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Figure 2-1: Four-chamber tomographic section of the heart as illustrated by Leonardo da

Vinci. Note the thin-walled right ventricle and thick-walled left ventricle and detailed anatomic connections. (From O'Malley and Saunders,2 with permission.)

Figure 2-2: Anatomic considerations in the treatment of supraventricular arrhythmias. AV, atrioventricular; Ao, ascending aorta; IVC, inferior vena cava; LV, left ventricle; PT, pulmonary trunk; RA, right atrium; RV, right ventricle; SVC, superior vena cava.

(Courtesy of Dr. Douglas L Packer, Mayo Clinic, Rochester, Minnesota.)

Figure 2-3: Anatomic considerations in the treatment of ventricular arrhythmias. LV, left ventricle; LA, left atrium; MI, myocardial infarction; VT, ventricular tachycardia; VF, ventricular fibrillation; other abbreviations as in Fig 2-2. (Courtesy of Dr. Douglas L

Packer, Mayo Clinic, Rochester, Minnesota.)

Figure 2-4: (Plate 1) The three primary planes of the body (left) and heart (right). Note that the planes of the body are aligned with vertical midline structures, such as the esophagus. In contrast, the major axis of the heart is oriented obliquely. Thus the heart's long and short axes do not lie in the same plane as the body's long and short axes. The body planes cut the heart obliquely and not in its primary planes. Conversely, the heart's primary planes cut the body obliquely.

Figure 2-5: (Plate 2) A. Anterior view of the heart in its usual anatomic position with its apex directed from right to left. Arrows point to the anterior interventricular groove. B. Nonanatomic positioning of the normal heart with its apex directed downward, thereby resembling a "valentine." The position of the cardiac apex is normally leftward (levocardia) but may anomalously be rightward (dextrocardia) or midline and inferiorly (mesocardia). Ao, ascending aorta; LV, left ventricle; PT, pulmonary trunk; RV, right ventricle; SVC, superior vena cava.

Figure 2-6: Apex-down four-chamber view of the heart (left) and an anatomically impossible mirror-image photograph (right). Mirror-image depiction (though unfortunately commonly used in publications) does not correspond to normal anatomic reality. Obviously, three-dimensional anatomic correctness is essential for accurate clinicopathologic correlations. LA, left atrium.

Figure 2-7: Inflow-outflow method of cardiac dissection. A. Left ventricular inflow view. B. Left ventricular outflow view. A, anterior mitral leaflet; Ao, ascending aorta; LA, left atrium; LV, left ventricle; P, posterior mitral leaflet.

Figure 2-8: (Plate 3) Ventricular slice method of cardiac dissection. Display of five slices (LV, left ventricle; RV, right ventricle) viewed as though looking from the base of the heart toward the apex.

Figure 2-9: (Plate 4) Bisected cardiac specimen, viewed in the short axis. A. The specimen is viewed from the apex toward the base. The esophagus (E) is posterior and adjacent to the both the thoracic aorta (Ao) and the inferior wall of the left ventricle (LV). The right ventricular (RV) cavity is to the left. B. The other half of the bisected specimen is viewed as though looking from the base toward the apex (comparable with Fig. 2-8). AW, anterior wall; IW, inferior wall; VS, ventricular septum.

