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1、Angiology 脉管学脉管学山东大学医学院山东大学医学院 解剖教研室解剖教研室Angiology 脉管学脉管学Composition nCardiovascular system 心血管系统心血管系统 nLymphatic system 淋巴系统淋巴系统The cardiovascular system 心血管系统心血管系统 Organization nHeart 心心qA muscle pump to maintain the flow of bloodqConsist of four chambers(right and left atria,right and left ventri
2、cles)nArtery(a.)动脉动脉 qCarry blood away from the heart nVein(v.)静脉静脉 qCarry blood back to the heartnCapillary 毛细血管毛细血管 qMicroscopic vessels,the area of exchange between blood and tissue fluid The cardiovascular system心血管系统心血管系统Blood circulationnSystemic circulation 体循环体循环 qLeft ventricleaorta and its
3、 branches capillaries of bodysuperior and inferior vena cavaright atriumnPulmonary circulation 肺循环肺循环 qRight ventriclepulmonary a.capillaries of lung pulmonary v.left atrium The cardiovascular system 心血管系统心血管系统Vascular anastomosis 血管吻合血管吻合nAnastomosis between a.nAnastomosis between v.nArteriolovenul
4、ar anastomosis 动静脉吻合nCollateral vessels 侧副管 nCollateral circulation 侧支循环Position of the heartnLies within the pericardium in middle mediastinum nBehind the body of sternum and coastal cartilages 2 to 6 nIn front of thoracic vertebrae 5 to 8 nA third of it lies to the right of median plan and 2/3 to
5、the leftSurfaces of the heartnPyramidal in shape,somewhat larger than a closed fistnOne apexnOne basenTwo surfacenThree bordersnFour sulcusesnCardiac apex 心尖心尖qFormed by left ventricle qDirected downwards,forward,and to the leftqLies at the level of the fifth left intercostal space,1-2 cm medial to
6、the left midclavicular line(9cm from the midline)Surfaces of the heartSurfaces of the heartnCardiac base 心底心底qFormed by the left atrium and to a small extent by the right atrium qFaces backward,upward and to the right qContinuous with the large vesselsSurfaces of the heartnSternocostal surface 胸肋面胸肋
7、面qFormed mainly by the right atrium and right ventricle,and a lesser portion of its left is formed by the left auricle and ventricleqDirected forwards and upwardsqLeft and right auricles 左、右心耳左、右心耳Surfaces of the heartnDiaphragmatic surface 膈面膈面qFormed the ventricleschiefly the left ventricleqDirect
8、ed backwards and downwards,and rest upon the central tendon of the diaphragmSurfaces of the heartnBorders of the heart qRight border 右缘右缘nVertical and roundnFormed entirely by right atrium qLeft border 左缘左缘 nRound nMainly formed by the left ventricle and partly by the left auricle qInferior border 下
9、缘下缘nHorizontal and sharpnFormed by the right ventricle and cardiac apexSurfaces of the heartnSulcuses of the heart qCoronary sulcus 冠状沟冠状沟n(circular sulcus)which marks the division between atria and ventricles,contains the trunks of the coronary vessels and completely encircles the heartqPosterior i
10、nteratrial sulcus后房间沟后房间沟 nSeparates the two atria and marks the posterior border of interatrial septumSurfaces of the heartnSulcuses of the heart qAnterior interventricular groove 前室间沟前室间沟qPosterior interventricular groove 后室间沟后室间沟nMark the division between ventricles(which separates the RV from th
11、e LV)qCardiac apical incisure 心尖切迹心尖切迹qAtrioventricular crux 房室交点房室交点n junction of the posterior interventricular groove，coronary sulcus and Interatrial sulcus.Chambers of the heart 心腔心腔Consists of four chambers nLeft and right atria 左、右心房左、右心房nLeft and right ventricles 左、右心室左、右心室Right atrium(RA)右心房
12、右心房 nThree inletsqOrifice of superior vena cava 上腔静脉口上腔静脉口 nreturns blood to the heart from the upper half of the bodyqOrifice of inferior vena cava 下腔静脉口下腔静脉口 nreturns blood to the heart from the lower half of the bodyqOrifice of coronary sinus 冠状窦口冠状窦口 nreturns blood to the heart from the cardiac
