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Adult Cardiac Surgery Board Review IA > Cardiac Anatomy > Flashcards

Cardiac Anatomy Flashcards

1
Q

What structure occupies the central portion of the heart and is wedged between all 3 other valves?

A

Aortic valve

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2
Q

Which AV cusp has fibrous continuity with the anterior leaflet of the mitral valve

A

Non-coronary cusp

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3
Q

Anatomic orientation of the AV groove

A

Obliquely oriented closer to vertical than horizontal

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4
Q

Two pericardial recesses

A
  1. Transverse sinus
    1. Anterior boarder: posterior surface of aorta/PA
    2. Posterior boarder: interatrial groove
  2. Oblique sinus
    1. Behind LA (between IVC and Pulmonary veins)
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5
Q

Location of phrenic nerve in mediastinum

A
  • Descends anterior to the anterior scalene muscle (posterior to IMA)
  • Passes anterior to the pulmonary hilum
  • Left phrenic: attached to the lateral aspect of persistent Left SVC
  • Right phrneic: attached to the lateral aspect of SVC
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6
Q

Anatomy of vagus nerve in mediastinum

A
  • Courses along carotid arteries and enters thorax posterior to phrenic.
  • Descends posterior to pulmonary hilum (phrenic is anterior)
  • Left vagus: descends btw LCCA and LSCA (posterior to Ao Arch), left RLN hooks anterior around ligamentum arteriosum and ascends in TE groove.
  • Right vagus: right RLN hooks under RSCA artery anteriorly and ascends in the TE groove
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7
Q

Coronary arteries arise from what structures

A

Sinuses of Valsalva

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8
Q

Coronary artery dominance defined by what?

A

Supply of PDA

(RCA 85% of cases)

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9
Q

Anatomy of Left Main Coronary Artery (LMCA)

A
  • Arises from left Sinus of Valsalva
  • Courses behind PA and anterior to LA appendage
  • Bifurcates into: LAD and LCx
    • Trifurcates: LAD, Ramus and OM
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10
Q

Anatomy of LAD

A
  • Courses along interventricular groove towards cardiac apex
  • Branches:
    • Septal perforators (dive perpendicularly into septum)
    • Diagonals (course over LV anterior wall)
    • RV branches (course to the RV anterior wall)
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11
Q

Anatomy of Circumflex Coronary Artery

A
  • Travels in left AV groove (ends near obtuse margin of LV)
  • In Left Dominant circulation, continues in AV groove to supply PDA (10-15%)
  • Branches:
    • Obtuse marginals (OM): supply lateral wall of LV and posteromedial PM
    • Sinoatrial (SA) node branch: 50% of population
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12
Q

Anatomy of RCA

A
  • Arises from right Sinus of Valsalva
  • Course: anterior to Ao and descends in right AV groove
  • Branches:
    • Conal branch: 1st branch, courses left of infundibulum
    • Acute marginals: supply anterior RV free wall
      • May continue across diaphragmatic surface to supply distal interventricular septum (10-15% pop)
    • Bifucates:
      • Posterior Descending Artery (PDA)
      • Right posterolateral artery (a.k.a. posterolateral ventricular branch [PLVB])
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13
Q

Anatomy of PDA

A
  • Courses along interventricular groove towards apex
  • Septal perforators (posteror 1/3 of septum)
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14
Q

Anatomy of PLVB

A

Provides branches to posterior wall of LV

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15
Q

Venous drainage of heart

A
  • Coronary sinus: 85% of coronary blood flow
  • Thebesian veins: 15% of coronary blood flow (directly into RA/RV)
  • Anterior interventricular vein: analog to LAD
  • Great cardiac vein: travels in AV groove and turns into coronary sinus
  • Posterior interventricular vein: analog to PDA
    • Last tributary and drains near the coronary sinus orifice
      • Explains why RV protection from retrograde cardioplegia can be marginal as cannula is usually inserted beyond entry point of vein.
  • Anterior RV veins: form small cardiac vein (right AV groove); drain into CS or RA
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16
Q

Anatomy of Persistent Left SVC

A
  • Usually drains into coronary sinus
  • Ineffective to adminster retrograde cardioplegia unless LSVC is occluded and flow diverted.
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17
Q