Figure 2-10: (Plate 5) Bisected cardiac specimen in the four-chamber view parallel to the base-apex axis of the heart. (Left) The bisected specimen has been partially opened to show the relative relationship of the bisected halves. (Right) The two components of the bisected specimen are opened completely. Note the positions of the pulmonary veins posteriorly and the positions of the atrial appendages at the atrioventricular groove. AL, anterolateral papillary muscle; AS, atrial septum; IVC, inferior vena cava; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; MV, mitral valve; PM, posteromedial papillary muscle; PulV, pulmonary vein; RA, right atrium; RAA, right atrial appendage; RV, right ventricle; TV, tricuspid valve; VS, ventricular septum. Figure 2-11: Tomographic cardiac dissection along the body primary planes. A,B. Transverse sections (looking from head toward feet) at the level of the great vessels (A) or the cardiac chambers (B). The aortic arch travels over the left bronchus and the right pulmonary artery. C,D. Frontal sections (looking from anterior to posterior) through both ventricles (C) or left ventricle and right atrium (D). E,F. Parasagittal sections looking from right (E) to left (F). Ao, ascending aorta; CS, coronary sinus; E, esophagus; IA, innominate artery; IVC, inferior vena cava; LA, left atrium; LAA, left atrial appendage; LB, left bronchus; LCX, left circumflex coronary artery; LIV, left innominate vein; LLPV, left lower pulmonary vein; LPA, left pulmonary artery; LUPV, left upper pulmonary vein; LSA, left subclavian artery; LV, left ventricle; MS, membranous ventricular septum; MV, mitral valve; PS, pericardial sac; PT, pulmonary trunk; PV, pulmonary valve; RA, right atrium; RAA, right atrial appendage; RPA, right pulmonary artery; RUPV, right upper pulmonary vein; RV, right ventricle; RVO, right ventricular outflow; SVC, superior vena cava; TV, tricuspid valve. Figure 2-12: A-D. Tomographic cardiac dissections along the heart's primary short-axis plane. This method of tomographic dissection shows the crescentic right ventricle (RV) and circular left ventricle (LV). The atrioventricular valves are sectioned at the level of their papillary muscles (in A), chordae tendineae (in B), atrioventricular valve leaflets (in C), and their annuli and the semilunar valves (in D). The infundibulum septum (IS) separates the pulmonary and aortic valves. The atrial septum (AS) separates the tricuspid and mitral valves and abuts the posterior (noncoronary) cusp of the aortic valve. LA, left atrium; MV, mitral valve; RA, right atrium; RVO, right ventricular outflow; TV, tricuspid valve.

Figure 2-13: Tomographic cardiac dissection along the heart's primary fourchamber plane. The heart is viewed as though one were looking from the anterosuperior surface toward the posteroinferior surface. In the floor of the right atrium is the orifice of the inferior vena cava (IVC). The pulmonary veins (PulV) enter the posterior aspect of the left atrium. AL, anterolateral mitral papillary muscle; AS, atrial septum; LA, left atrium; LV, left ventricle; MV, mitral valve; PM, posteromedial mitral papillary muscle; RV, right ventricle; TV, tricuspid valve; VS, ventricular septum.

Figure 2-14: Tomographic cardiac dissection along the heart's primary long-axis plane. A. Tomographic section showing the left ventricle and left atrium. The mitral valve is also well demonstrated. The left atrial appendage is located anteriorly. The specimen is viewed as though one were looking from the tip of the left scapula toward the right nipple. B. Analogous two-chamber transesophageal view. AW, anterior wall; Desc Ao, descending thoracic aorta; E, esophagus; IW, inferior wall; LA, left atrium; LAA, left atrial appendage; LB, left bronchus; LPA, left pulmonary artery; LV, left ventricle; MV, mitral valve; PulV, pulmonary vein; Tr, trachea.

Figure 2-15: Left ventricular long-axis method of tomographic cardiac dissection (looking from left flank toward the midsternum). Continuity between mitral and aortic valves is clearly seen. The oblique sinus (*) abuts the wall of the left atrium. A, anterior mitral leaflet; Ao, ascending aorta; CS, coronary sinus; LA, left atrium; LV, left ventricle; P, posterior aortic cusp; PM, posteromedial mitral papillary muscle; R, right aortic cusp; RVO , right ventricular outflow; SVC, superior vena cava; arrows point to the right upper and lower pulmonary veins.

Figure 2-16: Collage of four-chamber tomographic sections cutting from inferior wall to anterosuperior wall showing coronary sinus (A), internal cardiac crux (*) (B), and aortic valve (C). Ao, ascending aorta; CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; arrow in A points to a fenestrated eustachian valve.

