《系统解剖学 Systematic Anatomy》课程教学资源（书籍教材）Angiology Chapter 1 cardiovascular syste

PARTIANGIOLOGYChapter1 Cardiovascular SystemSection1 General DescriptionV.PericardiumI.Organization of the Cardiovascular SystemSection3ArteriesII.VascularAnastomosesI.Arteries of Pulmonary CirculationSection2HeartIL.Arteriesof SystemicCirculationI.Position and External Features of HeartSection4VeinsII. Chambers of HeartI. General DescriptionII.Structure of HeartII.Pulmonary VeinsIV.Conduction System of HeartIII.Systemic VeinsV. Vessels of HeartChapter2Lymphatic SystemSection1IntroductionII. Lymph Nodes and Lymph Drainage of Tho-I. Lymphatic VesselsraxII. Lymph NodesIV. Lymph Nodes and Lymph Drainage of Abdo-Section2LymphaticDuctsmenI.Thoracic DuctV.Lymph Nodes and Lymph Drainage of PelvisII. Right Lymphatic DuctVI.LymphNodes and LymphDrainageof LowerLimbSection 3Lymph Nodes and Lymph Drainage ofWhole BodySection4 LymphDrainage of Some OrgansI.Lymph Nodes and Lymph Drainage of HeadSection5 Spleen andThymusI.Spleenand NeckII.ThymusII.LymphNodes and LymphDrainageofUpperLimbIntroductionThe circulatory system includes the cardiovascular and lymphatic systems. The cardiovascular systemcomprises the heart and vessels. Theyform a tubular system which, with limited exception, is closed and linedthroughout with endothelium. The cardiovascular system is flled with blood. The lymphatic system consistsof the lymphatic vessels, lymphatic tissues, and lymphatic organs. The fuid in the lymphatics is called lymph.Some tissue fuid is absorbed into lymphatic capillaries, where it is drained by the lymphatic vessels throughthe lymph nodes to thegreat veins at the root oftheneck.The main function served by the circulatory system is transporting materials, The fluid products of diges-tion are absorbed from the digestivetract into the bloodstream.Oxygenfrom the air passes intolungs and theninto the bloodstream. Water, nutrients, oxygen and hormones are distributed to the various tssues and organsvia the bloodstreamThe waste products ofmetabolismformed inthe tissues,enter the bloodstream and arebrought by it to the excretory organs (kidneys, lungs and skin)..193.FD3扫描全能王创建

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23Cardiovascular SystemChapter 1elasti prieshwallhmedumizSection 1 General De-aemculararaeriachindivdaoaadbchnmscriptionwallischaracterizdyncuumsuaromonareutmmdmter and just visible to the naked eye.I . Organization of the Car-diovascular System3.CapillariesThe cardiovascular system consists of the heart,arteries,veins and capillaries.The capillaries are connected with arteries andveins. They form an anastomosing network. The1.Heartcapllaries can be found in various tissues and organsexceptfor the cartilage, cornea,lens,hairs, epide.mis, etc. Their wall favors exchange between bloodEven though anatomically the heart is a singleand the tissue fluid. The exchange includes oxygenorgan, the right and left sides of the heart function ascarbon dioxide,nutrients,water and inorganic ions,two separate pumps.The heart is divided into rightvitamins, hormones, metabolic products, etc.and left halvesandhasfourchambers,an upper andalower chamber within each half.The left and rightatria receive blood from veins and transfer it to the4.Veinsleft and right ventricles, which pump the blood intoarteries.The two halves of the heart are separated byThe vessels that return blood from the tissues tothe interatrial and interventricular septums.This septhe atria are veins. Veins accompany arteries and havearation is extremely important, because the right halfthe same tree-like pattern,thebranches being calledof the heartis receiving and pumping O,-poor bloodtributaries.Veins are characterized by a relatively thinwhiletheleft sideof theheart receives andpumps Owall in comparison with arteries of similar size andrich blood. Blood flows through the heart in one fixedby a large capacitance.In the cadaver the veins,evendirection from atria to ventricles,then to arteries.Thewhen collapsed, maintain their large diameter andvalves of the heart ensure that the blood flows in thethey are more likely to be found full ofblood than areproper direction through the heart.the arteries.The blood traverses two separate circuits, theArteriespulmonary and the systemic, each with its own pump.In the pulmonary circulation, the blood enteringThe vessels that carry blood away from the ven-the right atrium passes to the right ventricle, whichtricles to the tissue are arteries. The aorta and thepumps blood'through the pulmonary arteries to thepulmonary trunk branch and rebranch like a tree. Thecapillaries of the lungs, then through the pulmonarybranches become smaller as they become progressive-veinstothelef atriumInthesystemicirculatoly more numerous. The arteries arising from the heartthebloodeneringtheleatriumpassestthelefand their main branches are called the large arteriesventricle, which pumps bloodthroughtheaortand(elastic arteries), characterized by the dominantlyisarousbanchsthepllariesoar.194.2扫描全能王创建O

