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Human Anatomy Thorax Reference Editor Dr Meng Yu Wu Associate Professor Department of Cardiac Surgery Chang Gung Memorial Hospital and Chang Gung University

Hi Kate Kate Kate Cardiac Surgery Operative and Evolving techniques Kate Amazon Human Gross Anatomy Wilcox s Surgical Anatomy of the Heart

1 How and Why 2

Kate

Fig1 Sternum Thoracic spine 1 thoracic inlet diaphragm Fig2 thoracic inlet thoracic outlet bony structure

Fig 1 Roof First rib and clavicles Anterior Sternum Lateral aspect ribs Floor Diaphragm Posterior aspect T Spine Fig 2

1 Fig3 4 Fig 4 Innominate or brachiocephalic artery 1 Brachiocephalic vein

Fig 3 Fig 4 Structures in Pulmonary cavities Lungs airway pleurae L t Lung RA Ao R t Lung Structures in Mediastinum Heart great vessels trachea esophagus thymus RV

Ascending aorta Pulmonary artery Right atrium Right ventricle Right coronary artery Right internal thoracic artery Right phrenic nerve 345 Fig 7

2 Fig 5 manubriosternal joint superior inferior anterior middle posterior Table 1

Fig 5 Sternal angle divides mediastinum to the superior and inferior part j Mediastinum k l

Table 1 Mediastinum Contents Superior Thymus great vessels trachea esophagus phrenic nerve and vagus nerves and lymphatics Inferior Anterior Internal thoracic vessels Middle Heart Posterior Descending thoracic aorta Azygos veins esophagus lymphatics thoracic duct thoracic sympathetic trunk and thoracic splanchnic nerves

Fig 4 Fig 4 Fig 6 Fig 6 Fig 6

Superior Mediastinum Fig 4 Fig 7 Fig 6

Fig 8 Fig 9 Fig 9 Fig 8 hiatus

Posterior Mediastinum Fig 8 Fig 9

Fig 10 Fig 11 bony structure

Anterior Mediastinum Internal thoracic arteries Fig 10 Fig 11

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Fig 12 Fig 14 15 16

Fig 16 17 Fig 16 Kate I Fig 17

Median sternotomy for cardiac surgeries Fig 12 Median sternotomy From suprasternal notch to xiphoid DB Doty Cardiac Surgery Operative and Evolving techniques

Thoracotomy for lung esophagus aortic surgeries Fig 13 Fig 14 Fig 15

Fig 17 Fig 16 Aorta Right Atrium Ascending aorta Pulmonary artery Right atrium Right ventricle Pericardium Phrenic nerve DB Doty Cardiac Surgery Operative and Evolving techniques

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Fig 18

Cardiopulmonary bypass setup Fig 18 Video 1 Venous drainage Arterial flow

Cardiopulmonary system Heart Pumping blood Aorta Fig 19 Pulmonary artery Lung Blood gas exchange SVC Pulmonary veins SAN LA RA AVN Tricuspid valve IVC Pulmonary valve RV RV LV His bundle Mitral valve Aortic valve

Fig 19 SVC IVC RA tricuspid valve RV pulmonary valve PA Lung PVs LA mitral valve LV aortic valve Aorta Sinoatrial node SAN atrioventricular node AVN His bundle and its branches

Fig23 Fig24 Fig25 Fig20 Fig21 4 2 Fig 22 Transverse sinus Oblique sinus 4

Fig 20 Fig 22 Fig 21

Fig23 RA right atrium SVC superior vena cava Ao ascending aorta RCA right coronary artery PA pulmonary artery RV right ventricle LAD left anterior descending artery anterior interventricular artery LCA left coronary artery 2 LV left ventricle LA left atrium

Middle Mediastinum Heart Anterior Fig 23 SVC LA Ao PA LCA RA RCA LAD RV LV

Fig24 LA left atrium PV pulmonary vein RA right atrium SVC superior vena cava SAN Sinoatrial node RA SVC Ao ascending aorta aortic sinus left coronary cusp right coronary cusp Non coronary cusp 3

