Revisiting Cardiac Anatomy E-Book

Farhood Saremi

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 571

Veröffentlichungsjahr: 2011

Beschreibung

This new atlas represents a fresh fresh approach to cardiac anatomy, providing images of unparalleled quality, along with explanatory text, to show in vivo heart anatomy and explain the clinically relevant underlying anatomic concepts. In spite of amazing proliferation of information on the Internet and multiple websites filled with up-to-date information, there is no similarly detailed and systematic compilation of morphological imaging with CT. Organized for both systematic learning and to serve as a quick, yet detailed reference for specific clinical questions, this book is an invaluable resource for medical students and residents, cardiologists, and especially surgeons, interventionalists and electrophysiologists, who depend on ever more detailed imaging support in order to successfully perform increasingly complex coronary and noncoronary structural interventions and other procedures.

Leseprobe

Contents

List of Contributors

Preface

1 Anatomy of the Heart for a Dissector

Farhood Saremi & Damián Sánchez-Quintana

Introduction

Heart Orientation within the Thorax

The Right Atrium

The Left Atrium

Components of the Interatrial Septum

Septal Components of the AV Junction

The Right Ventricle

The Left Ventricle

The Pericardium

References

2 Anatomical and Pathophysiological Classification of Congenital Heart Disease

Carla Frescura, Emanuela Valsangiacomo Büchel, Siew Yen Ho & Gaetano Thiene

Introduction

Sequential Chamber Localization

Atrioventricular Connections

Ventriculoarterial Connections

Pathophysiological Classification of Congenital Heart Disease

CHD with Increased Pulmonary Blood Flow

CHD with Decreased Pulmonary Blood Flow

CHD with Obstruction to Blood Progression and No Septal Defect (No Shunt)

CHD Incompatible with Postnatal Blood Circulation

CHD Silent Until Adult Age

References

3 CT in Pediatric Heart Disease

Hyun Woo Goo

Introduction

Cardiac Segments

Connections of Cardiac Segments

Relationships of the Great Arteries

Septum of the Heart

Coronary Arteries

Typical Congenital Cardiac Defects

References

4 Mitral and Aortic Valves Anatomy for Surgeons and Interventionalists

Horia Muresian

The Position of the Valves

The Collective Description of the Mitral and Aortic Valves

The Mitral Valvar Complex

The Mitral Valve Leaflets

The Left Atrioventricular Orifice: The Mitral “Annulus”

The Mitral Subvalvar Apparatus: Cords and Papillary Muscles

Particular Elements of the Mitral Valve: Commissures and Mitral-aortic Curtain

The Normal Asymmetry of the Mitral Valve

The Vascularization of the Mitral Valve

The Aortic Root

The Vascularization of the Aortic Root

The Normal Functioning of the Mitral and Aortic Valves

References

5 Clinical Applications of CT Imaging of the Aortic and Mitral Valves

Hatem Alkadhi, Lotus Desbiolles & Sebastian Leschka

Introduction

CT Study of the Aortic Valve

CT Anatomy of the Bicuspid Aortic Valve

CT Anatomy of the Mitral Valve

References

6 Computed Tomography for Percutaneous Aortic Valve Replacement

Hursh Naik, Niraj Doctor, Gregory P. Fontana & Raj R. Makkar

Introduction

Iliac and femoral Assessment

Aortic Assessment

Ventricular Wall Thickness, Sinotubular Junction, Aortic Valve, and Aortic Annulus

References

7 Mitral Valve Disease Imaging

Javier G. Castillo, David H. Adams & Mario J. Garcia

Introduction

Normal Anatomy

Miral Valve Regurgitation

Mitral Valve Stenosis

References

8 The Aortic Root

Fabiana Isabella Gambarin, Massimo Massetti, Roberto Dore, Eric Saloux, Valentina Favalli & Eloisa Arbustini

Definition of the Aortic Root

Anatomy

Functional Anatomy

Pathophysiology of Aortic Root Dysfunction

Contribution of the Different Imaging Tools for the Evaluation of the Aortic Root