13、musclenOne outlet qRight atrioventricular orifice 右房室口右房室口Right atrium(RA)右心房右心房nCrista terminalis 界嵴界嵴 nvertical ridge that from orifice of superior vena cava to orifice of inferior vena cavanSulcus terminalis界沟界沟 qGroove on exterior of heart that corresponds to crista terminalisnTwo parts qSeparat
14、ed externally by sulcus terminalis and internally by the crista terminalisqAtrium proper 固有心房固有心房qSinus venarum cavarum 腔静脉窦腔静脉窦Right atrium(RA)右心房右心房nAtrium proper 固有心房固有心房qIn front of the ridgeqPectinate muscles in wallnSinus venarum cavarum 腔静脉窦腔静脉窦qSmooth wallsqFossa ovalis 卵圆窝卵圆窝nAn oval depres
15、sion,a remnant of the fetal foramen ovalenLies on the lower part of interatrial septumnThe most common location of atrial septal defects(ASD)qLimbus fossae ovalis 卵圆窝缘卵圆窝缘qAortic mound 主动脉隆凸主动脉隆凸qKoch triangle Koch三角三角下界：三尖瓣膈侧尖附着处下界：三尖瓣膈侧尖附着处上界：上界：todaro腱腱后界：冠状窦口前内侧缘，后界：冠状窦口前内侧缘，Right ventricle(RV)右
16、心室右心室nOne inlet qRight atrioventricular orifice 右房室口右房室口nOne outlet qorifice of pulmonary trunk 肺动脉口肺动脉口Right ventricle(RV)右心室右心室nSupraventricular crest 室上嵴室上嵴 qA muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk nTwo partsqInflow tract 流入道流入道qOutflow tract 流出道流出道R
17、ight ventricle(RV)右心室右心室nInflow tractqTrabeculae carneae 肉柱肉柱 nirregularly arranged bundles of myocardiumqSeptomarginal trabecula 隔缘肉柱隔缘肉柱nextends from interventricular septum to base of anterior papillary muscle,contains right bundle branch右束支qPapillary muscles 乳头肌乳头肌nConical-shaped nThree:anterior
18、,posterior and septalnTricuspid valve 三尖瓣三尖瓣qGuards right atrioventricular orifice qThree triangular cusps:nanterior,posterior and septalnBase of cusps are attached to fibrous ring surrounding the atrioventricular orifice nTheir free edges and ventricular surfaces are attached chordae tendineae 腱索腱索
19、,which connect the cusps to the papillary musclespright fibrous ring右纤维环(三尖瓣环tricuspid annulus)Right ventricle(RV)右心室右心室nTricuspid complex 三尖瓣复合体三尖瓣复合体qTricuspid ring 三尖瓣环三尖瓣环qTricuspid valve 三尖瓣三尖瓣qChordae tendineae 腱索腱索qPapillary muscles 乳头肌乳头肌Right ventricle(RV)右心室右心室Right ventricle(RV)右心室右心室nFun
20、ction of tricuspid complexqBlood returning to the heart fills atria,putting pressure against atrioventricular valves,atrioventricular vales forced open.Right ventricle(RV)右心室右心室nFunction of tricuspid complex qVentricles contract,forcing blood against atrioventricular valve cusps.Atrioventricular val
21、ves close.qPapillary muscles contract and chordae tendineae tighten,preventing valve flaps from everting into atria.Right ventricle(RV)右心室右心室nOutflow tract qConus arteriosus 动脉圆锥动脉圆锥 nCone-shape,smooth area leading upward to orifice of pulmonary trunknPumps blood through pulmonary orifice to pulmona
22、ry trunkRight ventricle(RV)右心室右心室nValve of pulmonary trunk 肺动脉瓣肺动脉瓣qGuards the orifice of pulmonary trunkqThree semilunar cusps neach with free border that has central nodules called nodules of semilunar valve 半月瓣小结半月瓣小结qPulmonary sinuses 肺动脉窦肺动脉窦nBulges in wall of pulmonary trunk at level of valve
23、that correspond to cusps pAnnulus of pulmonary valve肺动脉瓣环肺动脉瓣环Right ventricle(RV)右心室右心室nFunction of pulmonary valves qAs ventricles contract and intraventricular pressure rises,blood is pushed up against semilunar valves,forcing them openRight ventricle(RV)右心室右心室nFunction of pulmonary valves qAs ven
24、tricles relax and intraventricular pressure falls,blood flow back from arteries,filling the cusps of semilunar valves and forcing them to close Left atrium(LA)左心房左心房nLeft auricle左心耳左心耳projecting to the right,pectinate muscles in wallnFour inletsqFour orifices of pulmonary veins 肺静脉口肺静脉口nOne outletqL
25、eft atrioventricular orifice 左房室口左房室口Left ventricle(LV)左心室左心室nOne inlet qleft atrioventricular orifice 左房室口左房室口nOne outlet qAortic orifice 主动脉口主动脉口nTwo partsqDivided by anterior cusps of mitral valveqInflow tractrough wallsqOutflow tract nAortic vestibule 主动脉前庭主动脉前庭nSmooth area leading to aortic ori
