Angiology 脉管学

1. Angiology 脉管学

2. Angiology 脉管学 Composition • Cardiovascular system 心血管系统 • Lymphatic system淋巴系统

3. The cardiovascular system 心血管系统 Organization • 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.

4. 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

5. The cardiovascular system心血管系统 Vascular anastomosis血管吻合 • Anastomosis between A • Anastomosis between V • Arteriolovenular anastomosis 动静脉吻合 • Collateral vessels 侧副管 • Collateral circulation 侧支循环

6. The Heart

7. The heart Position • 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.

8. Surfaces of the heart • Pyramidal in shape, somewhat larger than a closed fist. • One apex • One base • Two surface • Three borders • Four sulcuses

9. Cardiac apex 心尖 • 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) .

10. 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.

11. 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.

12. Diaphragmatic surface 膈面 • Formed the ventricles－chiefly the left ventricle. • Directed backwards and downwards, and rest upon the central tendon of the diaphragm.

13. Borders of the heart • Right border右缘 • Vertical • Formed entirely by right atrium • Left border左缘 • Round • Mainly formed by the left ventricle and partly by the left auricle • Inferior border下缘 • Horizontal • Formed by the right ventricle and cardiac apex

14. Sulcuses of the heart • 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.

15. Sulcuses of the heart • Anterior interventricular groove 前室间沟 • Posterior interventricular groove 后室间沟 • 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

16. Chambers of the heart 心 腔

17. Chambers of the heart 心腔 Consists of four chambers • Left and right atria 左、右心房 • Left and right auricle 左、右心耳 • Left and right ventricles 左、右心室

18. Right atrium右心房 • Three inlets • 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

19. 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

20. Right atrium右心房 • Atrium proper固有心房 • In front of the ridge • Pectinate muscles in wall • Sinus venarum cavarum腔静脉窦 • 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.

21. Right ventricle右心室 • One inlet　　－right atrioventricular orifice右房室口 • One outlet　　－orifice of pulmonary trunk 肺动脉口

22. Right ventricle右心室 • 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

23. Right ventricle右心室 • Inflow tract • 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.

24. 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.

25. 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.

26. Tricuspid valve 三尖瓣

27. Tricuspid complex 三尖瓣复合体 • Tricuspid ring 三尖瓣环 • Tricuspid valve 三尖瓣 • Chordae tendineae 腱索 • Papillary muscles 乳头肌

28. 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

29. Valve of pulmonary trunk 肺动脉瓣 • three semilunar cusps which guards the orifice of pulmonary trunk

30. 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.

31. 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

32. Left ventricle 左心室 • One inlet left atrioventricular orifice左房室口 • One outlet － aortic orifice 主动脉口 • Two parts－divided by anterior cuspsof mitral valve. • Inflow tract－rough walls • Outflow tract • Aortic vestibule主动脉前庭 • Smooth area leading to aortic orifice

33. Mitral valve 二尖瓣 • Guards left atrioventricular orifice • Two triangular cusps－anterior and posterior with commissural cusps between them.

34. Mitral complex 二尖瓣复合体 • Mitral ring 二尖瓣环 • Mitral valve 二尖瓣 • Chordae tendineae 腱索 • Papillary muscles 乳头肌

35. 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

36. Aortic valve 主动脉瓣 • 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

37. Function of aortic valves • Opening during systole, with cusps pressed toward wall of vessel as blood is forced upward • Closed during diastole • Ventricular pressure drops in diastole • Floating together of valve cusps, with free borders meeting, thus closing the valve

38. Structures of the heart Walls of heart • 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

39. Structures of the heart • Interatrial septum房间隔 • Located between right and left atria • Contains fossa ovalis • Interventricular septum室间隔 • Located between right and left ventricles • Has upper membranous part • Has thick lower muscular part • Atrioventricular septum房室隔

40. Membranous part of interventricular septum

42. Fibrous skeleton of heart 纤维骨骼 • Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices. • Left and right fibrous trigones.

43. Conduction system of heart 心传导系统

44. Conduction system of heart 心传导系统 Composed of specialized myocardial cells. • 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

45. 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.

46. 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.

47. Conduction system of heart 心传导系统 Atrioventricular bundle(AV bundle)房室束 • 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.

48. Conduction system of heart 心传导系统 • Right and left bundle branches左、右束支 • Right bundle branch－passes down 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.

49. ★心传导系统 Sinatrial node Atrioventricular bundle Right and left bundle branches Atrioventricular node Purkinje network

50. Arterial supply of the heart Left coronary artery左冠状动脉 • 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.