Transcript 解剖学

Angiology 脉管学
Angiology 脉管学
Composition
 Cardiovascular system
心血管系统
 Lymphatic system
淋巴系统
The cardiovascular system 心血管系统
Organization
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Heart 心
 A muscle pump to maintain the flow
of blood.
 Consist of four chambers (right and
left atria, right and left ventricles).
Artery (A)动脉
carry blood away from the heart.
Veins (V)静脉
carry blood back to the heart
Capillary (Cap)毛细血管
microscopic vessels, the area of
exchange between blood and tissue
fluid.
The cardiovascular system心血管系统
Blood circulation

Systemic circulation 体循环
left ventricle→aorta and its
branches→capillaries of
body→superior and inferior vena
cava→right atrium

Pulmonary circulation 肺循环
right ventricle→pulmonary A→
capillaries of lung → pulmonary V
→left atrium
The cardiovascular system心血管系统
Vascular anastomosis
血管吻合

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Anastomosis between A
Anastomosis between V
Arteriolovenular anastomosis
动静脉吻合
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Collateral vessels 侧副管
Collateral circulation 侧支循环
The Heart
The heart
Position
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Lies within the pericardium in
middle mediastinum.
Behind the body of sternum and
2th. to 6th. coastal cartilages.
In front of 5th. to 8th. thoracic
vertebrae.
One third of it lies to the right of
median plan and 2/3 to the left.
Surfaces of the heart
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Pyramidal in shape,
somewhat larger than a
closed fist.
One apex
One base
Two surface
Three borders
Four sulcuses
Cardiac apex 心尖


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Formed by left ventricle
Directed downwards,
forward, and to the left
Lies at the level of the 5th
left intercostal space, 1~2
cm medial to the left
midclavicular line (9cm
from the midline) .
Cardiac base 心底


Formed by the left
atrium and to a small
extent by the right
atrium.
Faces backward,
upward and to the
right.
Sternocostal surface 胸肋面


Formed mainly by the
right atrium and right
ventricle, and a lesser
portion of its left is
formed by the left auricle
and ventricle.
Directed forwards and
upwards.
Diaphragmatic surface 膈面


Formed the ventricles－
chiefly the left ventricle.
Directed backwards and
downwards, and rest upon
the central tendon of the
diaphragm.
Borders of the heart

Right border 右缘
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Left border 左缘
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Vertical
Formed entirely by right atrium
Round
Mainly formed by the left ventricle
and partly by the left auricle
Inferior border 下缘
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Horizontal
Formed by the right ventricle and
cardiac apex
Sulcuses of the heart
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Coronary sulcus 冠状沟
(circular sulcus) which marks
the division between atrium
and ventricles, contains the
trunks of the coronary
vessels and completely
encircles the heart.
Interatrial sulcus 房间沟
－separates the two atrium
and is hidden by pulmonary
trunk and aorta in front.
Sulcuses of the heart

Anterior interventricular groove
前室间沟

Posterior interventricular groove
后室间沟
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Mark the division between
ventricles (which separates the R
from the L ventricle)
Cardiac apical incisure 心尖切迹
Atrioventricular crux 房室交点
Chambers of the heart
心 腔
Chambers of the heart
心腔
Consists of four chambers
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Left and right atria
左、右心房
 Left and right auricle
左、右心耳
Left and right ventricles
左、右心室
Right atrium 右心房

Three inlets
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Orifice of superior vena cava
上腔静脉口
returns blood to the heart from
the upper half of the body.
Orifice of inferior vena cava
下腔静脉口
returns blood to the heart from
the lower half of the body.
Orifice of coronary sinus
冠状窦口
returns blood to the heart from the
cardiac muscle.

One outlet
－right atrioventricular orifice
右房室口
Right atrium 右心房

Crista terminalis 界嵴－vertical ridge
that from superior vena cave to inferior
vena cave.

Sulcus terminalis界沟－groove on
exterior of heart that corresponds (一
致)to crista terminalis.

