《脉管系统和心》PPT课件.ppt

Angiology 脉管学,山东大学医学院 解剖教研室,Angiology 脉管学,Composition Cardiovascular system 心血管系统 Lymphatic system 淋巴系统,The cardiovascular system 心血管系统,Organization Heart 心A muscle pump to maintain the flow of bloodConsist of four chambers(right and left atria,right and left ventricles)Artery(a.)动脉 Carry blood away from the heart Vein(v.)静脉 Carry blood back to the heartCapillary 毛细血管 Microscopic vessels,the area of exchange between blood and tissue fluid,The cardiovascular system心血管系统,Blood circulationSystemic circulation 体循环 Left ventricleaorta and its branches capillaries of bodysuperior and inferior vena cavaright atriumPulmonary circulation 肺循环 Right ventriclepulmonary a.capillaries of lung pulmonary v.left atrium,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,Position of the heart,Lies within the pericardium in middle mediastinum Behind the body of sternum and coastal cartilages 2 to 6 In front of thoracic vertebrae 5 to 8 A third of it lies to the right of median plan and 2/3 to the left,Surfaces of the heart,Pyramidal in shape,somewhat larger than a closed fistOne apexOne baseTwo surfaceThree bordersFour sulcuses,Cardiac apex 心尖Formed by left ventricle Directed downwards,forward,and to the leftLies at the level of the fifth left intercostal space,1-2 cm medial to the left midclavicular line(9cm from the midline),Surfaces of the heart,Surfaces of the heart,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 Continuous with the large vessels,Surfaces of the heart,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 ventricleDirected forwards and upwardsLeft and right auricles 左、右心耳,Surfaces of the heart,Diaphragmatic surface 膈面Formed the ventricleschiefly the left ventricleDirected backwards and downwards,and rest upon the central tendon of the diaphragm,Surfaces of the heart,Borders of the heart Right border 右缘Vertical and roundFormed 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 and sharpFormed by the right ventricle and cardiac apex,Surfaces of the heart,Sulcuses of the heart Coronary sulcus 冠状沟(circular sulcus)which marks the division between atria and ventricles,contains the trunks of the coronary vessels and completely encircles the heartPosterior interatrial sulcus后房间沟 Separates the two atria and marks the posterior border of interatrial septum,Surfaces of the heart,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 RV from the LV)Cardiac apical incisure 心尖切迹Atrioventricular crux 房室交点 junction of the posterior interventricular groove，coronary sulcus and Interatrial sulcus.,Chambers of the heart 心腔,Consists of four chambers Left and right atria 左、右心房Left and right ventricles 左、右心室,Right atrium(RA)右心房,Three inletsOrifice of superior vena cava 上腔静脉口 returns blood to the heart from the upper half of the bodyOrifice of inferior vena cava 下腔静脉口 returns blood to the heart from the lower half of the bodyOrifice of coronary sinus 冠状窦口 returns blood to the heart from the cardiac muscleOne outlet Right atrioventricular orifice 右房室口,Right atrium(RA)右心房,Crista terminalis 界嵴 vertical ridge that from orifice of superior vena cava to orifice of inferior vena cavaSulcus terminalis界沟 Groove on exterior of heart that corresponds to crista terminalisTwo parts Separated externally by sulcus terminalis and internally by the crista terminalisAtrium proper 固有心房Sinus venarum cavarum 腔静脉窦,Right atrium(RA)右心房,Atrium proper 固有心房In front of the ridgePectinate muscles in wallSinus venarum cavarum 腔静脉窦Smooth wallsFossa ovalis 卵圆窝An oval depression,a remnant of the fetal foramen ovaleLies on the lower part of interatrial septumThe most common location of atrial septal defects(ASD)Limbus fossae ovalis 卵圆窝缘Aortic mound 主动脉隆凸Koch triangle Koch三角,下界：三尖瓣膈侧尖附着处上界：todaro腱后界：冠状窦口前内侧缘，,Right ventricle(RV)右心室,One inlet Right atrioventricular orifice 右房室口One outlet orifice of pulmonary trunk 肺动脉口,Right ventricle(RV)右心室,Supraventricular crest 室上嵴 A muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk Two partsInflow tract 流入道Outflow tract 流出道,Right ventricle(RV)右心室,Inflow tractTrabeculae carneae 肉柱 irregularly arranged bundles of myocardiumSeptomarginal trabecula 隔缘肉柱extends from interventricular septum to base of anterior papillary muscle,contains right bundle branch右束支Papillary muscles 乳头肌Conical-shaped Three:anterior,posterior and septal,Tricuspid valve 三尖瓣Guards right atrioventricular orifice Three triangular cusps:anterior,posterior and septalBase of cusps are attached to fibrous ring surrounding the atrioventricular orifice Their free edges and ventricular surfaces are attached chordae