Cardiac anatomy Flashcards
left coronary artery arises from:
left sinus of Valsalva near the sinotubular ridge
what is the difference between the septal branches and diagonal branches of the LAD?
septal branches quickly reach and penetrate the myocardium. the diagonal branches course laterally to the LV free wall
left main coronary artery branches into:
the left circumflex and LAD
what is the course of the LCx?
courses in the left AV groove, giving rise to obtuse marginal branches
what does the LCx supply?
LV free wall and a variable portion of the anterolateral papillary muscle
What is the ramus intermedius?
variant anatomy. in about 15% of people the left main trifurcates and the ramus intermedius courses laterally to supply the LV free wall
where does the RCA normally arise?
right coronary sinus
what is the “conus artery”
supplies the RVOT (conus arteriosis) and forms the circle of Vieussens - an anastomosis with the LAD circulation origin: 50-60% from RCA 30-40% directly from aorta
what i the circle of Vieussens?
anastomosis of RCA with LAD circulation. conus artery –> LAD
LCx branches
obtuse marginal
SA node artery supply:
60% of the time from RCA 40% from LCx
largest ventricular branch from RCA
acute marginal branch
what determines “dominance”
the coronary artery that gives rise to the posterior descending artery (PDA) determines dominance
% RCA is dominant
70%
proximal LAD
left main bifurcation to the first septal branch
average coronary artery diameter in men and women
men - 4mm women - 3mm
definition of a coronary artery aneurysm
1.5 times the diameter of an adjacent normal coronary artery
what is the Thebesian valve?
valve from coronary sinus to RA
what is the crista terminalis?
muscular ridge that separates the smooth muscle fibers of the posterior RA from the trabeculated muscle fibers anteriorly runs from entrance of SVC to IVC (will see this on sagittal)
what is the eustachian valve?
(also known as the “valve of the inferior vena cava”) is a ridge of variable thickness in the inferior right atrium. It is a remnant of a fetal structure that directed incoming oxygenated blood to the foramen ovale and away from the right atrium. Incomplete regression of this structure results in a thickened ridge at the IVC/RA junction, which can occasionally be thick enough to mimic thrombus or a right atrial mass on echocardiography, cardiac CT, or cardiac MRI.
what is the moderator band?
only in the RV (distinguishes RV from LV in congenital heart disease) muscular band extending from the interventricular septum to the base of the anterior papillary muscle. part of the right bundle branch conduction system
what variant pulmonary vein anatomy has a high association with atrial fibrillation
right middle PV
moderator band
fossa ovalis
this is spared in lipomatous hypertrophy
moderator band
crista terminalis
eustachian valve
thesbian valve
right atrial appendage
crista terminalis
right atrial appendage
normal coronary sinus
coronary sinus
cor triatrium
cor triatrium
crista supraventricularis
The pulmonary valve has three cusps, and is separated from the tricuspid valve by a thick muscle known as the crista supraventricularis.
This differs from the left ventricular outflow tract, where the mitral and aortic valves lie side by side.
left atrial appendage
How many patients have a ramus intermedius?
In approximately 15% of patients, a third branch, the ramus intermedius (RI) branch, arises at the division of the LCA, resulting in a trifurcation (Fig 5) (4). When present, the RI branch courses laterally toward the LV free wall. Its course is similar to that of a diagonal branch of the LAD artery.
Sinoatrial nodal branch
likely dominance?
Coronal MPR image shows a left-dominant system, with the RCA being smaller than normal
The RCA is typically diminutive compared with the LCx artery in patients with left-dominant systems
The LCA is dominant in approximately 10% of cases, supplying the entire LV, accompanied by the PDA and posterolateral branches from the LCx artery
dominance?
co-dominant
VR image shows a codominant system, with the inferior myocardial surface supplied equally by the RCA and the LCx artery.
dominance?
right dominant.
VR image shows the inferior surface of the heart. A right-dominant system is depicted, with the PDA (white arrowhead) arising from the RCA (black arrowhead). A posterolateral branch (arrow) is also seen.
left ventricular papillary muscles
vertical long axis MPR of the left atrial appendage
Right top pulmonary vein (least common supernumerary pulmonary vein)
= Supernumerary pulmonary veins, also known as accessory pulmonary veins
most common supernumerary pulmonary vein is the right middle lobe vein
important to identify these for ablation and surgical planning
normal pericardial recess. do not mistake this for a mass or lymph node
this anomaly is associated with:
this is PAPVR, which is associated with a sinus venosus type ASD
superior sinous venosis ASD
