Roentgen Anatomy Of Normal Heart (1965)

for sin fluorographic study with Venus catheterization provides physiologic data including pressure and flow measurements from the great veins right atrium right ventricle and the pulmonary arteries simultaneous contrast visualization permits study of the morphologic characteristics of these structures here a small volume of contrast medium is injected into the superior vnea it shows the rapid course of blood flow through the right side of the heart to the lungs a patient observes Obed in the frontal or postero anterior projection is oriented in a facing position the front of his chest is closest to the Observer by observing the external features of the heart in the frontal projection its physical characteristics may be outlined the superior and inferior Veni are the vessels through which blood returns from the body to the right atrium the right atrium forms the right lateral border of the heart shadow Venus blood passes from the right atrium to the right ventricle right ventricular blood is ejected into the pulmonary trunk which forms the left anterior Superior segment of the heart border oxygenated blood returns from the lungs through the pulmonary veins to the left atrium which occupies the posterior Central aspect of the heart it then ERS the left ventricle to the left and behind the right ventricle the left ventricle forms the left lateral and posterior borders of the heart Shadow blood next passes into the ascending aort to the right and behind the origin of the pulmonary trunk let us now observe the circulation angiographically in the frontal projection contrast medium injected into the superior vena passes through the right atrium and ventricle to the lungs it returns to the left atrium and ventricle and is ejected into the aorta the superior vena and right atrium were opacified in syy the medium outlines the atrial aspect of the tricuspid valve in diast it passes through the valve to fill the r ventricle it is rapidly ejected through the pulmonary valve into the pulmonary artery and its right and left branches to the lungs oxygenated blood returns from the lungs through the pulmonary veins to the left atrium in diast it passes to the left ventricle and is ejected into the ascending aorta the aorta carries all blood to the systemic circulation in the right anterior oblique projection the patient faces obliquely toward the right of the Observer the right side of the anterior chest wall is closest to the screen the view of the heart changes as indicated by the arrow this provides a better view of the tricuspid and mitro valves and the right ventricular outflow tract rapid opacification of the right atrium and the right anterior oblique projection causes reflux of medium into the superior vnea the right atrium is heavily opacified outlining the plane of the the tricuspid valve annulus in ventricular syy in diast the valve opens and the right ventricular inflow tract is opacified insistently the medium passes through the pulmonary annulus into the pulmonary trunk it passes slowly through the lungs on it turn it traverses the left atrium the left ventricle and the ascending a or the patient in the left anterior oblique projection faces partly toward the left of the Observer the left side of the anterior chest wall is closest to the observer in this projection the heart is observed is indicated by by the arrow this provides a good view of the pulmonary and aortic valve and the plane of the inter ventricular septum well pacifying the right atrium in the left anterior oblake projection allows a momentary view of the superior vena and R Atrium the r Atrium and ventricle are superimposed obscuring detail as the atrium is cleared of contrast medium the outline of the interventricular septum is faintly seen when the medium returns from the lungs it fills the left atrium it passes through the mitro valve to fill the superimposed left ventricle and aorta a gain outlining the plane of the inter ventricular septum the left side of the heart and aort are slowly cleared of contrast medium selective opacification of the right ventricle provides a better view of its outflow tract in diast the pulmonary valve annulus is well defined in syy the medium fills the main pulmonary trunk and its major branches it passes rapidly through the lungs a more concentrated Bolis of medium returns from the lungs to outline the left atrium left ventricle and ascending a Oro catheterization of the right brachial artery provides a direct approach to the aorta and left chambers of the heart the catheter traverses the right subcl Ian and Brach oalc arteries to the ascending aorta it moves down the ascending aorta to the aortic anulus where its passage is stopped by the aortic valve leaflets in the frontal projection these structures lie anterior to the vertebral column this demonstrates selective opacification of the asent aorta as seen in the frontal projection in this view the aortic anulus lies in an oblake plane perpendicular to the long axis of the heart the left and right coronary arteries arise from their respective sinuses the ascending aorta arches upward and toward the right the brachio calic left cored and left subclavian arteries arise from the arch as it passes backward to descend to the left of the vertebral column the thoracic aorta and its major branches are demonstrated best in the left anterior oake projection in the early phase of opacification during diast the closed aortic valve leaflets prevent reflux into the left ventricle the right posterior and left sinuses are well defined in ventricular syy nanop pacified blood from the left ventricle clears the aortic root and the elevated right and left cusps of the valve are outlined the origins of the great vessels of the aortic Arch are well seen the brachio celic left kateed and left subclavian arteries arise from its greater curvature as it passes backward and descends toward the diaphragm selective opacification of a normal right coronary artery is seen in the left anterior oblake projection the large smooth walled coronary artery rises from the right sinus its main trunk passes around the right atrioventricular sulcus to the posterior wall of the heart it provides marginal branches to the anal lateral wall of the right