Anatomy of SA Node

A
  • Junction of RA and SVC (between RA appendage and SVC)
  • Horeshoe SA node: draped along SVC/RA junction (10% of patients)
18
Q

Anatomy of fossa ovalis

A
  • True intra-atrial septum
  • Location where LA should be entered for transseptal approach
  • Location of PFO
19
Q

Thebesian valve

A

Valve of coronary sinus

20
Q

Eustachian valve

A

Valve of IVC

21
Q

Tendon of Todaro

A

Continuation of Thebesian valve to the Eustacian valve

22
Q

Important structure lying within Triangle of Koch

A

AV node

23
Q

Boundaries of Triangle Koch

A
  1. Tendon of Todaro
  2. Orifice of Coronary Sinus
  3. Septal leaflet of TV
24
Q

Anatomic structure located at apex of Triangle of Koch

A

Bundle of His (prior to branching on the interventricular septum)

25
Q

Crista terminalis

A

Confluence of trabeculated RA muscle into a well defined muscle band.

26
Q

Anatomy of Tricuspid Valve

A
  • Leaflets:
    • Anterior
    • Septal
    • Inferior
  • Continutiy with fibrous skelaton of heart
  • Does not have true fibrous annulus circumferentially
27
Q

Important anatomic relationships with Tricuspid Valve

A
  • AV node located at base of septal leaflet
  • Aortic valve near junction of septal and anterior leaflets
28
Q

Surgical access to Left Atrium

A
  • Anterior to right pulmonary veins (Sondargaard’s groove)
  • An incision in LA dome
    • Often involves transecting the SVC
  • Transseptal approach via RA (fossa ovalis)
29
Q

Anatomy of Mitral Valve

A
  • Leaflets:
    • Anterior (A1, A2, A3)
      • Fibrous continuity with non-coronary cusp of AV
      • Anterior in surgeons view
      • Covers 1/2 of annular circumference
      • Longer leaflet
    • Posterior (P1, P2, P3)
      • Covers 2/3 of annulus but is short with respect to dept of orifice coverage
    • Carpentier segments:
      • A1 and P1 most medial (to left in surgeons view)
30
Q

Important anatomic relationships to the mitral annulus/valve

A
  • Left side of posterior annulus (P1): circumflex artery
  • Right side of posterior annulus (P2/P3): coronary sinus
  • A3 segment: AV node
31
Q

Anatomy of right and left fibrous trigones

A
  • Dense collagenous tissue
  • Locations: 10 o-clock and 2 o-clock positions on the annulus
    • Anteror to the valve commisures
32
Q

Anatomy of RVOT

A
  • Infundibulum
  • Pulmonic valve (tricuspid)
    • No fibrous annulus (suspended in muscle)
    • Only valve not connected to fibrous skelaton of heart
33
Q

RV papillary muscle anatomy

A
  • Anteror PPM
  • Medial PPM
  • Suspend the Tricuspid Valve
34
Q

Anatomy of LV

A
  • Inflow: Mitral valve and subvalvular apparatus
  • LVOT:
    • Mitral-Aortic curtain:
      • fibrous sheet extending from the anterior leaflet of MV to mitral-aortic continutiy supporting the left and non-coronary leaflets of the AV
  • Left bundle branch:
    • enters LVOT posterior to membranous septum (between right and non-coronary AV cusps)
35
Q

Anatomy of Aortic Valve

A
  • Sinuses of Valsalva/AV Leaflets:
    • Right
    • Left
    • Non-coronary
  • Nodule of Arantius: thickened nodule, centrally located on each leaflet at point of coaptation.
36
Q

Definition of Aortic Root

A
  • Aortic annulus
  • AV leaflets
  • Sinus of Valsalva
  • Sinotubular junction
    • Junction at top of commissures
    • Point where the sinuses neck down to form the tubular Asc Ao.
37
Q

Posteromedial papillary muscle blood supply

A

RCA (90%)

38
Q

Anterolateral papillary muscle blood supply

A

LAD and Cx

39
Q

Average distance from the tips of each papillary muscle to the nearest trigone

A

~ 23 mm

40
Q
A

Adult Cardiac Surgery Board Review IA (29 decks)

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