Surgical Implications

Conclusions

References

9 Coronary Anatomy for Interventionalists

Stephan Achenbach

Introduction

Normal Coronary Anatomy

Coronary Dominance

Coronary Artery Segments

Origin of the Coronary Arteries from the Aortic Root

Details of Coronary Anatomy

Myocardial Bridging

Anomalous Coronary Arteries

Coronary Atherosclerosis

Coronary Artery Bypass Grafts

Coronary Veins

References

10 Coronary Anatomy for Surgeons

Farhood Saremi, Amir Abolhoda & Gustavo Abuin

Introduction

Normal Coronary Arteries

Anatomic Variants of the Coronary Arteries

CT Imaging of Coronary Bypass Grafts

References

11 Anatomy for Electrophysiologic Interventions

Farhood Saremi &Damián Sánchez-Quintana

Introduction

Catheter-Based Ablations

Tachycardias and Anatomic Considerations for Treatment

Cardiac Conduction System

Anatomic Landmarks of the Right Atrium

Interatrial Septum

Anatomic Landmarks of the LA

Important Related Structures of the LA

Excess Fat Around the RA and within the IAG

Imaging of Bachmann Bundle

Anomalous Pulmonary and Systemic Connections

Cardiac Venous System

References

12 Coronary Atherosclerosis: CT Imaging for the Preventive Cardiologist

Stephan Achenbach & Jagat Narula

Histopathology of Acute Coronary Syndromes

CT Imaging of Plaque

Summary

References

13 Nomograms for Coronary Computed Tomographic Angiography

Leslee J. Shaw, James K. Min & Daniel S. Berman

Normative Values for CT Measurements

Diagnosis of Obstructive CAD

Prognostic Accuracy of CCTA

Cost-Efficient Testing Algorithms Using CCTA

Future of CCTA

Conclusions

References

Appendix

Body planes: axial, coronal, sagital

Index

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Library of Congress Cataloging-in-Publication DataRevisiting cardiac anatomy: a computed-tomography-based reference and atlas/edited by Farhood Saremi … [et al.].p.; cm.Includes bibliographical references.ISBN 978-1-4051-9469-3 (hardback)1. Heart–Anatomy–Atlases 2. Heart–Tomography–Atlases I. Saremi, Farhood.[DNLM: 1. Heart–anatomy & histology. 2. Tomography, X-Ray Computed. WG 201 R454 2011]QM181.R48 2011611’.12–dc222010023428

List of Contributors

Amir Abolhoda, MDAssociate Professor of SurgeryDivision of Cardiothoracic SurgeryDepartment of SurgeryUniversity of CaliforniaIrvine, CA, USA

Gustavo Abuin, MDChief, Cardiovascular SurgeryInstituto Cardiovascular Rawson;Director of the Cardioanatomy Research LaboratoryInstituto de NeurobiologíaBuenos Aires, Argentina

David H. Adams, MDProfessor and ChairmanDepartment of Cardiothoracic SurgeryThe Mount Sinai School of MedicineLos Angeles, CA, USA

Hatem Alkadhi, MDAssociate ProfessorInstitute of Diagnostic RadiologyUniversity Hospital ZurichZurich, Switzerland

Daniel S. Berman, MDProfessor of MedicineDirector, Cardiac ImagingCedars-Sinai Medical CenterLos Angeles, CA, USA

Emanuela V. Büchel, MDDivision of Pediatric CardiologyUniversity Children’s HospitalZurich, Switzerland

Javier G. Castillo, MDResearch FellowDepartment of Cardiothoracic SurgeryThe Mount Sinai School of MedicineLos Angeles, CA, USA

Lotus Desbiolles, MDInstitute of Diagnostic RadiologyUniversity Hospital ZurichZurich, Switzerland

Niraj Doctor, MBBSResearch FellowCedars-Sinai Medical CenterLos Angeles, CA, USARoberto Dore, MDChief, Chest Radiology Section Radiology DepartmentIRCCS Foundation Policlinico San MatteoPavia, Italy

Valentina Favalli, BMEResearch FellowTelethon Centre for Inherited Cardiovascular DiseasesIRCCS Foundation, Policlinico San MatteoPavia, Italy

Gregory P. Fontana, MDVice Chairman of SurgeryAttending Cardiac SurgeonCedars-Sinai Medical CenterLos Angeles, CA, USA