tendineae 腱索,which connect the cusps to the papillary musclesright fibrous ring右纤维环(三尖瓣环tricuspid annulus),Right ventricle(RV)右心室,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,Right ventricle(RV)右心室,Right ventricle(RV)右心室,Function of tricuspid complexBlood returning to the heart fills atria,putting pressure against atrioventricular valves,atrioventricular vales forced open.,Right ventricle(RV)右心室,Function of tricuspid complex Ventricles contract,forcing blood against atrioventricular valve cusps.Atrioventricular valves close.Papillary muscles contract and chordae tendineae tighten,preventing valve flaps from everting into atria.,Right ventricle(RV)右心室,Outflow tract Conus arteriosus 动脉圆锥 Cone-shape,smooth area leading upward to orifice of pulmonary trunkPumps blood through pulmonary orifice to pulmonary trunk,Right ventricle(RV)右心室,Valve of pulmonary trunk 肺动脉瓣Guards the orifice of pulmonary trunkThree semilunar cusps each with free border that has central nodules called nodules of semilunar valve 半月瓣小结Pulmonary sinuses 肺动脉窦Bulges in wall of pulmonary trunk at level of valve that correspond to cusps Annulus of pulmonary valve肺动脉瓣环,Right ventricle(RV)右心室,Function of pulmonary valves As ventricles contract and intraventricular pressure rises,blood is pushed up against semilunar valves,forcing them open,Right ventricle(RV)右心室,Function of pulmonary valves As ventricles 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,Left auricle左心耳projecting to the right,pectinate muscles in wallFour inletsFour orifices of pulmonary veins 肺静脉口One outletLeft atrioventricular orifice 左房室口,Left ventricle(LV)左心室,One inlet left atrioventricular orifice 左房室口One outlet Aortic orifice 主动脉口Two partsDivided by anterior cusps of mitral valveInflow tractrough wallsOutflow tract Aortic vestibule 主动脉前庭Smooth area leading to aortic orifice,Mitral valve 二尖瓣Guards left atrioventricular orificeTwo triangular cuspsAnterior and posterior with commissural cusps between them(posteromedial and anterolateral commissures)right fibrous ring右纤维环(mitral annulus二尖瓣环）,Ant.,Post.,Left ventricle(LV)左心室,Posterior cusp,Anterior papillary muscle,Posterior papillary muscle,Anterior cusp,Mirtal 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,Left ventricle(LV)左心室,Left ventricle(LV)左心室,Function of mitral complexOpen during diastole舒张(期)to allow blood to enter ventricles from atriaClosed during systole收缩(期)to prevent regurgitation of blood into atria,Similar functions for right and left atriventricular valvesOpen during diastole舒张(期)of ventricles to allow blood to enter ventricles from atriaClosed during systole收缩(期)of ventricles to prevent regurgitation(reflow)of blood into atria,Left ventricle(LV)左心室,Aortic valve 主动脉瓣Guards the aortic orificeThree semilunar cusps(right,left and posterior)Each with free border that has nodules of semilunar valve 半月瓣小结 Annulus of aortic valve主动脉瓣环Aortic sinus 主动脉窦 Bulges in aortic wall at level of valve that correspond to cuspsRightcontains opening of right coronary arteryLeftcontains opening of left coronary arteryPosteriorno opening,L,R,P,Anterior cusp,Left ventricle(LV)左心室,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 diastoleFloating together of valve cusps,with free borders meeting,thus closing the valve,Similar functions for pulmonary and aortic valvesOpening during systole收缩(期),with cusps pressed toward wall of vessel as blood is forced upward Closed during diastole舒张(期)Ventricular pressure drops in diastoleprevent regurgitation反流of blood into ventricle,Structures of the heart,Walls of the heart,Endocardium 心内膜 Inner coat of the heart wall Continuous with the valve flaps Myocardium 心肌Arranged spirallyAttached to fibrous rings surrounding the four orifices of heartThe walls of left ventricle are about three times thicker than that of right Epicardium 心外膜 OuterVisceral layer of serous pericardium,Structures of the heart,Interatrial septum 房间隔Located between right and left atria Contains fossa ovalisInterventricular septum 室间隔Located between right and left ventriclesHas upper membranous part Has thick lower muscular partAtrioventricular septum 房室隔,Fibrous skeleton of heart 纤维骨骼,Fibrous rings that surround the atrioventricular,pulmonary,and aortic orificesLeft and right fibrous trigones,Heat in diastole,Heat in systole,Conduction system of heart 心传导系统,Conduction system of heart 心传导系统,Composed of specialized myocardial cellsComposition 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,Conduction system of heart 心传导系统,Sinuatrial node(SA node)窦房结 Called the pacemaker cell(P cell)Located at