Angiology脉管学培训课件-002

Angiology脉管学Angiology脉管学CompositionCardiovascularsystem

心血管系统

Lymphaticsystem

淋巴系统2Angiology脉管学Thecardiovascularsystem心血管系统

★OrganizationHeart心AmusclepumptomaintaintheflowofbloodConsistoffourchambers(rightandleftatria,rightandleftventricles)

Artery

动脉bloodvesselscarringbloodawayfromtheheart

Vein

静脉bloodvesselscarringbloodtowardstheheartCapillary毛细血管smallestbloodvessels，exchangesiteofsubstancesbetweenbloodandsurroundingtissues3Angiology脉管学TheHardWorkingHeartLVSV70ml/beatHMO70x70=5000mlHHO70x70x60=300000mlHDO70x70x60x24=7200000mlHAO70x70x60x24x365=2600000000mlHLO70x70x60x24x365x70=210,000,000,000ml210,000/50/50=84Trains4Angiology脉管学Thecardiovascularsystem心血管系统★BloodcirculationSystemiccirculation

体循环

Leftventricle→aortaanditsbranches→capillariesofbody→superiorandinferiorvenacava→rightatriumPulmonarycirculation

肺循环Rightventricle→pulmonarya.→capillariesoflung→pulmonaryv.→leftatrium5Angiology脉管学

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6Angiology脉管学Heart丁兆习山东大学医学院人体解剖教研室Office:1205dingzhaoxi@7Angiology脉管学★Positionoftheheart

★PositionoftheheartLieswithinthepericardiuminmiddlemediastinumBehindthebodyofsternumandcoastalcartilages2to6InfrontandatthelevelofT5-8Athirdofitliestotherightofmedianplanand2/3totheleft8Angiology脉管学★SurfacesoftheheartPyramidalinshape,somewhatlargerthanaclosedfistOneapex-

Cardiacapex

Onebase-

Cardiacbase

TwosurfaceSternocostalsurfaceDiaphragmaticsurfaceThreebordersRightborderLeftborderInferiorborderFoursulcusesCoronarysulcusAnteriorinterventriculargroovePosteriorinterventriculargrooveInteratrialsulcus9Angiology脉管学Cardiacapex

心尖FormedbyleftventricleDirecteddownwards,forward,andtotheleftLiesatthelevelofthefifthleftintercostalspace,1-2cmmedialtotheleftmidclavicularline(9cmfromthemidline)★Surfacesoftheheart10Angiology脉管学★SurfacesoftheheartCardiacbase

心底FormedbytheleftatriumandtoasmallextentbytherightatriumFacesbackward,upwardandtotherightContinuouswiththelargevessels11Angiology脉管学★SurfacesoftheheartSternocostalsurface

胸肋面Formedmainlybytherightatriumandrightventricle,andalesserportionofitsleftisformedbytheleftauricleandventricleDirectedforwardsandupwardsLeftandrightauricles

左、右心耳12Angiology脉管学★SurfacesoftheheartDiaphragmaticsurface

膈面Formedtheventricles－chieflytheleftventricleDirectedbackwardsanddownwards,andrestuponthecentraltendonofthediaphragm13Angiology脉管学★SurfacesoftheheartBordersoftheheartRightborder

右缘VerticalFormedentirelybyrightatrium

Leftborder

左缘

RoundMainlyformedbytheleftventricleandpartlybytheleftauricleInferiorborder

下缘HorizontalFormedbytherightventricleandcardiacapex14Angiology脉管学★SurfacesoftheheartSulcioftheheartCoronarysulcus

冠状沟(circularsulcus)whichmarksthedivisionbetweenatriaandventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartInteratrialsulcus

房间沟Separatesthetwoatriaandishiddenbypulmonarytrunkandaortainfront15Angiology脉管学★SurfacesoftheheartSulcioftheheartAnteriorinterventriculargroove

前室间沟Posteriorinterventriculargroove

后室间沟Markthedivisionbetweenventricles(whichseparatestheRVfromtheLV)Cardiacapicalincisure

