Anatomy of the Heart: Difference between revisions

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Royal Brompton Hospital

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[[Image:Figure1.jpg|thumb|right|The endocast is viewed from 5 different perspectives to demonstrate the spatial relationship between right (coloured blue) and left (coloured red) heart chambers and between atria and ventricles. The blue and white arrows represent the right and left ventricular outflow tracts respectively.]]

==The morphologically right atrium==

'''B.''' The lateral wall of the appendage incised and flipped backward to show the pectinate muscles and the thin, membrane-like atrial wall between the muscle bundles. The terminal crest (dots) marks the border between the pectinated appendage and the smooth-walled venous sinus. The oval fossa is surrounded by its muscular rim. The smooth-walled vestibule leads to the tricuspid valve orifice.]]

The right atrium is composed of an anterior appendage, a posterior venous sinus, a septal portion and a vestibule. The junction between the appendage and the venous sinus is marked epicardially by an atrial groove the terminal groove, in which lies the sinus node. Inside the chamber, the terminal groove is represented by a muscle bundle, the terminal crest (crista terminalis), from which pectinate muscles radiate into the appendage (Figure 5). The appendage has a characteristic triangular shape and a wide communication with the venous sinus. The smooth-walled venous sinus receives the superior and inferior caval veins in its cephalic and caudal extremities respectively. The coronary sinus opens close to the septal portion and near the opening of the inferior caval vein. The outlet portion of the atrium, the vestibule leading to the tricuspid valve orifice, is also smooth walled. The obliquely orientated atrial septum extends from right posterior to left anterior position. When viewed from the right atrial aspect, the atrial septum is characterised by a muscular rim – the limbus - which surrounds the flap valve of the oval fossa (Figure 5). The extent of the true septum, however, is limited to the flap valve and the immediate part of its surrounding muscular rim. On the epicardial side much of the rim is filled by the interatrial groove which separates the right atrium from the right pulmonary veins posteriorly and superiorly. In its anterior part, the infolded rim contains the continuation of the interatrial groove and its musculature extends to the anterior wall of the right atrium, directly related to the transverse pericardial sinus. Only a small portion of the inferior rim is part of the true atrial septum. Its major portion is the continuation of the right atrial wall, the vestibule, overlying the crest of the ventricular septum (Figure 5). In fetal life, the flap valve of the oval fossa allows venous return mostly from the inferior caval vein to enter the left atrium. After birth the valve is normally large enough to close the interatrial communication as higher left atrial pressure pushes the valve against the muscular rim forming a complete seal. A probe patency (a probe could be passed from right to left atrium through an unsealed antero-superior part of the rim) exists in about a quarter of the normal population and is generally referred to as a PFO.  

==The morphologically left atrium==

'''B.'''  This section through the aortic root and mitral valve displays the left atrial aspect of the septum enface. The crescentic edge (arrow) of the fossa valve has not sealed completely resulting in a PFO. The asterisk marks the location of the transverse pericardial sinus.]]

==The cardiac conduction system==

The full complement of the histologically specialised tissues making the conduction system of the heart comprises the sinus node and the atrioventricular system (Figure 10). The latter is made up of the atrioventricular node, the penetrating atrioventricular bundle and the ventricular bundle branches. The geometry of the right atrium is such that it is made up of bands of muscle which separate the orifices of the great veins and the oval fossa. The spread of excitation from the sinus to the atrioventricular node has been shown to spread preferentially along these broad bands of ordinary atrial myocardium.

==References==

<biblio>

#Wenckebach Wenckebach KF. ''Beiträge zur Kenntnis der menschlichen Herztätigkeit.'' Arch Anat Physiol l907; 2:1.

#Rosenbaum Rosenbaum MB, Elizari MV, Lazzari JO. ''The hemiblocks.'' In: Tampa Tracings. Oldsmar, Fla. 1970.

</biblio>