Figure 2-17: Tomographic sections of the heart in the transverse (A) and frontal (B) planes of the body. A tomographic section in the transverse plane of the body (A) results in a four-chamber view of the heart. A tomographic section along the frontal plane of the body (B) results in an oblique short-axis view of the heart. C. MRI image corresponding to A. CS, coronary sinus; DAo, descending thoracic aorta; IVC, inferior vena cava; LA, left atrium; LAD, left anterior descending coronary artery; LV, left ventricle; RA, right atrium; RCA, right coronary artery; RV, right ventricle; RVO, right ventricular outflow; TV, tricuspid valve; VS, ventricular septum.

Figure 2-18: Oblique methods of tomographic cardiac dissection. A, B. Right anterior oblique sections, viewed from the right, are taken parallel to the ventricular and atrial septa, may include the right side of the heart (A) or the left side of the heart (B), and are similar to the two-chamber tomographic sections. C,D. Left anterior oblique sections, viewed from the apex toward the base, may be taken at various levels and are similar to the short-axis tomographic sections. Ao, aorta; CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; MV, mitral valve; PT, pulmonary trunk; PV, pulmonary valve; RA, right atrium; RV, right ventricle; RVO, right ventricular outflow; SVC, superior vena cava; TV, tricuspid valve. Figure 2-19: Anterior view of the heart. The anterior portion of the parietal pericardium has been removed, exposing the intrapericardial portions of the superior vena cava (SVC), ascending aorta (Ao), and pulmonary trunk (PT). LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 2-20: Tomographic section in the short-axis plane of the body, looking from apex toward the base, showing the oblique (OS) and transverse (TS) pericardial sinuses. Ao, ascending aorta; DAo, descending thoracic aorta; LA, left atrium; LAS, left aortic sinus; LMA, left main coronary artery: PS, pericardial sac; PV, pulmonary valve; RAA, right atrial appendage; SVC, superior vena cava.

Figure 2-21: (Plate 8) Base of heart. A. Section through the base of the heart, looking from base toward apex, with the atria and great arteries removed, shows all four cardiac valves. B. A comparable schematic diagram of the fibrous cardiac skeleton. The centrally located aortic valve forms the cornerstone of the cardiac skeleton. Its fibrous extensions anchor and support the other three valves. A, anterior; AoV, aortic valve; AV, atrioventricular; CS, coronary sinus; IV, interventricular; L, left; LCX, left circumflex coronary artery; MV, mitral valve; P, posterior; PV, pulmonary valve; R, right; RCA, right coronary artery; S, septal; TV, tricuspid valve.

Figure 2-22: Long-axis section of the left ventricle. The intervalvular fibrosa (dashed triangle) lies between the anterior mitral leaflet and the posterior cusp of the aortic valve and abuts the floor of the transverse pericardial sinus (*). Ao, ascending aorta; IW, inferior wall; LA, left atrium; LV, left ventricle; RVO, right ventricular outflow; VS, ventricular septum.

Figure 2-23: This oblique short-axis view of the heart shows the triangular-shaped tricuspid orifice (TV) and the elliptical mitral orifice (MV) at midleaflet level. The anterior tricuspid and anterior mitral leaflets (A) separate the inflow and outflow tracts of the right and left ventricles, respectively, and are parallel to one another. PV, pulmonary valve. Figure 2-24: (Plate 9) Mitral valve, viewed from left atrial aspect. Minor commissures (*) divide the posterior leaflet into four scallops (arrows). A, anterior; C, major commissures; P, posterior.

