Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
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Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
Lesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2ted if the heart is thought of as having three distinct septal structures: the atrial septum, the atrioventricular septum, and the ventricular septum (Figure 7.1). ’ITte normal atrial septum is relatively small. It is made up. for the most part, by the flEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
considered to represent a secondary septum, or septum secundum, the larger parts of the rims, specifically the superior, anterosuperior, and posterioLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2ular septum (Figure 7.2). This part of the rim is contiguous with the atrioventricular septum, which is the superior component of the fibrous membranous septum. In the normal heart, this fibrous septum is also contiguous with the atrial wall of thetriangle of Koch (Figure 7.3). In the past, we consi Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2dered this component of the atrial wall, which overlaps the upper pari of the ventricular musculature between the attachments of the leaflets of the tEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
ricuspid and mitral valves, as the muscular atrioventricular septum. As we discussed in ( Tiaptcr 2, we now know that it is better viewed as a sandwicLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2ers of atria) and ventricular myocardium (Figure 7.4). From the stance of understanding septal defects, nonetheless, it is helpful to consider the entire area comprising the fibrous septum and the muscular sandwich as an atrioventricular separating structure, xs it is absent in the hearts we describ Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2e as having atrioventricular septa) defects.‘Hie ventricular septum is usually seen by the surgeon only from its right ventricular aspect For this andEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
other reasons we will discuss, holes between the V entriclcs are best considered in terms of their right ventricular landmarks. Taken overall, the veLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2t. The muscular pan, w hich is significantly curved, is more complex geometrically than the other septal structures, which lie almost completely in the corona) plane. At first sight, it seems posable to divide the muscular septum into inlet, apical trabecular, and outlet components, each of these pa Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2rts seemingly corresponding with the components of the right ventricle, and abutting centrally on the membranous septum (Figure 7.5). Closer inspectioEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
n shows that such analysis is simplistic. By virtue of the deeply wedged location of the subaortic outflow tract, much of the septum delimited on the Lesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2.6). The muscular wall forming the back of the subpulmonarv inf undibulum is, at first sight, an outlet septum Only a small part of this wall, however, interposes between the cav itics of the right and left ventricles Illis is because most of the subpulmonary infundibulum is a freestanding muscular Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2sleeve, which forms partFig. 7.1 The four-chamber section through the tieart, in anatomical orientation, shows the atrial and ventricular septal compoEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
nents, along with the location of the muscular structures that separate the cavities of the right atrium and left ventricle. We had previously consideLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2ayers of atrial and ventricular musculature (see Figure 7.3). It is this area that is deficient in the setting of a common atrioventricular junction. Note also that the superior rim of the oval fossa (arrow) is an infolding between the right and left atrial walk.152Wilcox's Surgical Anatomy of thp H Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2eartFig. 7.2 The heart has been sectioned in the four-chamber plane, showing that the superior rim of the oval fossa IS a deep infolding (arrow) betweEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
en the origin of the supenor caval vein from the right atrium (red star), and the entry of the right superior pulmonary vein into the left atrium (whiLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2he surgical view, through a right atriotomy. shows the landmarks of the triangle of Koch (triangle). This area is the atrial aspect of the muscular atrioventricular sandwich Note that this patient also has a defect within the oval fossa.of the supraventricular crest (Figure 7.7). The small septa! co Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2mponent interposing between the ventricular outlets is inextricably linked with the more extensive component of the crest, theventriculiHnfundihular fEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
old, or inner heart curvature (Figure 7.8). It is the muscular wall separating the apical trabecular components, therefore, which forms the greater paLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2ht ventricle and the conical left ventricle. Reinforcing the right ventricular aspect ofNormal segmental connectionsFig. 7.4 This four-chamber section of a normal heart, taken across the floor of the triangle of Koch, illustrates the differential attachments of the atrioventricular valves (arrows). Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2Note the adipose tissue interposed between the right atrial wall and the crest of the ventricular septum, which forms the ‘meat’ in the atrioventriculEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
ar muscular sandwich.Fig. 7.5 The dissection, seen in anatomical orientation, shows how the ventricular septum ran be separated from the remainder of Lesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2 right ventricle. Apart from the apical part, however, these parts of the right ventricle do not correlate with comparable components on the left Side of the heart.this pari of the septum is the septomarginal trabccubtion, or septal band. This muscular strap has a body and limbs, the toner extending Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2 to the base of the heart to chip thesupraventricular crest. A scries of septoparictal trabcculations extend from its anterocephalad surface and reachEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
the parietal ventricular wall. One of these, themoderator band, is particularly prominent.It crosses from the septomarginal trabccutotion to join theLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2ardiographic cut, shows how the inferoposterior part of the muscular septum separates the right ventricular inlet from the left ventricular outlet (double-headed arrow).Fig. 7.7 The dissection of the ventricular outflow tracts, in anatomical orientation, shows the free-standing sleeve of infundibulu Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2m that supports the leaflets of the pulmonary valve. This is not a septal structure Note the extensive tissue plane that separates the infundibular slEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
eeve from the aortic root (arrow).Normal segmental connections—(1»yFig. 7.8 The dissection, seen m anatomical orientation, shows how most of the supraLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2beculation (star), can be removed so as to provide a communication with the left ventricle. The area has no obvious anatomical boundaries. Note that the drslal part of the crest becomes continuous with the free-standing muscular infundibular sleeve.Fig. 7.9 The septal surface of the right ventricle Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2has been displayed by making a window in the anterior wall to show the septomarginal trabeculation, or septal band (black Y). The supraventricular creEbook Wilcox’s surgical anatomy of the heart (4th edition): Part 2
st inserts between its basal limbs The moderator band takes origin from the apical part of its body, crossing the cavity of the ventricle to become coLesions with normal segmental connectionsNormal tegmental connections-->SEPTAL DEFECTSUnderstanding the anatomy of septal defects is greatly facilitat Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2e major septomarginal trabeculation.Interatrial communicationsThere arc several lesions that permit interatrial shunting (Figure 7.10).Although collectively termed atrial septal defects, not all are w ithin the confines of Ebook Wilcox’s surgical anatomy of the heart (4th edition): Part 2Gọi ngay
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