Two parts －separated externally by
sulcus terminalis and internally by the
crista terminalis.
 Atrium proper 固有心房
 Sinus venarum cavarum 腔静脉窦
Right atrium 右心房

Atrium proper 固有心房
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In front of the ridge
Pectinate muscles in wall
Sinus venarum cavarum
腔静脉窦
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Smooth walls
Fossa ovalis 卵圆窝－ an oval
depression, a remnant of the
fetal foramen ovale, on the
lower part of interatrial septum,
the most common location of
atrial septal defects (ASD)-房间
隔缺损.
Right ventricle 右心室

One inlet
－right atrioventricular orifice
右房室口

One outlet
－orifice of pulmonary trunk
肺动脉口
Right ventricle 右心室
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Supraventricular crest 室上嵴
(a muscular ridge between right
atrioventricular orifice and orifice
of pulmonary trunk )
Two parts
 Inflow tract 流入道
 Outflow tract 流出道
Right ventricle 右心室

Inflow tract
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Trabeculae carneae 肉柱
irregularly arranged bundles
of myocardium.
Septomarginal trabecula
隔缘肉柱－extends from
interventricular septum to
base of anterior papillary
muscle, contains right bundle
branch.
Papillary muscles 乳头肌
 Conical-shaped
 Three: anterior, posterior
and septal.
Right ventricle 右心室

Outflow tract —Conus arteriosus
动脉圆锥

Cone-shape , smooth area
leading upward to orifice of
pulmonary trunk

Pumps blood through pulmonary
orifice to pulmonary trunk.
Tricuspid valve 三尖瓣

Guards right atrioventricular orifice

Three triangular cusps:
 anterior, posterior and septal
 Base of cusps are attached to
fibrous ring surrounding the
atrioventricular orifice.
 To their free edges and
ventricular surfaces are
attached chordae tendineae 腱
索, which connect the cusps to
the papillary muscles.
Tricuspid valve 三尖瓣
Tricuspid complex 三尖瓣复合体
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Tricuspid ring 三尖瓣环
Tricuspid valve 三尖瓣
Chordae tendineae 腱索
Papillary muscles 乳头肌
Function of tricuspid complex

Open during diastole to allow blood to enter ventricles from atria

Closed during systole to prevent regurgitation of blood into atria
Valve of pulmonary trunk 肺动脉瓣

three semilunar
cusps which guards
the orifice of
pulmonary trunk
Function of pulmonary valves

Opening during systole(心脏收缩) ,
with cusps pressed toward wall of
vessel as blood is forced upward.

Closed during diastole(心脏舒张)
 Ventricular pressure drops in
diastole.
 Floating together of valve cusps,
with free borders meeting, thus
closing the valve.
Left atrium 左心房

Four inlets－four orifices of pulmonary veins 肺静脉口

One outlet－left atrioventricular orifice 左房室口
Left ventricle 左心室

One inlet
left atrioventricular orifice

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左房室口
One outlet － aortic orifice 主动脉口
Two parts－divided by anterior cusps of
mitral valve.
 Inflow tract－rough walls

Outflow tract
 Aortic vestibule 主动脉前庭
 Smooth area leading to aortic
orifice
Mitral valve 二尖瓣
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Guards left atrioventricular orifice
Two triangular cusps－anterior
and posterior with commissural
cusps between them.
Mitral complex 二尖瓣复合体
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Mitral ring 二尖瓣环
Mitral valve 二尖瓣
Chordae tendineae 腱索
Papillary muscles 乳头肌
Function of mitral complex

Open during diastole to allow blood to enter ventricles from atria

Closed during systole to prevent regurgitation of blood into atria
Aortic valve 主动脉瓣
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Guards the aortic orifice
Three semilunar cusps (right,
left and posterior)
Aortic sinus 主动脉窦 – bulges
in aortic wall at level of valve
that correspond to cusps.
 Right－contains opening of
right coronary artery.
 Left－contains opening of left
coronary artery.
 Posterior－no opening
Function of aortic valves

Opening during systole, with cusps
pressed toward wall of vessel as blood is
forced upward

Closed during diastole
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Ventricular pressure drops in diastole
Floating together of valve cusps, with
free borders meeting, thus closing the
valve
Structures of the heart
Walls of heart
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Endocardium 心内膜
 Inner coat of the heart wall
 Continuous with the valve flaps
Myocardium 心肌
 Arranged spirally
 Attached to fibrous rings surrouding
the four orifices of heart
 The walls of left ventricle are about
three times thicker than that of right
Epicardium 心外膜
 Outer
 Visceral layer of serous pericardium
Structures of the heart
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Interatrial septum 房间隔
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Interventricular septum 室间隔
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Located between right and left atria
Contains fossa ovalis
Located between right and left
ventricles
Has upper membranous part
Has thick lower muscular part
Atrioventricular septum 房室隔
Membranous part of
interventricular septum
Fibrous skeleton of heart 纤维骨骼
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Fibrous rings that surround the
atrioventricular, pulmonary, and
aortic orifices.
Left and right fibrous trigones.
Conduction system of heart
心传导系统
Conduction system of heart 心传导系统
Composed of specialized myocardial cells.
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Sinuatrial node 窦房结
Internodal tract 结间束
Atrioventricular node 房室结
Atrioventricular bundle 房室束
Right and left bundle branches 左、右束支
Purkinje network 普肯野氏纤维网
Conduction system of heart 心传导系统
Sinuatrial node 窦房结

