposteriorinterventriculargrooveandcoronarysulcus,Chambersoftheheart,Rightatrium右心房(RA)ThreeinletsOrificeofsuperiorvenacava上腔静脉口returnsbloodtotheheartfromtheupperhalfofthebodyOrificeofinferiorvenacava下腔静脉口returnsbloodtotheheartfromthelowerhalfofthebodyOrificeofcoronarsinus冠状窦口returnsbloodtotheheartfromthecardiacmuscleOneoutlerightatrioventricularorifice右房室口,Cristaterminalis界嵴verticalridgethatjfromsuperiorvenacavetoinferiorvenacaveSulcusterminalis界沟grooveonexteriorofheartthatcorrespondstocristaterminalisTwopartsseparatedexternallybysulcusterminalisandinternallybythecristaterminalisAtriumproper固有心房InfrontoftheridgePectinatemusclesinwallRightauricle右心耳asmallconicalmuscularpouch,projectstotheleftfromtherootofsuperiorvenacava,pectinatemusclesinwall,Sinusvenarumcavarum腔静脉窦LiesposteriortotheridgeSmoothwallsFossaovalis卵圆窝anovaldepression,aremnantofthefetalforamenovale,onthelowerpartofinteratrialseptum,themostcommonlocationofatrialseptaldefects(ASD)Limbusfossaeovalis卵圆窝缘prominentmarginoffossaovalisTorusaortious主动脉隆凸,Rightventricle(RV)右心室,ReceivesdeoxygenatedbloodfromrightatriumthroughrightatrioventricularorificeOneinletrightartrioventricularorifice右房室口Oneoutletorificeofpulmonarytrunk肺动脉口Twopartsdividedbythesupraventricularcrest室上嵴,amuscularridgebetweenrightatrioventricularorificeandorificeofpulmonarytrunk,InflowtractroughwallsTrabeculaecarneae肉柱irregularlyarrangedbundlesofmyocardiumSeptomarginaltrabecula隔缘肉柱extendsfrominterventricularseptumtobaseofanteriorpapillarymuscle,containsrightbundlebranchPapillarymuscles乳头肌conical-shaped,anterior,posteriorandseptalOutflowtractConusarteriosus动脉圆锥cone-shaped,smootharealeadingupwardtoorificeofpulmonarytrunkPumpsbloodthroughpulmonaryorificetopulmonarytrunk,Leftatrium(LA)左心房,Leftauricle左心耳projectingtotheright,pectinatemusclesinwallFourinletsfourorificesofpulmonaryveins肺静脉口openthroughtheposteriorwallOneoutletleftatrioventricularorifice左房室口,bloodleavesthroughleftatrioventricularorificetoleftventricle,Leftventricle(LV)左心室,HaswallthreetimesthickerthanthatofrightventricleOneinletleftatrioventricularorifice左房室口Oneoutletaorticorifice主动脉口TwopartsdividedbyanteriorcuspsofmitralvalveInflowtractroughwallsOutflowtractaorticvestibule主动脉前庭,smootharealeadingtoaorticorifice,Valves,Tricuspidvalve三尖瓣GuardsrightatrioventricularorificeThreetriangularcusps:anterior,posteriorandseptal,thebaseofcuspsareattachedtofibrousringsurroundingtheatrioventricularorificeChordaetendineae腱索fine,white,connectivetissuecords,attachmarginofcuspstopapillarymuscles乳头肌,Mitralvalve二尖瓣GuardsleftatrioventricularorificeTwotriangularcuspsanteriorandposteriorwithcommissuralcuspsbetweenthem(posteromedialandanterolateralcommissures)Similarstructurestothoseofright,SimilarfunctionsforrightandleftatriventricularvalvesOpenduringdiastoletoallowbloodtoenterventriclesfromatriaClosedduringsystoletopreventregurgitationofbloodintoatria,Valveofpulmonarytrunk肺动脉瓣GuardstheorificeofpulmonarytrunkHasthreesemilunarcuspseachwithfreeborderthathascentralnodulesofsemilunarvalve半月瓣小结,Aortivavle主动脉瓣GuardstheaorticorificeThreesemilunarcusps(right,leftandpost)ThreeaorticsinusesbulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRightcontainsopeningofrightcoronaryarteryLeftcontainsopeningofleftcoronaryarteryPosteriornoopening,SimilarfunctionsforpulmonaryandaorticvalvesOpeningduringsystole,withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastoleVentricularpressuredropsindiastoleFloatingtogetherofvalvecusps,withfreebordersmeeting,thusclosingthevalve,Structureoftheheart,WallsofheartEndocardium心内膜innercoatoftheheartwall,andcontinuouswiththevalveflapsMyocardium心肌ArrangedspirallyAttachedtofibrousringssurroudingthefourorificesofheartEpicardium心外膜serousmembrane(visceralpericardium),Interatrialseptum房间隔LocatedbetweenrightandleftatriaContainsfossaovalisandlimbusInterventricularseptum室间隔LocatedbetweenrightandleftventriclesHasuppermembranouspartHasthicklowermuscularpart,Fibrousskeleton纤维骨骼Fibrousringsthatsurroundtheatrioventricular,pulmonary,andaorticorificesLeftandrightfibroustrigons,Conductionsystemofheart心传导系,ConsistsofspecializedmyocardialcellsSinuatrialnode窦房结(SAnode)Calledthepacemakercell(Pcell)Locatedatthejunctionofrightatriumandsuperiorvenacava,upperpartofthesulcusterminalis,undertheepicardium,Atrioventricularnode房室结(AVnode)Locatedinthelowerpartofinteratrialseptumjustabovetheorificeofcoronarysinus,undertheendocardiumLowerpartrelatedtomembranouspartofinterventricularseptumAtrioventricularbundle房室束(AVbundle)PassesforwardthroughrightfibroustrigontoreachinferiorborderofmembranouspartDividesintorightandleftbundlebranchesatupperborderofmuscularpartofinterventricularseptum,Rightandleftbundlebranches左、右束支Rightbundlebranchpassesdownonrightsideofinterventricularseptumtoreachtheseptomarginaltrabecularandintothebaseofanteriorpapillarymuscle.HereitbecomescontinuouswiththefibersofPurkinjefibresLeftbundlebranchpassesdownonleftsideofinterventricularseptumbeneaththeendocardium.Itusuallydividesintotwobranches,whicheventuallybecomecontinuouswiththePurkinjefibersPurkinjefibers普肯野氏纤维continuouswithmyocardium,Arterialsupply,Leftcoronaryartery左冠状动脉ArisesfromleftaorticsinusRunsbetweenpulmonarytrunkandleftauricleintocoronarysulcusBranchesAnteriorinterventricularbranch前室间支travelsdownwardinanteriorinterventriculargroovearoundinferiormarginofhearttoposteriorinterventriculargrooveCircumflexbranch旋支travelstoleftincoronarysulcustoposterioraspectDistributionsuppliesleftatriumandventricle,lesserportionofanteriorwallofrightventricle,andanterior2/3ofinterventricularseptum,Rightcoronaryartery右冠状动脉ArisesfromtherightaorticsinusRunsforwardbetweenrightauricleandpulmonarytrunkintocoronarysulcusBranchesRightmarginalbranch右缘支travelsalonginferiorbordPosterorinterventricularbranch后室间支travelsdownwardinposteriorinterventriculargroove,itanastomosisesneartheapexwiththeanteriorinterventricularbranchoftheleftcoronaryarteryDistribution:suppliesrightatriumandventricle,posterior1/3ofinterventricularseptum,posteriorwallofleftventricle,thesinuatrialnodeandatrioventricularnode,Venousdrainage,Coronarysinus冠状窦LocatedinposteriorpartofcoronarysinusCarriesmostofvenousbloodfrommyocardiumtorightatriumTributariesGreatcardiacvein心大静脉Middlecardiacvein心中静脉Smallcardiacvein心小静脉,Anteriorcardiacveins心前静脉34smallvessels,drainintorightatriumSmallestcardiacveins心最小静脉drainintoallchambers,mainlyatria,Pericardium心包,Fibrouspericardium纤维心包Attachedtocentraltendonofdiap