00:01
Now, let's start looking at some
of the internal structures.
00:04
There's a lot more to see
internally than externally.
00:07
So we'll go one side at a time,
and we'll focus just on
the right heart to begin with.
00:13
So here we have a nice view
of the right atrium,
and there's another sulcus here
that we haven't mentioned yet.
00:21
And that sulcus is called
the sulcus terminalis cordis.
00:25
We throw in the word
cordis referring to heart
because there's another
sulcus terminalis
that you'll learn about
in the tongue.
00:31
But this is an important landmark
for something happening internally.
00:37
So if we were to cut that wall
of the right atrium
open and reflect it,
we can see the
sulcus terminalis cordis
corresponds with a ridge
called the Crista terminalis
on the inside of the atrium.
00:53
And this is an important border,
because on one side of this
Crista terminalis,
we have all of these somewhat
parallel aligned muscles
on the surface of the heart
called pectinate muscles.
01:07
Pectin means comb,
and they're nice and parallel,
like the little teeth of a comb.
01:11
And it's these pectinate muscles,
from an interior point of view
that tell you you're
in the atrial appendage
as opposed to the rest
of the right atrium.
01:22
And the fact that the rest
of the atrium looks smooth
compared to this bumpy,
pectinate muscle type
arrangement of the appendage
can be explained by the embryology
and they have two different
embryologic origins.
01:33
In the cryista terminalis
the border between the two.
01:38
As we will eventually see
in the ventricles,
there is a septum or wall separating
the right from the left atrium.
01:46
We call the atrial septum.
01:48
And in this atrial septum,
we see a little shallow depression,
called the fossa ovalis.
01:56
And a little bit of rem
along its superior edge
called the Limbus of this fossa.
02:01
And if you saw the
fetal circulation video,
you'll know that this landmark here
is the remnant of what used to be
the foramen ovale
during fetal circulation,
or used to be a hole
that blood could pass through
to reach the left atrium.
02:18
Usually, that's closed
off to become a fossa.
02:22
We can also see a little
bit of the tricuspid valve
which we'll see more of from
the ventricle point of view.
02:28
But before we hit
the tricuspid valve,
there's a little opening here.
02:33
And this is an opening for
something called the coronary sinus.
02:37
And we'll see that
the coronary sinus
is the major venous drainage
of the heart itself.
02:45
We talked about what the heart does
in terms of receiving venous blood
and pumping out venous blood,
but it's an organ, it's a muscle
and it needs its own
arteries and veins itself
and the veins that supply the heart
are coming into this region here
to enter the rest of
the right atrial blood.
03:03
coming from the IVC in the SVC.
03:07
So let's go ahead and zoom in
on this area a little bit more.
03:12
Here we see the SVC and the IVC,
both entering the right atrium.
03:18
And again, we see the fossa ovalis,
the remnant of what used to be
a foramen ovale
when we wanted some of the blood
from the IVC to cross over
to the left atrium.
03:28
After birth, it's sealed off
so that we have
just deoxygenated blood coming
from both the SPC and IVC
into the right atrium,
down to the right ventricle
and then out into
the pulmonary artery
to get oxygenated in the lungs.
03:43
But we have that third source
of deoxygenated venous blood
coming from the heart itself
via the coronary sinus.
03:51
And that's where this opening is.
03:53
We see this opening
of the coronary sinus
just between the IVC
and the tricuspid valve.
04:01
And it has a little bit of
a valve covering its opening
called thebesian valve.
04:06
That's right up against
another ridge of tissue
that's called the valve of the
IVC or the Eustachian valve.
04:13
And if you've heard the term
eustachian tubes
and your eustachian tubes
are blocked up
and you're wondering
if it's this same guy is.
04:18
It's the same guy,
he was very busy.
04:21
This valve of the IVC,
or eustachian valve, though,
isn't a valve,
like we typically think about
other heart valves
like the tricuspid valve.
04:30
In the sense that it's not
really preventing backflow.
04:33
What it's really doing is well,
not much in the adult heart,
but in fetal circulation, it was
this ridge that guided the IVC blood
up through the foramen ovale
where we now have a fossa ovalis.
04:47
So it's function as really
in fetal circulation.
04:53
If we get down into
the right ventricle,
and we cut away the portion of
ventricle that's not on the septum,
called the free wall.
05:02
We can see the inner workings
of the ventricle a lot better.
05:07
We can see that the inner
surface of the ventricle
is thrown into some bumpy ridges,
kind of like the
right atrial appendage.
05:16
Although they're not
quite as parallel,
they're a little more haphazard.
05:19
So they're not pectinate muscles,
they're called trabeculae carnae.
05:24
We still have a septum here
separating the right ventricle
from the left ventricle.
05:30
And something that we only have
on the right ventricle
that we won't see on the left
is this circular ridge of tissue,
what we call outflow tract or the
area leading up to the artery.
05:42
And that's the conus arteriosus
or the infundibulum.
05:46
And that means that there's
some muscle, this conus muscle
between the tricuspid valve
and the pulmonary valve,
and that's something that
we will not see on the left side.
05:58
So again, we have a tricuspid
valve as our inflow.
06:02
And we have our pulmonary
valve as our outflow.
06:06
Pulmonary valves are very
simple and very passive.
06:10
But tricuspid valve
because it has to
bear the brunt of force
of a ventricular contraction
has a lot of apparatus
attached to it.
06:19
So in addition to the
tricuspid valve leaflets here,
there are these tenderness cords
called chordae tendinae
that attach to these finger like
projections of the ventricle wall
called papillary muscles.
06:32
And they're going to help
resist backflow of blood
that's being pushed up
against the tricuspid valve.
06:38
So if we look at the tricuspid valve
from the atriums point of view,
it looks pretty simple.
06:44
And I have this soft surface that
seems like blood would be
easily able to push through
on their way down
into the ventricle.
06:52
And we have three leaflets as
the name tricuspid would imply.
06:57
One up against the septum
called the septal leaflet
then an anterior leaflet,
and a posterior leaflet.
07:04
And we can see those from
the ventricle side as well.
07:07
We have the septal,
anterior and posterior leaflets.
07:12
Accordingly, we have three sets
of papillary muscles.
07:15
Although, they're actually not
lined up exactly with the leaflets,
they're somewhat in between,
so that they have chordae tendinae
going to two leaflets
instead of just one,
but they are located in
generally the same area.
07:27
We have a septal papillary.
We have an anterior papillary.
07:31
And we have a posterior
papillary muscle.
07:35
And an interesting
feature of the right side,
in addition to the conus arteriosus
is this little band of muscle
that goes from the septum
out to the anterior papillary.
07:46
And it's called the moderator band.
07:49
It's again a unique
feature of the right
that won't happen on
the left ventricle.
07:53
And we're going to see
it's important a little bit later
in conduction.
07:56
But for now, it's essentially
kind of a shortcut for conduction
to make sure that
the anterior can function
the same time as the
septal and posteriors.
08:06
Finally,
we have the pulmonary valve.
08:09
And it has three leaflets:
An anterior, a right, and a left.
08:16
And these are much
simpler in structure.
08:19
They're basically little half cups,
and it's called a semilunar valve
for that reason.
08:24
That can prevent backflow
by passive filling
and closing up against each other
and not letting any blood
working its way
back into the right ventricle.
08:33
So it's a lot simpler.
08:35
And here from the pulmonary
arteries point of view,
we can see the anterior,
right, and left leaflets.