Figure 2-25: Gross anatomy of the mitral valve and papillary muscle-chordal apparatus, as demonstrated in an excised and unfolded valve. Each commissure overlies a papillary muscle. Arrows point to minor commissures. A, anterior leaflet; ALPM, anterolateral papillary muscle; P, posterior leaflet; PMPM, posteromedial papillary muscle. Figure 2-26: (Plate 10) Components of the mitral valve. A. Each leaflet has a large clear zone (CZ) and a smaller rough zone (RZ) between its free edge and closing edge (dotted line). A fanlike commissural chorda tendinea (*) connects the tip of the papillary muscle to the commissure. B. Schematic diagram of an open anterior mitral leaflet comparable to A. Section obtained along the dotted lines shows the relationship of the mitral annulus and free edge to the closing edge.

Figure 2-27: Each cusp of a semilunar valve is pocket-shaped. The aortic valve is viewed from above in simulated closed (A) and open (B) positions, showing the three commissures (arrows). Note that the length of the closing edge exceeds the straight-line distance between the commissures.

Figure 2-28: An opened aortic valve shows the right (R), left (L), and posterior (P) cusps. The dashed line marks the closing edge. Between the free and closing edges of each cusp are two lunular areas, representing the surfaces of apposition between adjacent cusps during valve closure. The commissures (*) attain the level of the aortic sinotubular junction (STJ). Conus, conus coronary ostium; LC, left coronary ostium; LV, left ventricle; N, nodule of Arantius; RC, right coronary ostium.

Figure 2-29: Aortic cusp fenestrations (arrows) occurring in the lunular regions near the commissures. This is a common age-related degenerative finding and normally accounts for little or no aortic valve regurgitation.

Figure 2-30: The commissure between the right and posterior aortic cusps (arrow) overlies the transilluminated membranous septum (arrowhead). A, anterior mitral leaflet; Ao, ascending aorta; LV, left ventricle; P, posterior aortic cusp; R, right aortic cusp. Figure 2-31: View of the diaphragmatic aspect of the heart shows the intersection of the atrioventricular (arrowheads), posterior interventricular (long arrow), and interatrial (small arrow) grooves at the external cardiac crux (*). (Left) Diagram. (Right) Cardiac specimen. LA, left atrium; LV, left ventricle; RV, right ventricle.

Figure 2-32: Right ventricle. A. The right ventricular free wall has been removed to show the archlike crista supraventricularis, which consists of the parietal band (PB), infundibular septum (IS), and septal band (SB). The moderator band (*) joins the septal band to the anterior tricuspid papillary muscle (A). The anteroapical portion of the chamber is heavily trabeculated. M, medial tricuspid papillary muscle; PV, pulmonary valve; RAA, right atrial appendage; RCA, right coronary artery; TV, tricuspid valve. B. The right ventricle has been opened by the inflow-outflow method to show the parietal band (PB) separating the tricuspid and pulmonary valves, as well as the two upper limbs (arrows) of e septal band (SB). A, anterior leaflet of the tricuspid valve; P, posterior leaflet of the tricuspid valve; PT, pulmonary trunk; S, septal leaflet of the tricuspid valve; other abbreviations as in A.

Figure 2-33: Long-axis view of the right ventricular outflow (RVO) tract showing the pulmonary valve (PV) and main pulmonary artery (MPA). AoV, aortic valve; LA, left atrium; LCA, left coronary artery; LVO, left ventricular outflow; MV, mitral valve; PulV, pulmonary vein; VS, ventricular septum; *, transverse sinus.

Figure 2-34: (Plate 11) Four-chamber slice of the heart shows the characteristic normal apical displacement of the tricuspid valve septal leaflet insertion (arrowhead) when compared with septal insertion of the mitral valve (solid arrow). This tomographic section also shows the interatrial septum (IAS), atrioventricular septum (AVS), and interventricular septum (IVS). Open arrow points to fossa ovalis. LA, left atrium; LLPV, left lower pulmonary vein; LV, left ventricle; RA, right atrium; RLPV, right lower pulmonary vein; RV, right ventricle.

