心脏瓣膜（半月瓣）肺动脉瓣：连接RV与PA主动脉瓣：连接LV与AOPulmonicValveAorticValve收缩期瓣膜舒张期瓣膜心脏瓣膜在心动周期中的作用心传导系定义：特殊心肌细胞自律性、传导性概述由特殊分化的心肌细胞构成，产生和传导冲动，节律性控制心脏活动。心肌层心壁心肌的起止、走行心壁结构心外膜最外层Outermostlayer薄层，浆膜Thin,serousmembrane心肌层Myocardium中层Middlelayer工作心肌Workingmuscleofheart心内膜Endocardium最内层InnermostlayerLinesmyocardium心包Pericardium心包腔PericardialSac内含少量浆膜液Smallamountofliquid心包纤维心包浆膜心包心包腔心包横窦心包斜窦心的血管左冠状动脉右冠状动脉右缘支后室间支房室结支左前降支左回旋支右冠状动脉(RCA)供应血液至:右心房右心室左室的后壁和下壁(如为右室优势型)左前降支(LAD)供应血液至左室的:前壁侧壁心尖部室间隔左回旋支(LCx)供应血液至:左心房左心室侧壁后壁下壁(左室优势型)壁冠状动脉（心肌桥）冠状动脉的壁内分支冠状静脉心的神经心的听诊区心的体表投影心的体表投影在左胸前壁第五肋间隙锁骨中线内侧1-2cm处，故在此处可看到或摸到心尖搏动。心脏heart位于胸腔的纵隔内，膈肌中心腱的上方，夹在两侧胸膜囊之间。Theheartissuspendedwithinthethoraxbyarteriesandveins.Twothirdsoftheheartislocatedtotheleftofthemid-sternallinewhileonethirdliestotherightofthesternum.Thebaseislocatedatthe2nd-3rdintercostalspacewhiletheapexislocatedatthe5thintercostalspace.Thebaseistiltedbackwards(posterior),whiletheapexistiltedforward(anterior).Duetoforwardtilt-PMI(pointofmaximalimpulse)islocatedattheapex.“Rightandleft”referencesthepatient’srightorleftside.RAreceivesunoxygenatedbloodfromthebodythroughsuperiorvenacava(SVC)andinferiorvenacava(IVC),andfromtheheartmusclethroughthecoronarysinus(CS)LAreceivesoxygenatedbloodfromthelungsthoughthepulmonaryveinsThetriangleofKochhasbecomevitallyimportantinperformingtranscatheterablations.Koch’striangleisdefinedposteriorlybytheosofthecoronarysinus.TheapexofthetriangleisdefinedanteriorlybytheHisbundle.ThetendonofTodaroandthetricuspidvalveannuluscomprisetheothertwosidesofthetriangle.FastpathwayalongTendonofTodaro,SlowpathwayalongtricuspidvalveannulusThepulmonaryveinsreturnthearterializedbloodfromthelungstotheleftatriumoftheheart.Theyarefourinnumber,twofromeachlung,andaredestituteofvalves.Thecommenceinacapillarynet-workuponthewallsoftheairsacs,wheretheyarecontinuouswiththecapillaryramificationsofthepulmonaryartery,and,joiningtogether,formonevesselforeachlobule.Thesevesselsunitingsuccessively,formasingletrunkforeachlobe,threefortheright,andtwofortheleftlung.Theveinfromthemiddlelobeoftherightlunggenerallyuniteswiththatfromtheupperlobe,sothatultimatelytwotrunksfromeachlungareformed;theyperforatethefibrouslayerofthepericardiumandopenseparatelyintotheupperandbackpartoftheleftatrium.Occasionallythethreeveinsontherightsideremainseparate.Notinfrequentlythetwoleftpulmonaryveinsendbyacommonopening.???1??Attherootofthelung,thesuperiorpulmonaryveinliesinfrontofandalittlebelowthepulmonaryartery;theinferiorissituatedatthelowestpartofthehilusofthelungandonaplaneposteriortotheuppervein.Behindthepulmonaryarteryisthebronchus.???2??Withinthepericardium,theiranteriorsurfacesareinvestedbytheserouslayerofthismembrane.???3??Therightpulmonaryveinspassbehindtherightatriumandsuperiorvenacava;theleftinfrontofthedescendingthoracicaorta.PapillaryMuscle–Coneshapedmuscularpillars,whichpreventthevalvesfromreopeningintotheatrial.Thepapillarymusclesoftherightventriclecomprise:Small,cone-shapedmusclesprojectingfromthewallsofthelowerheartchambers(theventricles)towhichareattachedfibrouscords(chordaetendineae)stretchinguptotheflapsofthevalvesbetweenupperandlowerchambers.Whentheventriclesfillwithbloodandcontract,thepapillarymusclesalsocontractandtightenthecords,allowingthevalvestobepressedshut,butpreventingthemfrombeingpushedbackandopenintotheupperchambers(theatria)bythesurgingblood.anteriorpapillarymuscle:largestoriginatesfromright,anteriorandlateralventricularwallmergeswiththeseptomarginaltrabeculaitschordaetendineaeinsertintoanteriorandposteriortricuspidvalveleafletsposteriorpapillarymuscle:secondlargestarisespredominantlyfromposteriorwalloccasionally,mayexistwiththemassofmuscledividedintotwoorthreeitschordaeinsertintotheseptalandposteriorleafletsofthevalveaccessorypapillarymuscles:ifpresent,smallandoftennumerousmayarisefromtheventricularwallortheseptalregionoftheinfundibulumtheirchordaeinsertintotheanteriorandseptalleafletsChordaeTendineae–Tendinouscordswhichattachthemitralvalveleafletstotheventricularsurfacestoprotectagainstallowingbloodtoflowbackintotherightatriumduringventricularcontraction.Duringatrialsystoletheatriumcontractsandtopsoffthevolumeintheventriclewithonlyasmallamountofblood.Atrialcontractioniscompletebeforetheventriclebeginstocontract.心脏基础解剖心脏解剖位置心的构造心传导系心包心的血管心的神经心的体表投影心脏解剖位置心脏位于胸腔的纵隔内。其所在位置相当于第2-6肋软骨或第5-8胸椎之间的范围。整个心脏2/3偏在身体正中线的左侧。2/3在中线左侧方向：右后上－左前下外形心脏如一倒置的，前后略扁的圆锥体像一个桃子。心尖钝圆，朝向左前下方，与胸前壁邻近。心尖搏动左侧第五肋间隙锁骨中线内侧1~2cm。一尖一底：心尖、心底三缘：左缘、右缘、下缘两面：前（胸肋）面下（膈）面肺动脉和肺静脉心腔的钟面关系(水平切面)心腔心脏的组成心脏的腔室心房：左、右心房心室：左、右心室心脏传导系统心脏的血供系统位置术语前Anterior后Posterior上Superior下Inferior中间Median侧Oblique头侧的Cranial足侧的Caudal心房：薄壁，低压心腔概述：心房为薄壁，低压心腔左右心房以房间隔分隔导管从右心房到左心房，需行房间隔穿刺术，经卵圆窝通路进入左心房右心房：在右心室收缩期充盈接受来自于SVC，IVC，CS的血液静脉血左心房在左心室收缩期充盈接受来自肺静脉的血液动脉血右心耳界沟、界嵴冠状窦口卵圆窝右房室口Todaro腱Koch三角（一）右心房固有心房腔静脉窦TriangleofKochKoch三角在右心房的冠状窦口前内缘、三尖瓣隔侧尖附着缘和Todaro腱之间的三角区，称Koch三角。Todaro腱为下腔静脉口前方心内膜下可触摸到的一个腱性结构，它向前经房室隔附着于中心纤维体（右纤维三角），向后与下腔静脉瓣相延续。Koch三角的前部心内膜深面为房室结，其尖对着膜性室间隔的房室部。此三角为心内直视手术中的重要标志，用以指示房室结的位置所在，以防术中损伤。此外，在行心导管检查时，在此三角区过分刺激，可引起心率失常。（二）右心室固有心腔动脉圆锥室上嵴隔缘肉柱三尖瓣复合体节制索肺动脉口左房室口（三）左心房左心耳左心房窦左心房肺静脉（PV）右上PV右下PV左上PV左下PV左心房心耳卵圆窝二尖瓣环（四）左心室窦部主动脉前庭左室条索二尖瓣复合体主动脉瓣（窦）主动脉口Viewedfromabove左右心室横截面心纤维性支架右纤维三角Todaro腱左纤维三角圆锥韧带瓣膜间隔纤维骨架纤维骨架分离心房和心室为心脏瓣膜提供框架心的瓣膜左、右纤维三角心间隔房间隔室间隔肌部膜部房室隔心脏瓣膜(房室瓣)只允许血液从心房单向流向心室三尖瓣连接RA和RV二尖瓣连接LA和LV心室压力低于心房压力时，房室瓣开放腱索与乳头肌腱索腱索连接房室瓣和乳头肌乳头肌发自心内膜,连接于腱索作用心室收缩迫使房室瓣关闭乳头肌收缩引起腱索紧张预防血液从动脉逆向回流至心室二尖瓣三尖瓣主动脉瓣心脏heart位于胸腔的纵隔内，膈肌中心腱的上方，夹在两侧胸膜囊之间。Theheartissuspendedwithinthethoraxbyarteriesandveins.Twothirdsoftheheartislocatedtotheleftofthemid-sternallinewhileonethirdliestotherightofthesternum.Thebaseislocatedatthe2nd-3rdintercostalspacewhiletheapexislocatedatthe5thintercostalspace.Thebaseistiltedbackwards(posterior),whiletheapexistiltedforward(anterior).Duetoforwardtilt-PMI(pointofmaximalimpulse)islocatedattheapex.