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CT Cardiac Anatomy

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CT cardiac anatomy

M.Todorova
Tokuda Hospital Sofia

1

MDCT vs US

2

Position of the heart

•
Position in the

thoracic cavity

••
Cardiac apex Cardiac base

3

Systematic approach Cardiac CT

••••••
•••••
Right atrium Right ventricle PA
Aorta Coronaries Cardiac Veins

  • Valves
  • PV

Left atrium Left ventricle
Pericardium

4

Right atrium

5

Right atrium

RA appendage

Pectinate muscles >2mm 20 sc.cm normal size on 4

ch.view
Crista terminalis Sulcus terminalis Coronary sinus Thebesian valve Eustachian valve Internal septum

6

Tricuspid valve

•
Tricuspid valve-

separates RA from RV

•
Trileflet valve-

anterior,posterior,

septal
•
Structure-

leflet,annulus,commi ssures

7

Right ventricle

8

RV-anatomy

inflow tract
4 chamber view outflow tract

9

Volumetric parameters of RV

•
Normal quantitative RV

Values

••
EF = 61+/-6 End diastolic volume = 173+/-39

•
End systolic volume =

69+/-22

••
Strike volume = 104+/=21 Mass = 35-45

10

RV-anatomic structure

••••
Tricuspid valve RV wall Pulmonary valve Intrventricular septum

•

••
Anterior longitudinal sulcus

Posterior longitudinal sulcus

Moderator band

11

•
Interventricular

septum

–––
Separates ventricles Thin wall Convexity toward the right ventricle

–

–
Muscular ventricular septum

Membrannous ventricular septum

•
Anterior and posterior

longitudinal sulcus

––––
Ventricles separeted externally by grooves

Anterior longitudinal sulcus

Posterior longitudinal sulcus

Moderator band

12

Pulmonary valve

••
Three leaflet Semilunar morphology

13

PA anatomy

14

Left atrium and pulmonary veins

15

•
Pulmonry veins

–
Two inferior and two superior into either

side of LA

16

LA - anatomy

••
LA LA appendage

–––
Arises from the superiorlateral aspect of the LA

Projects anteriorly over the proximal LCX artery

Pectinate muscles >1mm

17

Mitral valve

••••represent inflow tract of LV bicuspid fibrous ring mitral valve-annulus triangular leaflets

18

Left ventricle

19

LV - anatomy

••••
Inflow tract Outflow tract Chordae tendinae Papillary muscles

20

LV wall

Normal
Anterior MI

Ferencik et al. Am J Cardiol 2004;93:949951

LV papillary muscles

diastolic systolic

21

AHA Scientific Statement
Standard Myocardial Segmentation

17 segment model

22

Cerqueira et al. Circulation 2002;105:539542

••••••
Normal quantitative LV Values EF = 69+/-6

GLOBAL AND REGIONAL
LV FUNCTION

End diastolic volume = 150+/-31 End systolic volume = 47+/-15 Strike volume = 104+/=21 Mass = 96-123

END SYSTOLE
END DIASTOLE

23

Cury RC et al, RSNA 2006

Aortic Valve

••
Three semilunar leaflet Aortic sinuses of Valsalva

••
Outflow tract of LV Annulus,cusps and commissures

24

Sinus of Valsalva

•••
Left coronarius sinus of Valsalva

Right coronarius sinus of Valsalva

Posterior sinus of Valsalva

25

CORONARY ARTERIES

AHA Coronary Coronary Segments Segments Classification

1.RCA prox 2. RCA mid 3. RCA dist 4. RCA PDA 16. RCA PLV

5. LM
6. LAD prox 7. LAD mid 8. LAD dist 9. LAD D1 10. LAD D2 11. LCX prox 12. LCX OM1 13. LCX mid 14. LCX OM2 15. LCX distal

26

17. RI

Coronary arteries

••
Normal diameter – 3-4mm Arterial wall

•

Coronary arteries-dominance

The CA that gives rise to the PDA and posterolateral branch is referred as the dominant artery

••

Aneurysm – focal abnormal

dilatation of an adjacent normal CA

Ectasia – diffuse process

27

Main Left Coronary Artery

••••
Arises from left sinus of Valsalva Courses antrolaterally in the epicardial fat Bi/trifurcates Supplies the LV

28

LCA – segmental anatomy

••
LCA – main branch to the level of bi/trifurcation LAD

–––
Proximal – to the first septal branch Middle – to the level of obtuse angle (second septal perforator) Distal – to the apex of the heart

•
LCX

–
Proximal – to the first obtuse marginal branch

29

–
Distal

Left coronary artery

••
LAD

–
Courses antrolaterally in the epicardial fat

of the ant. interventricular groove

––
Diagonal (supplies LV free wall) Septal perforating arteries (supplies interventricular septum and the AV bundle)

CX

–
Courses in the left AV groove

Marginal branches
––
Supplies the LV free wall and

anterolateral papillary muscle

30

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