Figure 2-35: Various locations of left ventricular false tendons. A. Two false tendons (arrows) from posteromedial mitral papillary muscle (PM) to ventricular septum (VS), representing the most common location. B. Complex branching false tendon (arrows) with origin from the left ventricular free wall (FW) and insertions into the ventricular septum (VS) and base of posteromedial mitral papillary muscle (PM).

Figure 2-36: (Plate 12) Calcified left ventricular false tendon (arrows) seen in short-axis view.

Figure 2-37: Prominent left ventricular trabeculations. Multiple large muscle bundles extend from the anterior free wall to the septum (probes). A single muscle bundle extends from the posteromedial mitral papillary muscle to the posterior septum (probe with white arrow), and one bundle extends from one portion of the posterior septum to another (probe with black arrow). Such trabeculations become even more prominent in noncompaction of the left ventricular myocardium.

Figure 2-38: (Plate 13) Four-chamber tomographic slice through the aortic root (Ao) and aortic valve (arrows) showing the small membranous (MS) and large muscular (*) portion of the ventricular septum. The membranous septum is divided into atrioventricular (AV) and interventricular (IV) components by the septal tricuspid leaflet (white arrowhead). Black arrowhead points to the expected location of the AV (His) bundle. LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 2-39: Tomographic section of the heart along a long-axis plane of the body. The aortic root lies in this plane. The left ventricle and aortic valve are cut obliquely. The membranous ventricular septum (arrow) lies beneath the right and posterior aortic cusps. AoV, aortic valve; Asc Ao, ascending aorta; LA, left atrium; LB, left bronchus; MV, mitral valve; RPA, right pulmonary artery; TS, transverse sinus; TV, tricuspid valve; VS, muscular ventricular septum.

Figure 2-40: (Plate 14) A view of the right ventricle. Transilluminated membranous ventricular septum (arrow) in contact with the commissure between the anterior and septal leaflets of the tricuspid valve. A, anterior tricuspid leaflet; Ao, ascending aorta; APM, anterior tricuspid papillary muscle; PT, pulmonary trunk.

Figure 2-41: (Plate 15) Ratios of ventricular wall thicknesses (means ± 2 standard deviations) versus age. RV/LV, ratio of right to left ventricular wall thickness; VS/LV, ratio of ventricular septal to left ventricular free wall thickness. (From Kitzman DW, et al. Mayo Clin Proc 1988; 63:137-146. Reproduced with permission of Mayo Foundation.) Figure 2-42: Age-related changes in the left-sided cardiac structures. Normal heart from an 84-year-old man demonstrates shortening of the base-to-apex (long-axis) dimension, decreased internal left ventricular dimension, aortic root dilatation, left atrial enlargement, and sigmoid-shaped septum. (Compare with Fig. 2-15 from an 18-year-old man.) Ao, ascending aorta; LA, left atrium; VS, ventricular septum.

Figure 2-43: A. Fossa ovalis. Opened right atrium shows the thick muscular limbus of the atrial septum (arrow), in contrast to the thin valve of the fossa ovalis (transilluminated). B. Patent foramen ovale (black probe) as seen from the right atrium. There is also an aneurysm of the valve of the fossa ovalis (FO). S, septal leaflet of the tricuspid valve. Figure 2-44: Tomographic section of the heart along a long-axis of the body. The valve of the fossa ovalis (arrows) and a patent foramen ovale (arrowhead) are seen in this view. Asc Ao, ascending aorta; E, esophagus; IVC, inferior vena cava; LA, left atrium; LB, left bronchus; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; TS, transverse sinus; TV, tricuspid valve.

Figure 2-45: (Plate 16) Four-chamber slice through the heart showing lipomatous hypertrophy of the atrial septum (arrows).

Figure 2-46: Right atrial free wall showing separation of the posterior smooth-walled (*) portion from the anterior muscular portion with its pectinate muscles (PeM) and right atrial appendage (RAA) by the crista terminalis (CT). IVC, inferior vena cava; SVC, superior vena cava.