Called the pacemaker cell.
Located at the upper part of the
sulcus terminalis close to the
superior vena cava, under the
epicardium.
Conduction system of heart 心传导系统
Atrioventricular node (AV node) 房室结
 Located in the lower part of
interatrial septum, near orifice of
coronary sinus and base of tricuspid
valve.
 Under the endocardium
 Lower part related to membranous
part of interventricular septum.
Conduction system of heart 心传导系统
Atrioventricular bundle (AV bundle)
房室束
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Passes forward through right
fibrous trigone to reach inferior
border of membranous part.
Divides into right and left bundle
branches at upper border of
muscular part of interve ntricular
septum.
Conduction system of heart 心传导系统

Right and left bundle branches
左、右束支
 Right bundle branch－passes down
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
on right side of interventricular
septum to reach the septomarginal
trabecular and into the base of
anterior papillary muscle. Here it
becomes continuous with the fibers
of Purkinje fibres.
Left bundle branch－passes down
on left side of interventricular
septum beneath the endocardium. It
usually divides into two branches,
which eventually become
continuous with the Purkinje fibers.
Purkinje network 普肯野氏纤维网
continuous with myocardium.
★心传导系统
Sinatrial node
Atrioventricular bundle
Right and left
bundle branches
Atrioventricular node
Purkinje network
Arterial supply of the heart
Left coronary artery 左冠状动脉

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
Course
 Arises from left aortic sinus
 Runs between pulmonary trunk and left
auricle into coronary sulcus.
Branches
 Anterior interventricular branch 前室间
支－runs downward in anterior
interventricular groove around inferior
margin of heart to posterior
interventricular groove.
 Circumflex branch 旋支－travels to left in
coronary sulcus to posterior aspect.
Distribution－supplies left atrium and
ventricle, lesser portion of anterior wall of
right ventricle, and anterior 2/3 of
interventricular septum.
Arterial supply of the heart
Right coronary artery 右冠状动脉

Course
 Arises from the right aortic sinus
 Runs forward between right auricle and
pulmonary trunk into coronary sulcus.

Branches
Right marginal branch 右缘支－ travels
along inferior border.
 Posteror interventricular branch 后室间支
travels downward in posterior interventricular
groove, it anastomosises near the apex with
the anterior interventricular branch of the left
coronary artery.
Distribution: supplies right atrium and ventricle,
posterioinferior 1/3 of interventricular septum,
posterior wall of left ventricle, the sinuatrial node
and atrioventricular node.
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Coronary artery bypass
grafting (CABG)
Precutaneous translaminal
coronary angioplasty (PTCA)
Stent in an artery
Venous drainage of the heart
Coronary sinus 冠状窦
 Lies in posterior part of coronary
sulcus.
 Carries most of venous blood
from myocardium to right atrium.
 Tributaries
 Great cardiac vein 心大静脉
 Middle cardiac vein 心中静脉
 Small cardiac vein 心小静脉
Venous drainage of heart

Anterior cardiac veins
心前静脉－3~4 small vessels,
drain into right atrium.

Smallest cardiac veins
心最小静脉－drain into all
chambers, mainly atria.
Pericardium 心包

Fibrous pericardium 纤维心包
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
Serous pericardium 浆膜心包



Attached to central tendon of
diaphragm inferiorly
Blends with outer coat of great
vessels superiorly
Visceral layer (epicardium)
Parietal layer
Pericardial cavity 心包腔


Potential space between visceral and
parietal layes.
Contains film of pericardium fluid as a
lubricant to facilitate cardiac
movements.
Pericardium 心包
Pericardium sinus


Formed by reflection of serous
pericardium.
Transverse sinus of pericardium
心包横窦


Posterior to ascending aorta and
pulmonary trunk
Anterior to superior vena cava and
left atrium.
Pericardium sinus


Oblique sinus of pericardium
心包斜窦－cul-de-sac(死胡同),
posterior to heart, bounded by
pulmonary veins on either side.
Anterior inferior sinus of
pericardium 心包前下窦
Surface markings of heart
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R. superior point－ lies on the
upper border of right third costal
cartilage ±1.2cm from the margin
of sternum
R. inferior point － lies on the
sixth sternocostal joint
L. superior point － lies on lower
border of left second costal
cartilage ±1.2cm from sternal
margin
Cardiac apex－in the fifth left
intercostal space 7~9cm from the
midline