26、ficenMitral valve 二尖瓣二尖瓣qGuards left atrioventricular orificeqTwo triangular cuspsnAnterior and posterior with commissural cusps between them(posteromedial and anterolateral commissures)nright fibrous ring右纤维环(mitral annulus二尖瓣环二尖瓣环）Ant.Post.Left ventricle(LV)左心室左心室Posterior cuspAnterior papillary m
27、usclePosterior papillary muscleAnterior cuspnMirtal complex 二尖瓣复合体二尖瓣复合体qMitral ring 二尖瓣环二尖瓣环qMitral valve 二尖瓣二尖瓣qChordae tendineae 腱索腱索qPapillary muscles 乳头肌乳头肌Left ventricle(LV)左心室左心室Left ventricle(LV)左心室左心室nFunction of mitral complexqOpen during diastole舒张(期)to allow blood to enter ventricles fro
28、m atriaqClosed during systole收缩(期)to prevent regurgitation of blood into atriaSimilar functions for right and left atriventricular valvesnOpen during diastole舒张(期)of ventricles to allow blood to enter ventricles from atrianClosed during systole收缩(期)of ventricles to prevent regurgitation(reflow)of bl
29、ood into atriaLeft ventricle(LV)左心室左心室nAortic valve 主动脉瓣主动脉瓣qGuards the aortic orificeqThree semilunar cusps(right,left and posterior)qEach with free border that has nodules of semilunar valve 半月瓣小结半月瓣小结 nAnnulus of aortic valve主动脉瓣环主动脉瓣环qAortic sinus 主动脉窦主动脉窦 nBulges in aortic wall at level of valv
30、e that correspond to cuspsnRightcontains opening of right coronary arterynLeftcontains opening of left coronary arterynPosteriorno opening LRPAnterior cuspLeft ventricle(LV)左心室左心室nFunction of aortic valves qOpening during systole,with cusps pressed toward wall of vessel as blood is forced upward qCl
31、osed during diastole nVentricular pressure drops in diastolenFloating together of valve cusps,with free borders meeting,thus closing the valve Similar functions for pulmonary and aortic valvesnOpening during systole收缩(期),with cusps pressed toward wall of vessel as blood is forced upward nClosed duri
32、ng diastole舒张(期)qVentricular pressure drops in diastoleqprevent regurgitation反流of blood into ventricleStructures of the heartWalls of the heartnEndocardium 心内膜心内膜 qInner coat of the heart wall qContinuous with the valve flaps nMyocardium 心肌心肌qArranged spirallyqAttached to fibrous rings surrounding t
33、he four orifices of heartqThe walls of left ventricle are about three times thicker than that of right nEpicardium 心外膜心外膜 qOuterqVisceral layer of serous pericardiumStructures of the heartnInteratrial septum 房间隔房间隔qLocated between right and left atria qContains fossa ovalisnInterventricular septum 室
34、间隔室间隔qLocated between right and left ventriclesqHas upper membranous part qHas thick lower muscular partnAtrioventricular septum 房室隔房室隔Fibrous skeleton of heart 纤维骨骼纤维骨骼 nFibrous rings that surround the atrioventricular,pulmonary,and aortic orificesnLeft and right fibrous trigonesHeat in diastoleHea
35、t in systoleConduction system of heart 心传导系统心传导系统Conduction system of heart 心传导系统心传导系统nComposed of specialized myocardial cellsnComposition qSinuatrial node 窦房结窦房结qInternodal tract 结间束结间束qAtrioventricular node 房室结房室结qAtrioventricular bundle 房室束房室束qRight and left bundle branches 左、右束支左、右束支qPurkinje n
36、etwork 普肯野氏纤维网普肯野氏纤维网Conduction system of heart 心传导系统心传导系统nSinuatrial node(SA node)窦房结窦房结 qCalled the pacemaker cell(P cell)qLocated at the upper part of the sulcus terminalis close to the superior vena cava,under the epicardiumConduction system of heart 心传导系统心传导系统nAtrioventricular node(AV node)房室结房
37、室结 qLocated in the Koch triangle qUnder the endocardiumqLower part related to membranous part of interventricular septumConduction system of heart 心传导系统心传导系统nAtrioventricular bundle(AV bundle)房室束房室束 qPasses forward through right fibrous trigone to reach inferior border of membranous part of interven