Figure 2-47: (Plate 17) Opened right atrium. Two arrow-shaped probes show that superior vena caval flow is directed toward the tricuspid orifice and inferior vena caval flow is directed toward the fossa ovalis (FO). CS, coronary sinus; IVC, inferior vena cava; RV, right ventricle; SVC, superior vena cava ; TV, tricuspid valve.

Figure 2-48: Oblique, short-axis cut at the base of the heart. The esophagus (E) is posterior and adjacent to the left atrium (LA) and adjacent to the descending thoracic aorta (DAo). The left upper pulmonary (LUPV) and left lower pulmonary vein (LLPV) are clearly seen. The right ventricular outflow tract (RVO) is anterior. AS, atrial septum; AoV, aortic valve; LA, left atrium; LAA, left atrial appendage; RA, right atrium.

Figure 2-49: (Plate 18) Left atrial appendages (LAA). A. Left atrial free wall showing appendage with four lobes (arrows). B. Biatrial specimen demonstrating left atrial appendage with two lobes (arrows). LA, left atrium; RA, right atrium; RLPV, right lower pulmonary vein; RUPV, right upper pulmonary vein.

Figure 2-50: (Plate 19) Schematic diagram of coronary artery distribution viewed at the base of the heart. In this right-dominant system, the right coronary artery (RCA) gives rise to the posterior descending artery (PDA), and the left main coronary artery (LMA) gives rise to the left anterior descending (LAD) and left circumflex (LCX) branches. A, anterior; AV, atrioventricular; L, left; P, posterior; R, right; S, septal.

Figure 2-51: Differences in angulation at the origins of the right (RCA) and left main (arrow) coronary arteries. L, left aortic cusp; P, posterior aortic cusp; R, right aortic cusp. Figure 2-52: The right coronary artery gives rise to the conus branch (CB). A rod retracts the right atrial appendage (*) to disclose the sinus node artery (SNA). Arrow points to an intermediate left coronary artery; arrowhead points to a circumflex marginal branch. L, left aortic cusp; LA, left atrium; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; P, posterior aortic cusp; PT, pulmonary trunk; R, right aortic cusp; RUPV, right upper pulmonary vein; SVC, superior vena cava. (From McAlpine,30 with permission.)

Figure 2-53: (Plate 20) Septal branches of the left anterior descending coronary artery (LAD); * points to the first septal perforator. (From McAlpine,30 with permission.) Figure 2-54: Intramyocardial course of the left anterior descending coronary artery (arrow).

Figure 2-55: (Plate 21) Schematic diagram of the coronary venous circulation. IVC, inferior vena cava; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; SVC, superior vena cava.

Figure 2-56: (Plate 22) Schematic diagram shows placement of the tip of a pacing/mapping catheter within a coronary vein (arrow) via the coronary sinus (CS). LA, left atrium; LV, left ventricle.

Figure 2-57: Short-axis views. A. Collage of anatomic sections obtained by "bread slicing" the heart in its short-axis plane, corresponding to the tomographic sections obtained by echocardiography and SPECT imaging, viewed from the apex toward the base of the heart. B. Comparable sestamibi SPECT images of the left ventricle showing normal myocardial perfusion at rest and with exercise. SA, short axis.

Figure 2-58: Schematic diagram of the three levels of short-axis tomographic views used in echocardiography for 16-segment wall motion analysis. A, anterior; AL, anterolateral; AS, anterior ventricular septum; I, inferior; IL, inferolateral; IS, inferior ventricular septum; L, lateral; LV, left ventricle; LVOT, left ventricular outflow tract; P, posterior; PL, posterolateral; PS, posterior ventricular septum; RV, right ventricle; S, septum. The most basal segment of the inferior wall is the anatomically true posterior segment. At this level, the adjacent ventricular septum is commonly referred to as either the basal posterior septum or the basal inferior septum and the adjacent lateral wall as either the basal posterolateral wall or the basal inferolateral wall.

