CT Cardiac Anatomy

CT cardiac anatomy M.Todorova Tokuda Hospital Sofia 1MDCT vs US 2Position of the heart • Position in the thoracic cavity •• Cardiac apex Cardiac base 3Systematic approach Cardiac CT •••••• ••••• Right atrium Right ventricle PA Aorta Coronaries Cardiac Veins <ul style="display: flex;"><li style="flex:1">Valves </li><li style="flex:1">PV </li></ul>Left atrium Left ventricle Pericardium 4Right atrium 5Right 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 6Tricuspid valve • Tricuspid valve- separates RA from RV • Trileflet valve- anterior,posterior, septal • Structure- leflet,annulus,commi ssures 7Right ventricle 8RV-anatomy inflow tract 4 chamber view outflow tract 9Volumetric 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

CT Cardiac Anatomy

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