心尖切迹Atrioventricularcrux

房室交点16Angiology脉管学★Chambersoftheheart心腔Chambersoftheheart心腔Consistsoffourchambers

Leftandrightatria左、右心房Leftandrightventricles左、右心室17Angiology脉管学★Rightatrium(RA)右心房ThreeinletsOrificeofsuperiorvenacava

上腔静脉口

returnsbloodtotheheartfromtheupperhalfofthebodyOrificeofinferiorvenacava

下腔静脉口

returnsbloodtotheheartfromthelowerhalfofthebodyOrificeofcoronarysinus

冠状窦口returnsbloodtotheheartfromthecardiacmuscleOneoutlet

Rightatrioventricularorifice右房室口18Angiology脉管学★Rightatrium(RA)右心房Cristaterminalis界嵴

Verticalridgethatfromsuperiorvenacavetoinferiorvenacave

Sulcusterminalis界沟

GrooveonexteriorofheartthatcorrespondstocristaterminalisTwopartsSeparatedexternallybysulcusterminalisandinternallybythecristaterminalisAtriumproper固有心房Infrontofthecristaterminalis

Sinusvenarumcavarum腔静脉窦19Angiology脉管学★

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20Angiology脉管学★Rightventricle(RV)

右心室Oneinlet

Rightatrioventricularorifice

右房室口Oneoutlet

Orificeofpulmonarytrunk肺动脉口21Angiology脉管学★Rightventricle(RV)

右心室Supraventricularcrest

室上嵴

Amuscularridgebetweenrightatrioventricularorificeandorificeofpulmonarytrunk

TwopartsInflowtract流入道Outflowtract流出道(conusarteriosus动脉圆锥)22Angiology脉管学Rightventricle(RV)

右心室Inflowtract★

Tricuspidvalve

三尖瓣GuardsrightatrioventricularorificeThreetriangularcusps:anterior,posteriorandseptalBaseofcuspsareattachedtofibrousTricuspidring

surroundingtheatrioventricularorifice

Chordaetendineae

腱索

fibrousbandthat

Connectthefreeedgesandventricularsurfacesofcuspstothepapillarymuscles

Papillarymuscles

乳头肌Conical-shapedThree:anterior,posteriorandseptal23Angiology脉管学

Trabeculaecarneae肉柱

irregularlyarrangedbundlesofmyocardium★Septomarginaltrabecula隔缘肉柱/morderatorband节制索extendsfrominterventricularseptumtobaseofanteriorpapillarymuscle,containsrightbundlebranchRightventricle(RV)右心室24Angiology脉管学

★

Tricuspidcomplex三尖瓣复合体Tricuspidring三尖瓣环Tricuspidvalve三尖瓣Chordaetendineae腱索Papillarymuscles乳头肌★

Function:preventthereflowofbloodfromtherightventricleintorightatriumRightventricle(RV)右心室diastole

systole25Angiology脉管学

Ant.Post.septalTricuspidvalve三尖瓣Rightventricle(RV)右心室26Angiology脉管学ChordaetendineaePapillarymuscles27Angiology脉管学Rightventricle(RV)右心室★FunctionoftricuspidcomplexVentriclesrelax,bloodreturningtotheheartfillsatria,puttingpressureagainstatrioventricularvalves,atrioventricularvalesforcedopen.diastole28Angiology脉管学Rightventricle(RV)右心室★Functionoftricuspidcomplex

Ventriclescontract,forcingbloodagainstatrioventricularvalvecusps.Atrioventricularvalvesclosed.Papillarymusclescontractandchordaetendineaetighten,preventingvalveflapsfromevertingintoatria.systole29Angiology脉管学★Rightventricle(RV)

右心室Outflowtract--Conusarteriosus

动脉圆锥

Cone-shape,smootharealeadingupwardtoorificeofpulmonarytrunkPumpsbloodthroughpulmonaryorificetopulmonarytrunkorificeofpulmonarytrunk肺动脉口valveofpulmonarytrunk肺动脉瓣30Angiology脉管学★Rightventricle(RV)右心室★PulmonaryValve