38、tricular septum qDivides into right and left bundle branches at upper border of muscular part of interventricular septum Conduction system of heart 心传导系统心传导系统nRight and left bundle branches 左、右束支左、右束支qRight bundle branchnpasses down on right side of interventricular septum to reach the septomarginal
39、 trabecular and into the base of anterior papillary muscle.nHere it becomes continuous with the fibers of Purkinje fibresqLeft bundle branchnpasses down on left side of interventricular septum beneath the endocardium nIt usually divides into two branches,which eventually become continuous with the P
40、urkinje fibersnPurkinje network 普肯野氏纤维网普肯野氏纤维网 qContinuous with myocardium Conduction system of heart 心传导系统心传导系统Sinuatrial nodeAtrioventricular nodeAtrioventricular bundleRight and left bundle branchesPurkinje networkArterial supply of the heartLeft coronary artery 左冠状动脉左冠状动脉nCourse qArises from lef
41、t aortic sinusqRuns between pulmonary trunk and left auricle into coronary sulcusnBranchesqAnterior interventricular branch 前室间支前室间支 nRuns downward in anterior interventricular groove around inferior margin of heart to posterior interventricular grooveqCircumflex branch 旋支旋支nTravels to left in coron
42、ary sulcus to posterior aspectnDistribution qsupplies left atrium and ventricle,lesser portion of anterior wall of right ventricle,and anterior 2/3 of interventricular septum,the sinuatrial node(40)and atrioventricular node(7)Right coronary artery 右冠状动脉右冠状动脉nCourseqArises from the right aortic sinus
43、 qRuns forward between right auricle and pulmonary trunk into coronary sulcus nBranchesqBranch of sinuatrial node 窦房结支窦房结支qRight marginal branch 右缘支右缘支 n travels along inferior border qPosterior interventricular branch 后室间支后室间支ntravels downward in posterior interventricular groovenit anastomosises n
44、ear the apex with the anterior interventricular branch of the left coronary arterypRight circumflex branch右旋支右旋支nDistributionqsupplies right atrium and ventricle,posterioinferior 1/3 of interventricular septum,posterior wall of left ventricle,the sinuatrial node and atrioventricular nodeStent in an
45、arteryPrecutaneous translaminal coronary angioplasty(PTCA)Coronary artery bypass grafting(CABG)Venous drainage of the heartVenous drainage of the heartnCoronary sinus 冠状窦冠状窦qLies in posterior part of coronary sulcus qCarries most of venous blood from myocardium to right atrium qTributaries 属支属支nGrea
46、t cardiac vein 心大静脉心大静脉nMiddle cardiac vein 心中静脉心中静脉nSmall cardiac vein 心小静脉心小静脉Venous drainage of heartnAnterior cardiac veins 心前静脉心前静脉q34 small vessels,drain into right atrium nSmallest cardiac veins 心最小静脉心最小静脉qDrain into all chambers,mainly atriaPericardium 心包心包Pericardium 心包心包nFibrous pericardiu
47、m 纤维心包纤维心包qAttached to central tendon of diaphragm inferiorlyqBlends with outer coat of great vessels superiorlynSerous pericardium 浆膜心包浆膜心包qVisceral layer(epicardium)qParietal layer nPericardial cavity 心包腔心包腔qPotential space between visceral and parietal layersqContains film of pericardium fluid as
48、 a lubricant to facilitate cardiac movementsPericardium 心包心包nPericardium sinus 心包窦心包窦qFormed by reflection of serous pericardium nTransverse sinus of pericardium 心心包横窦包横窦qPosterior to ascending aorta and pulmonary trunk qAnterior to superior vena cava and left atriumPericardium 心包心包nOblique sinus of
49、 pericardium 心包斜窦心包斜窦qCul-de-sac,posterior to heart,bounded by pulmonary veins on either sidenAnterior inferior sinus of pericardium 心包前下窦心包前下窦 Surface markings of heart Surface markings of heart nR.superior pointqLies on the upper border of right third costal cartilage 1.0cm from the margin of ster
50、num nR.inferior point qLies on the 7th sternocostal joint nL.superior point qLies on lower border of left second costal cartilage 1.2cm from sternal margin nCardiac apexqIn the fifth left intercostal space 7-9cm from the midlineSurface markings of the Heart Valves nTricuspid valve qLies behind the r