' Figure 2-59: Regional coronary flow, with a short-axis slice of the heart. A large diagonal branch (D) of the left anterior descending coronary artery (LAD) supplies the lateral wall, and an acute marginal branch (arrowhead) of the right coronary artery (arrow) supplies the anterior right ventricular free wall. The distal segment of the LAD is intramural. RA, right atrium; RV, right ventricle. (From McAlpine,30 with permission.)

' Figure 2-60: (Plate 23) Coronary distribution using a 16-segment model. D, diagonal branch of the left anterior descending coronary artery; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; LMA, left main coronary artery; OM, obtuse marginal branch of the circumflex coronary artery; PD, posterior descending coronary artery; RCA, right coronary artery; RM, right marginal branch; other abbreviations as in Fig 2-58.

' Figure 2-61: Tortuous coronary arteries (arrow) typically seen in the elderly with nondilated hearts. Ao, ascending aorta; PT, pulmonary trunk.

' Figure 2-62: The longer left (LIV) and shorter right (RIV) innominate veins normally join to form the right superior vena cava (SVC). Ao, ascending aorta; PT, pulmonary trunk.

' Figure 2-63: Long-axis view of the superior vena cava (SVC) and inferior vena cava (IVC). The specimen is viewed from the left looking toward the free wall of the right atrium. The right atrium (RA) and its appendage (RAA) are anterior. This is a commonly used tomographic plane in transesophageal echocardiography. AS, atrial septum; LA, left atrium; LB, left bronchus; RPA, right pulmonary artery.

' Figure 2-64: (Plate 24) Schematic diagrams showing the ligament/vein of Marshall in normal hearts (left) and persistent left superior vena cava (LSVC) (right). CS, coronary sinus; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; RA, right atrium; RSVC, right superior vena cava.

' Figure 2-65: Thoracic aorta. The entire thoracic aorta has been cut in a tomographic manner. The aortic arch travels over the left bronchus and the right pulmonary artery. Asc Ao, ascending aorta; AoV, aortic valve; CS, coronary sinus; Desc Ao, descending thoracic aorta; E, esophagus; IA, innominate artery; IV, innominate vein; LA, left atrium; LB, left bronchus; LCCA, left common carotid artery; LS, left subclavian artery; LV, left ventricle; MV, mitral valve; RPA, right pulmonary artery; RVO, right ventricular outflow; TS, transverse sinus; VS, ventricular septum.

' Figure 2-66: Tomographic section of the heart in the frontal plane of the body showing the aortic sinotubular junction (dashed line). Ao, ascending aorta; AoV, aortic valve; LCCA, left common carotid artery; LV, left ventricle; PT, pulmonary trunk; RA, right atrium; RV, right ventricle; LV, left ventricle; VS, ventricular septum.

' Figure 2-67: (Plate 25) Schematic diagram of the cardiac conduction system. (Left) The right side of the heart showing the sinus node, atrioventricular (AV) node, AV (His) bundle, and right bundle branch. (Right) The left side of the heart showing incomplete anatomic separation of the left bundle into antero and posterior fascicles. Ao, ascending aorta; AV, atrioventricular; CS, coronary sinus; CT, crista terminalis; FO, fossa ovalis; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; PT, pulmonary trunk; PV, pulmonary valve; RA, right atrium; RV, right ventricle; SVC, superior vena cava.

' Figure 2-68: (Plate 26) The atrioventricular node (AVN) lies within the triangle of Koch (dashed triangle), and the AV (His) bundle (AVB) travels through the tricuspid annulus to rest along the summit of the ventricular septum. CS, coronary sinus; FO, fossa ovalis; IVC, inferior vena cava; S, septal leaflet of the tricuspid valve; SVC, superior vena cava.

s Figure 2-69: Real-time three-dimensional CT reconstruction of the thoracic aorta in a patient with coarctation (arrow) distal to the left subclavian artery. AoV, aortic valve. Desc, descending thoracic aorta.

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