肺动脉瓣GuardstheorificeofpulmonarytrunkThreesemilunarcuspseachwithfreeborderthathascentralnodulescalled

nodulesofsemilunarvalve半月瓣小结Pulmonarysinuses肺动脉窦Bulgesinwallofpulmonarytrunkatlevelofvalvethatcorrespondtocusps★FunctionPreventthereflowofbloodfromthepulmonarytrunktorightventricle31Angiology脉管学Rightventricle(RV)右心室★FunctionofpulmonaryvalvesAsventriclescontractandintraventricularpressurerises,bloodispushedupagainstsemilunarvalves,forcingthemopen32Angiology脉管学Rightventricle(RV)右心室★FunctionofpulmonaryvalvesAsventriclesrelaxandintraventricularpressurefalls,bloodflowbackfromarteries,fillingthecuspsofsemilunarvalvesandforcingthemtoclose33Angiology脉管学

★

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leftatrialsinus

Fourinlets:

orificesofpulmonaryveins

肺静脉口Oneoutlet:

leftatrioventricularorifice

左房室口34Angiology脉管学★Leftventricle(LV)左心室Oneinlet:leftatrioventricularorifice

左房室口Oneoutlet:Aorticorifice

主动脉口Twoparts:DividedbyanteriorcuspsofmitralvalveInflowtract－roughwallsOutflowtractAorticvestibule主动脉前庭Smootharealeadingtoaorticorifice35Angiology脉管学

★Mitralvalve二尖瓣GuardsleftatrioventricularorificeTwotriangularcusps:AnteriorandposteriorFunction:preventthereflowofbloodfromtheleftventricleintoleftatrium

Leftventricle(LV)左心室36Angiology脉管学

★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37Angiology脉管学Leftventricle(LV)左心室

FunctionofmitralcomplexOpenduringdiastoletoallowbloodtoenterventriclesfromatriaClosedduringsystoletopreventregurgitationofbloodintoatria38Angiology脉管学Leftventricle(LV)左心室★

Aorticvalve主动脉瓣GuardstheaorticorificeThreesemilunarcusps(right,leftandposterior)Eachwithfreeborderthathasnodulesofsemilunarvalve半月瓣小结Aorticsinus

主动脉窦BulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRight－containsopeningofrightcoronaryarteryLeft－containsopeningofleftcoronaryarteryPosterior－noopening★

Function：preventthereflowofbloodfromaortaintoleftventricleLRP39Angiology脉管学Leftventricle(LV)左心室★FunctionofaorticvalvesOpenedduringsystole,withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastole

VentricularpressuredropsindiastoleFloatingtogetherofvalvecusps,withfreebordersmeeting,thusclosingthevalve

40Angiology脉管学41Angiology脉管学42Angiology脉管学43Angiology脉管学StructuresoftheheartEndocardium

心内膜

Myocardium心肌Epicardium

心外膜

44Angiology脉管学Wallsoftheheart

Endocardium

心内膜

InnercoatoftheheartwallContinuouswiththevalveflapsMyocardium心肌ArrangedspirallyAttachedtofibrousringssurroundingthefourorificesofheartThewallsofleftventricleareaboutthreetimesthickerthanthatofrightEpicardium

心外膜

OuterViscerallayerofserouspericardium45Angiology脉管学Structuresoftheheart★Interatrialseptum

房间隔LocatedbetweenrightandleftatriaContainsfossaovalisASD(AtrialSeptalDefect)★Interventricularseptum

室间隔LocatedbetweenrightandleftventriclesHasuppermembranouspart

HasthicklowermuscularpartVSD(VentricularSeptalDefect)Atrioventricularseptum

房室隔46Angiology脉管学Membranouspartofinterventricularseptum

Muscularpartofinterventricularseptum

47Angiology脉管学48Angiology脉管学VentricularSeptalDefect49Angiology脉管学Fibrousskeletonofheart纤维骨骼

