美国最经典 心脏外科图解 2015年.docx

Understanding cardiac anatomy is fundamental to success in cardiac surgery.The following drawings show the cardiac surgeon’s view of the heart from theright side of a supine patient through a midsternal incision. Photographs illustratethe anatomic position as if looking at an upright patient, unless otherwise noted.Figure 1-1A The cardiac structures most accessible to view arethe superior vena cava, right atrium, right ventricle,main pulmonary artery, and aorta. Only a smallportion of the anterior wall of the left ventricle isvisible. Medial displacement of the right atriumexposes the left atrium and right pulmonary veins.B The right coronary artery is partly visible in the fatof the atrioventricular groove, with the ventricularbranches and the acute marginal branch in fullview. The posterior descending artery originatesfrom the right coronary artery near the crux of theheart. The crux is defied as the cross point or junction of the atrioventricular septum and the atrioventricular groove. In its course in theatrioventriculargroove, the right coronary artery is in close relationto the anterior portion of theannulus of the tricuspidvalve. The distal portion of the right coronary arterysupplies blood to the atrioventricular node and is inclose proximity to the annulus of the mitral valve.The left coronary artery originates posteriorly fromthe aorta and, after a short distance, divides into theanterior descending and circumflx branches. Theanterior descending coronary artery deviates fromthe atrioventricular groove onto the left ventricle,lateral to the pulmonary artery. Once it is on the anterior wall of the heart over the ventricular septum,the left anterior descending coronary arterybecomes visible. Thecircumflx coronary artery liesin theatrioventriculargroove posteriorly, in close relation to the annulus of the mitral valve. Marginalbranches of the circumflx coronary artery supplythe posterolateral surface of the left ventricle.C Visualization of the distal portion