ventricle and a branch to the sinoatrial node and right atrium its terminal branches profuse the diaphragmatic surface of the right ventricle a small branch anch passes upward to the atrio ventricular node another terminal Branch passes behind the heart in the left atrio ventricular sulcus to profuse the left atrium and the superior aspect of the left ventricle here is the left coronary artery of the same patient in the left of Blake projection it arises from the left sinus the short Main trunk fills its anterior descending branch which passes down the anterior interventricular sulcus to the cardiac Apex it provides Perforating branches to the inter ventricular septum and a large diagonal Branch passing over the adderal lateral wall of the left ventricle the circumflex branch of the left coronary artery passes behind the heart to the left atrio ventricular sulcus its terminal branches here profuse only the posterior lateral aspect of the left ventricle the diaphragmatic and posterior surfaces of the left ventricle are profused by the right coronary artery in this patient the same vessel is viewed with a patient rotated 30° toward the right the left main trunk appears to continue in almost a straight line as the anterior descending or interventricular artery its Perforating branches pass into into the inter ventricular septum its diagonal Branch passes over the anterolateral wall here the left circumflex trunk provides branches only to the posterior lateral wall the left coronary artery of another patient is seen in the r oblake view he has a dominant left coronary artery the anterior branch is similar to that seen in the previous patient the circumflex Branch carries blood to the postero lateral wall in addition it gives off a large Branch around the left atrio ventricular sulcus to the back of the heart where it becomes the posterior descending coronary artery in such instances nearly all of the left ventricle is refused by the left coronary artery in the same dominant left coronary artery viewed in the left oblake projection the atrio ventricular branch of the circumflex trunk crosses behind the heart to the posterior inter ventricular sulcus its postal lateral branches are seen at the right a heavy myocardial blush occurs during capillary profusion the anterior and posterior interventricular veins fill the great cardiac Vein The Great cardiac vein empties through the coronary sinus into the right atrium when the coronary artery is dominant the right coronary artery does not profuse the left ventricle a small Branch passes to the right atrium marginal branches peruse the right ventricle terminal branches pass to the diaphragmatic and apical as aspects of the right ventricle only Twigs cross the inter ventricular septum in a third patient here is a dominant right coronary artery a small Branch pass behind the heart to the left atrium marginal Branch passes to the anterior wall of the right ventricle its main trunk passes around the right Atria ventricular sulcus to the back of the heart here it gives off the posterior descending coronary artery a small Branch passes to the atrio ventricular node terminal branches Supply the diaphragmatic apical and posterolateral aspects of the left ventricle and the posterior segment of the inter ventricular septum when the right coronary artery peruses most of the left ventricle the circumflex branch of the left coronary artery seen here at the right is usually small its terminal branches often fail to reach the cardiac Apex the cavity of the left ventricle may be opacified after the catheter has passed through the aortic valve this also permits direct pressure measurement to estimate the severity of obstructions at the aortic valve or within the left ventricle as contrast medium outlines the chamber in late diast the ventricular outflow tract is bound by the closed aortic valve leaflets the membranous portion of the inter ventricular septum and by the large anterior or aortic leaflet of the mitro valve in the early phase of systolic contraction the mital valve leaflet swings back into its annulus widening the outflow tract before the ejection phase of ventricular syy the aortic leaflets have not yet opened in late syy they disappear in The Surge of blood into the aortic root but are seen in successive diastolic filling periods as The ventricle is cleared of medium with the patient in the right anterior oblake position the long axis of the left ventricle is well demonstrated this projection gives a good view of the mitro valve annulus as The ventricle is reop pacified the apical segment of its cavity and its outflow tract leading to the aorta may be seen this outlines the plane of the mital valve anulus ins cyly its cusps prevent regurgitation into the left atrium above and posterior to the left ventricle and aortic root a premature beat causes slight artifactual mital regurgitation in syy the anterior and posterior papillary muscles of the mital valve are well outlined the closed posterior mitro valve leaflet is well seen its larger anterior leaflet is obscured by the opacified outflow tract the mital valve leaflets move downward into the left ventricular cavity as it relaxes in diate and nanop pacified blood passes through the mital anulus on a broad front The ventricle is then rapidly cleared of contrast medium selective opacification of the left atrium in the right obl projection may be accomplished by passing the catheter through the mital valve from the left ventricle as the catheter is with drawn from the left atrium into the left ventricle across a normal mitro valve pressure measurements recorded from the catheter tip show that diastolic pressure in the left atrium equals that in the left ventricle this rules out any mechanically significant obstruction at the mitro valve the left ventricle is cleared as medium passes through the aortic valve into the ascending aorta and in left atrial filling the atrial aspect of the mitro valve leaflets are seen in late syy in diast the normal leaflets open they disappear as contrast medium passes the mital anulus to fill the left ventricle the small normal left atrial chamber shows no evidence of filling defects on normal noral cardiac output is indicated by rapid clearance of medium when the injection is completed