Carla Frescura, MDDepartment of Medico-Diagnostic SciencesUniversity of Padua Medical SchoolPadua, Italy

Mario J. Garcia, MDProfessor and Director of Noninvasive CardiologyThe Zena and Michael A. Wiener Cardiovascular InstituteThe Mount Sinai School of MedicineLos Angeles, CA, USA

Fabiana Isabella Gambarin, MDCardiologist, Echo-Lab Centre for Inherited Cardiovascular DiseasesIRCCS Foundation Policlinico San MatteoPavia, Italy

Siew Yen Ho, PhDRoyal Brompton Hospital and Imperial College LondonLondon, UK

Sebastian Leschka, MDInstitute of Diagnostic RadiologyUniversity Hospital ZurichZurich, Switzerland

Raj R. Makkar, MDDirector, Interventional Cardiology and Cardiac Catheterization LaboratoryCedars-Sinai Medical Center;Associate ProfessorUCLA School of MedicineLos Angeles, CA, USA

Massimo Massetti, MDProfessor of Thoracic and Cardiovascular SurgeryChief, Division of Cardiac SurgeryUniversity Hospital of CaenCaen, France

James K. Min, MDAssistant Professor of MedicineThe Department of Medicine and RadiologyWeill Medical College of Cornell UniversityThe New York Presbyterian HospitalNew York, NY, USA

Horia Muresian, MD, PhDSan Donato MilanItalyandThe University Hospital of BucharestBucharest, Romania

Hursh Naik, MDInterventional CardiologistCardiovascular Intervention CenterCedars-Sinai Medical CenterLos Angeles, CA, USA

Eric Saloux, MDChief, Echo-Lab Division of CardiologyUniversity Hospital of CaenCaen, France

Damián Sánchez-Quintana, MDProfessor of Anatomy and Human EmbryologyDepartment of Anatomy and Cell BiologySchool of Medicine of BadajozUniversity of ExtremaduraBadajoz, Spain

Leslee J. Shaw, PhDProfessor of MedicineEmory University School of MedicineAtlanta, GA, USA

Gaetano Thiene, MD, FRCPProfessorDepartment of Medical-Diagnostic Sciences andSpecial TherapiesUniversity of Padua Medical SchoolPadua, Italy

Hyun Woo Goo, MDAssociate ProfessorDepartment of RadiologyAsan Medical CenterUniversity of UlsanSeoul, Korea

Preface

The past two decades have witnessed a revolution not only in management but also in the diagnostic approach to cardiovascular disease. Modern imaging tools provide invasive and noninvasive strategies that allow increasingly accurate characterization of morphology and function of the heart. Nuclear medicine, echocardiography (including transesophageal, intravascular, and intracardiac imaging) as well as cardiac magnetic resonance have all immensely contributed to the ability to provide accurate diagnostic and prognostic information. At the same time, modern surgical and interventional treatment requires accurate anatomic information and guidance. The success of increasingly complex coronary and noncoronary structural interventions as well as electrophysiological procedures depends on ever more detailed imaging support. The interface between imaging, diagnosis, and treatment is of tremendous importance and at the same time needs to face increasingly challenging requirements.

In addition to the more established techniques, highresolution multidetector CT imaging of the heart and cardiovascular system has recently entered the stage. Modern hardware allows truly isotropic imaging with high temporal resolution and a spatial resolution of 0.5 mm or better. Two-dimensional and three-dimensional reconstructions allow to perform “virtual dissection” of complex cardiac anatomy with phenomenal image quality. In fact, in vivo imaging will often provide a more realistic depiction of true anatomic relationships than postmortem analysis.

However, while modern imaging provides new possibilities, it also creates new needs and challenges. To fully realize the potential inherent to the large, detailed datasets, a new type of “imager,” needs to fulfill many roles—from teaching medical students and residents to helping the cardiologist better define and the interventionalist or surgeon better correct cardiovascular defects by fully understanding the underlying anatomy.