“Rightandleft”referencesthepatient’srightorleftside.RAreceivesunoxygenatedbloodfromthebodythroughsuperiorvenacava(SVC)andinferiorvenacava(IVC),andfromtheheartmusclethroughthecoronarysinus(CS)LAreceivesoxygenatedbloodfromthelungsthoughthepulmonaryveinsThetriangleofKochhasbecomevitallyimportantinperformingtranscatheterablations.Koch’striangleisdefinedposteriorlybytheosofthecoronarysinus.TheapexofthetriangleisdefinedanteriorlybytheHisbundle.ThetendonofTodaroandthetricuspidvalveannuluscomprisetheothertwosidesofthetriangle.FastpathwayalongTendonofTodaro,SlowpathwayalongtricuspidvalveannulusThepulmonaryveinsreturnthearterializedbloodfromthelungstotheleftatriumoftheheart.Theyarefourinnumber,twofromeachlung,andaredestituteofvalves.Thecommenceinacapillarynet-workuponthewallsoftheairsacs,wheretheyarecontinuouswiththecapillaryramificationsofthepulmonaryartery,and,joiningtogether,formonevesselforeachlobule.Thesevesselsunitingsuccessively,formasingletrunkforeachlobe,threefortheright,andtwofortheleftlung.Theveinfromthemiddlelobeoftherightlunggenerallyuniteswiththatfromtheupperlobe,sothatultimatelytwotrunksfromeachlungareformed;theyperforatethefibrouslayerofthepericardiumandopenseparatelyintotheupperandbackpartoftheleftatrium.Occasionallythethreeveinsontherightsideremainseparate.Notinfrequentlythetwoleftpulmonaryveinsendbyacommonopening.???1??Attherootofthelung,thesuperiorpulmonaryveinliesinfrontofandalittlebelowthepulmonaryartery;theinferiorissituatedatthelowestpartofthehilusofthelungandonaplaneposteriortotheuppervein.Behindthepulmonaryarteryisthebronchus.???2??Withinthepericardium,theiranteriorsurfacesareinvestedbytheserouslayerofthismembrane.???3??Therightpulmonaryveinspassbehindtherightatriumandsuperiorvenacava;theleftinfrontofthedescendingthoracicaorta.PapillaryMuscle–Coneshapedmuscularpillars,whichpreventthevalvesfromreopeningintotheatrial.Thepapillarymusclesoftherightventriclecomprise:Small,cone-shapedmusclesprojectingfromthewallsofthelowerheartchambers(theventricles)towhichareattachedfibrouscords(chordaetendineae)stretchinguptotheflapsofthevalvesbetweenupperandlowerchambers.Whentheventriclesfillwithbloodandcontract,thepapillarymusclesalsocontractandtightenthecords,allowingthevalvestobepressedshut,butpreventingthemfrombeingpushedbackandopenintotheupperchambers(theatria)bythesurgingblood.anteriorpapillarymuscle:largestoriginatesfromright,anteriorandlateralventricularwallmergeswiththeseptomarginaltrabeculaitschordaetendineaeinsertintoanteriorandposteriortricuspidvalveleafletsposteriorpapillarymuscle:secondlargestarisespredominantlyfromposteriorwalloccasionally,mayexistwiththemassofmuscledividedintotwoorthreeitschordaeinsertintotheseptalandposteriorleafletsofthevalveaccessorypapillarymuscles:ifpresent,smallandoftennumerousmayarisefromtheventricularwallortheseptalregionoftheinfundibulumtheirchordaeinsertintotheanteriorandseptalleafletsChordaeTendineae–Tendinouscordswhichattachthemitralvalveleafletstotheventricularsurfacestoprotectagainstallowingbloodtoflowbackintotherightatriumduringventricularcontraction.Duringatrialsystoletheatriumcontractsandtopsoffthevolumeintheventriclewithonlyasmallamountofblood.Atrialcontractioniscompletebeforetheventriclebeginstocontract.
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