Fibrousringsthatsurroundtheatrioventricular,pulmonary,andaorticorificesLeftandrightfibroustrigones50Angiology脉管学Fibrousskeletonofheart纤维骨骼

51Angiology脉管学Conductionsystemofheart

心传导系统52Angiology脉管学Conductionsystemofheart心传导系统窦房结房室结房室束左、右束支Purkinje纤维Composedofspecializedmyocardialcells★ComponentsSinoatrialnode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53Angiology脉管学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sinusbradycardia54Angiology脉管学Conductionsystemofheart心传导系统★Atrioventricularnode(AVnode)

房室结

LocatedintheKochtriangleUndertheendocardiumLowerpartrelatedtomembranouspartofinterventricularseptum房室结55Angiology脉管学Conductionsystemofheart心传导系统Atrioventricularbundle(AVbundle)房室束

PassesforwardthroughrightfibroustrigonetoreachinferiorborderofmembranouspartofinterventricularseptumDividesintorightandleftbundlebranchesatupperborderofmuscularpartofinterventricularseptum房室束56Angiology脉管学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Purkinjenetwork57Angiology脉管学Conductionsystemofheart心传导系统58Angiology脉管学ArterialsupplyoftheheartArteries：leftcoronaryarteryrightcoronaryartery59Angiology脉管学ArterialsupplyoftheheartLeftcoronaryartery左冠状动脉★

Course

ArisesfromleftaorticsinusRunsbetweenpulmonarytrunkandleftauricleintocoronarysulcus★

BranchesAnteriorinterventricularbranch前室间支RunsdownwardinanteriorinterventriculargroovearoundinferiormarginofhearttoposteriorinterventriculargrooveCircumflexbranch旋支Travelstoleftincoronarysulcustoposterioraspect★

Distribution

suppliesleftatriumandventricle,lesserportionofanteriorwallofrightventricle,andanterior2/3ofinterventricularseptum60Angiology脉管学Arterialsupplyoftheheart

Rightcoronaryartery右冠状动脉★

CourseArisesfromtherightaorticsinusRunsforwardbetweenrightauricleandpulmonarytrunkintocoronarysulcus★

BranchesBranchofsinoatrialnode窦房结支Rightmarginalbranch

右缘支

travelsalonginferiorborder

Posterorinterventricularbranch后室间支travelsdownwardinposteriorinterventriculargrooveitanastomosisesneartheapexwiththeanteriorinterventricularbranchoftheleftcoronaryartery★

Distributionsuppliesrightatriumandventricle,posterioinferior1/3ofinterventricularseptum,posteriorwallofleftventricle,thesinuatrialnodeandatrioventricularnode61Angiology脉管学ArterialsupplyoftheheartThrombusinCoronaryArteryAngiogram冠状动脉造影显示动脉血栓62Angiology脉管学ArterialsupplyoftheheartStentinanarteryPrecutaneoustranslaminalcoronaryangioplasty(PTCA)Coronaryarterybypassgrafting(CABG)63Angiology脉管学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64Angiology脉管学Venousdrainageoftheheart

★Coronarysinus

冠状窦LiesinposteriorpartofcoronarysulcusCarriesmostofvenousbloodfrommyocardiumtorightatrium

TributariesGreatcardiacvein心大静脉Middlecardiacvein心中静脉Smallcardiacvein心小静脉65Angiology脉管学Venousdrainageofheart

Anteriorcardiacveins

心前静脉3~4smallvessels,drainintorightatriumSmallestcardiacveins

心最小静脉Drainintoallchambers,mainlyatria66Angiology脉管学Pericardium心包Fibrouspericardium

纤维心包Serouspericardium

浆膜心包Pericardialcavity

心包腔67Angiology脉管学★Pericardium心包Fibrouspericardium

纤维心包AttachedtocentraltendonofdiaphragminferiorlyBlendswithoutercoatofgreatvesselssuperiorlySerouspericardium

浆膜心包Viscerallayer(epicardium)ParietallayerPericardia