Hence, as we embarked on this atlas, we set ambitious goals for our project. We resolved to provide a valuable resource and useful companion to a broad spectrum of readership, from medical students starting their career in a dissection hall to cardiologists and cardiothoracic surgeons who rely on ever more accurate imaging for diagnosis and treatment. This atlas is a fresh approach to cardiac anatomy that provides high-quality in vivo anatomy through carefully rendered images with explanatory texts of the clinically relevant underlying anatomic concepts. In spite of amazing proliferation of information on the Internet and multiple Web sites filled with up-to-date information, there is no similarly detailed and systematic compilation of morphological imaging with CT to demonstrate normal in vivo anatomy of the heart and its variants. For good understanding of health and disease, a good anatomy book is irreplaceable and will allow both for systematic learning and as a quick, yet detailed reference for specific clinical questions.

The fantastic imaging quality that can be achieved with state-of-the-art CT imaging hardware and protocols in the hands of experts has deeply impressed and convinced us. We are confident that it will also convince our readership: imaging is a virtual reality.

1

Anatomy of the Heart for a Dissector

Farhood Saremi1 & Damián Sánchez-Quintana2

1University of California Irvine, CA, USA

2University of Extremadura, Badajoz, Spain

Introduction

This chapter provides a general description of the heart anatomy and offers an outline of the relevant clinical information. Images are produced using state of the art multidetector scanner on living subjects and by meticulous dissection techniques on cadaveric specimens. Detailed discussions on specific anatomic locations are presented in the subsequent chapters.

Heart Orientation within the Thorax

Generally, cross-sectional imaging study of the heart requires reconstruction of two groups of imaging planes including body and heart planes. Standard body planes include three orthogonal cuts in axial (transverse), coronal, and sagittal orientations. Heart planes also include three orthogonal planes in relation to the heart axes [1, 2]. Short-axis images, which correspond to the plane of the atrioventricular (AV) groove, are oblique and are oriented closer to the vertical than to the horizontal plane. Horizontal long-axis (four-chamber) views are double oblique planes perpendicular to both the interventricular septum and the AV plane of the heart. Vertical long-axis (two-chamber) views of the heart are parallel to the interventricular septum (Figure 1.1).

Everyone must be familiar with radiographic borders of the heart in different projections (Figure 1.2). On anterior projection, the right cardiac border is formed by the right atrium (RA), while the left cardiac border is formed by the left ventricle (LV). The right ventricle (RV) and the left atrium (LA) are superimposed structures and are not border-forming, and additional projections are required to review them. Diaphragmatic surface is formed by the RV. On the lateral projection, the anterior cardiac border is the RV, while the posterior cardiac border is composed of both the LV and the LA.

Anteriorly, the heart is covered by the sternum and the costal cartilages. The heart has an extensive diaphragmatic surface inferiorly (Figure 1.3). Posteriorly, the heart lies on the esophagus and the tracheal bifurcation, and bronchi that extend into the lung. The sternum lies anteriorly and provides rigid protection to the heart during blunt trauma.

The true posterior surface of the heart is commonly termed the base of the heart, which is formed largely by the LA. The term “base of the heart” is not frequently used and is restricted to the “origin of the great vessels.” The inferior surface of the heart is also closely related to the diaphragm and should not be entirely called posterior. In supine position, along with elevation of the diaphragm, the lower surface of the heart largely faces inferiorly; however, in upright position, with full inspiration, the heart stands vertically and these walls face posteroinferiorly [1]. Because of the obliquity of the surfaces of the ventricles, the diaphragmatic surface of the RV is truly inferior and the diaphragmatic wall of the LV faces posteroinferiorly (Figures 1.3–1.5).

The heart is a three-sided pyramid located in the middle mediastinum. When viewed from its apex, the three sides of the ventricular mass are readily seen (Figure 1.5). Two of the edges are named. The acute margin lies inferiorly and describes a sharp angle between the sternocostal and diaphragmatic surfaces. The obtuse margin lies superiorly and is much more diffuse. The posterior margin is unnamed but is also diffuse in its transition.

The Right Atrium

The RA is the chamber of the heart that receives systemic venous blood return from the superior vena cava (SVC) and inferior vena cava (IVC) and coronary venous return from the coronary sinus. Looking at three-dimensional images of the heart from the top, RA is positioned to the right and anteriorly, while the LA is situated to the left and mainly posteriorly [3] ()