Heart Superior View Fig 24 RV PV NCC R A LA SAN SVC RA

Fig25 IVC inferior vena cava CS coronary sinus left circumflex Posterior descending artery posterior interventricular artery middle cardiac vein LAD left anterior descending artery great cardiac vein

Heart bottom Fig 25 PV IVC LA RA CS RV LV

Fig26 27 28 4 Fig 26 28 Fig 26 Fig 31 Fig 26 Fig 28 central fibrous body

Cardiac Skeleton superior atriums removed Fig 26 LCC RCC Left circumflex artery Right fibrous trigone central fibrous body

Fig 28 Fig 27 LAD LV LCX PA RV P A Anterior LAD RCA Ao LCA RA TV TV RCA MV PV s LA Ao By Dr Wumengyu LCX Posterior Right fibrous trigone central fibrous body Left fibrous trigone

Fig25 Fig27 28 19 Fig29 31 Fig27 28 Fig29 Fig 30 Fig29 Fig 31

Sagittal Section of the Heart Correlations of chambers septum and valves Fig 29 Fig 31 Fig 30 A B IAS MV TV C IVS MV TV MV LVOT IVS AV RA RV LA LV Ao TV tricuspid valve MV Mitral valve AV Aortic Valve IAS Interatrial septum IVS Interventricular septum LVOT Left ventricular outflow tract

Aortic root Semilunar valve Coronary artery opening Aorta RCA opening NCC Membranous part of interventriclar septum Left bundle branch LCA opening Anterior mitral leaflet Fig 32 Non coronary cusp is in continuity with anterior mitral leaflet LCC NCC RCC Fig 33

Fig 32 33 His bundle

Right Atrium SVC Fig 34 S A P O CS

Fig 34 Right atrium RA Fig34 RA sinus venosus primitive atrium Septum Secundum Septum Primum

Triangle of Koch and AV node Fig 36 Fig 35 Atrioventricular Node Tricuspid valve ASDII By Dr Wumengyu

Fig 35 36 Sinoatrial node SAN RA RA Fig 24 Atrioventricular AVN RA Triangle of Koch Triangle of Koch Tendon of Todaro Tendon of Todaro central fibrous body

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Atrial septal defect ASD Fig 37 Ostium secundum ASD Sinus venosus ASD Coronary sinus ASD By Dr Wumengyu Ostium primum ASD

ASD Fig34 Atrial septal defect ASD ASD sinus venous ASD ASD coronary sinus type ASD ASD Ostium secundum ASD patent foramen ovale PFO ASD Ostium primum ASD

Fig 29 30 31 Left main coronary artery 1 2 Left anterior descending artery LAD anterior interventricular artery anterior interventricular groove Septal branches Diagonal branches

Fig 38 Fig 40 Fig 39 Coronary Artery

Left circumflex artery LCX Fig26 LCX obtuse marginal branches Right coronary artery RCA Fig26 RCA Acute marginal branch posterior descending artery PDA inferior interventricular artery inferior interventricular groove

50 SA nodal artery 90 PDA and AV Nodal artery RCA 10 PDA and AV Nodal artery LCX PDA RCA right side dominant circulation 90 PDA LCX left side dominant circulation 10 Fig 32 33 Intermediate branch ramus intermedius 3 LAD LCX intermediate branch ramus intermedius 1st diagonal branch

Fig 42 Fig 41 LMCA LMCA LAD LAD 1st Diagonal branch LCX intermediate branch LCX

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Internal thoracic arteries for coronary artery bypass grafting CABG Fig 43 Stenotic lesion By Dr Wumengyu

CABG CABG CABG Fig 43 graft great saphenous vein GSV GSV

LITA LITA Fig 10 RITA LITA Y

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