the upper part of the sulcus terminalis close to the superior vena cava,under the epicardium,Conduction system of heart 心传导系统,Atrioventricular node(AV node)房室结 Located in the Koch triangle Under the endocardiumLower part related to membranous part of interventricular septum,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 of interventricular septum Divides into right and left bundle branches at upper border of muscular part of interventricular septum,Conduction system of heart 心传导系统,Right and left bundle branches 左、右束支Right bundle branchpasses 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 fibresLeft bundle branchpasses down on left side of interventricular septum beneath the endocardium It usually divides into two branches,which eventually become continuous with the Purkinje fibersPurkinje network 普肯野氏纤维网 Continuous with myocardium,Conduction system of heart 心传导系统,Sinuatrial node,Atrioventricular node,Atrioventricular bundle,Right and left bundle branches,Purkinje network,Arterial supply of the heart,Left coronary artery 左冠状动脉,Course Arises from left aortic sinusRuns between pulmonary trunk and left auricle into coronary sulcusBranchesAnterior interventricular branch 前室间支 Runs downward in anterior interventricular groove around inferior margin of heart to posterior interventricular grooveCircumflex branch 旋支Travels to left in coronary sulcus to posterior aspectDistribution supplies 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,CourseArises from the right aortic sinus Runs forward between right auricle and pulmonary trunk into coronary sulcus BranchesBranch of sinuatrial node 窦房结支Right marginal branch 右缘支 travels along inferior border Posterior interventricular branch 后室间支travels downward in posterior interventricular grooveit anastomosises near the apex with the anterior interventricular branch of the left coronary arteryRight circumflex branch右旋支Distributionsupplies right atrium and ventricle,posterioinferior 1/3 of interventricular septum,posterior wall of left ventricle,the sinuatrial node and atrioventricular node,Stent in an artery,Precutaneous translaminal coronary angioplasty(PTCA),Coronary artery bypass grafting(CABG),Venous drainage of the heart,Venous drainage of the heart,Coronary sinus 冠状窦Lies in posterior part of coronary sulcus Carries most of venous blood from myocardium to right atrium Tributaries 属支Great cardiac vein 心大静脉Middle cardiac vein 心中静脉Small cardiac vein 心小静脉,Venous drainage of heart,Anterior cardiac veins 心前静脉34 small vessels,drain into right atrium Smallest cardiac veins 心最小静脉Drain into all chambers,mainly atria,Pericardium 心包,Pericardium 心包,Fibrous pericardium 纤维心包Attached to central tendon of diaphragm inferiorlyBlends with outer coat of great vessels superiorlySerous pericardium 浆膜心包Visceral layer(epicardium)Parietal layer Pericardial cavity 心包腔Potential space between visceral and parietal layersContains film of pericardium fluid as a lubricant to facilitate cardiac movements,Pericardium 心包,Pericardium sinus 心包窦Formed by reflection of serous pericardium Transverse sinus of pericardium 心包横窦Posterior to ascending aorta and pulmonary trunk Anterior to superior vena cava and left atrium,Pericardium 心包,Oblique sinus of pericardium 心包斜窦Cul-de-sac,posterior to heart,bounded by pulmonary veins on either sideAnterior inferior sinus of pericardium 心包前下窦,Surface markings of heart,Surface markings of heart,R.superior pointLies on the upper border of right third costal cartilage 1.0cm from the margin of sternum R.inferior point Lies on the 7th sternocostal joint L.superior point Lies on lower border of left second costal cartilage 1.2cm from sternal margin Cardiac apexIn the fifth left intercostal space 7-9cm from the midline,Surface markings of the Heart Valves,Tricuspid valve Lies behind the right half of the sternum opposites the fourth interxostal spaceMitral valve Lies behind the left half of the sternum opposite the fourth costal cartilagePulmonary valve Lies behind the medial end of the third left costal cartilage and the adjoining part of the sternumAortic valve Lies behind the left half of the sternum opposite the third intercostals space,心移植,1.胸部做一切口，劈开胸骨，切开心包，显露有病变的心,2人工心肺机取代循环后，钳夹主动脉，把病变的心与主动脉、两个心房的前壁和肺动脉干断离，移除心。,3原心房后壁保留，将供体心和残留心的游离缘及房间隔做对应缝合。,4将病人的主动脉和肺动脉与供体心缝合，移去主动脉夹，待心重新跳动后，断开人工心肺机。,Teaching outline,1.Master the composition of the vascular system.2.Master the composition of cardiovascular system.3.Master concept of the greater(systemic)circulation and lesser(pulmonary)circulation.4.Master the position and external features of the heart.M