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Chapter1 Cardiovascular System ·195 .of the body, then through veins to right atrium (Fig.nent arteries and veins, while the others disappear.-1-1).Normally the blood is red in color when theSome vascular anastomoses remain after birth (Fig.oxygen content is high, and bluish when the oxygenIII-1-2)is low. Therefore, the blood is red in the pulmonaryveins, the leff side ofthe heart and the systemic arterArterial anastomosesies, and it is blue in the systemic veins, the right sideof the heart and the pulmonary arteries.The arterial anastomoses occur between certainlargevessels,forming arterialnetworks (e.g.,artic-ular networks)，arterial arches (e.g.,superficial anddeep palmar arches),and arterial circle(e.g-,cere-bral arterial circle).Anastomoses also occur betweenmany small vessels and precapillaryvessels.2.Venous anastomosesThe venous anastomoses are richer than the arteri-al anastomoses. Surrounding the organs or within thewalls of the organs, some veins anastomose one an-other,formingvenousplexuses(e.g.vesicalplexus,uterine plexus,and rectal plexus).In some parts theyjoinwitheach other toform venousnetworks, for ex-ample,the dorsal venous network of the hand.3.Arteriovenous anastomosesIn someregions arterioles communicatedirectlywith venules, e.g, in the skin of the terminal phalan-ges, lips and nose, and in the nail bed. Function of ar-teriovenous anastomoses is regulating the local bloodflow.Fig.II-1-1 Diagram of the circulatory system4.Collateral anastomosesThe adjacent collaterals of the larger arteries anas-I.Vascular Anastomosestomose one another,forming colleteral anastomoses.In cases of obstruction of the larger arteries, it is byDuring development, networks of vessels sproutthe enlargement of these anastomoses that a collateralin to actively growing parts and as the parts enlarge,circulation is established and the vitality of distantthe networks advance farther into them.Certain chan-parts is preserved.nels through these networks are chosen to be perma-口扫描全能王创建

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IANGIOLOGY.196.PARTⅢArterial networkArteriovenousanastomosesCommunicatingbranchArterial archTrunk of arteryCollateralbranchCollateral anastomosesCollateral circulationFig.I-1-2Vascular anastomosestilted forward and to the left, about two-thirds of itSection 2 Heartlies to the left of the midline and one-third on theright. It is described as having a base and an apex,three surfaces and three borders.There arefive groovesI .Position and Externalon the cardiac surfaces (Fig. II-1-4 and II-1-5)Features of HeartThe cardiac base is somewhat quadrilateral,and faces posteriorly and to the right. It is formedThe heart is a hollow, muscular organ about themainly by the left atrium, and only partly by thesize of a closed fist. An average adult heart is aboutposterior part of the right atrium. At the cardiac284g(from240-350g)inmalesand258g(from220base, two pulmonary veins on each side open into280 g) in females. The size and weight of the heartthe left atrium, while the superior and inferior vevary considerably depending on age, height, bodynae cavae open into the right atrium. The cardiacweight and physical activities. For cxample, the sizebase is separated from the esophagus and aorta byand weight of his or her heart increases if someonethe pericardium.often labors and does physical exercise.Enclosed inThe cardiac apexfaces anteriorly and tothe lef.the pericardium, it occupies the middle mediastinumIt is formed by the lef ventricle and located behindbetween the pleurac and the lungs. It is placed behindthe leffifh intercostal space1-2cm medial to thethe bodyofthe sternumandthe secondto sixth costalmidlaviularlWhnhabats,esecaycartilages and in the front of the body of the fourthwhnitontractsforcfuythecardiacapexthumto eighth vertebra. It rests upon the diaphragm. At itsagainst thechest wallwebcomawareofthebeaupper extremity large blood vessels enter or leave iting heartthroughtheapexbeatonthelefsidefthe(Fig. III-1-3) .chest.Theheartbeat ispalpableonpatients chestThe heart is somewhat conical or pyramidal formwall.D扫描全能王创建D

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Chapter.1CardiovascularSystem·197.LeftcommoncarotidaBrachioccphalictrunLeftsubclavianaAorticarchLeft vagus n.:Superior vena cavAscending aorta-PulmonarytrunkPericardiumRight lunLeft lungApexofheartDiaphragnFig.Il-1-3PositionoftheheartAorticarchArterial ligamentSuperiorvena caveLeftpulmonarya.Pulmonary trunkLeft auricleBranchofsinoatrialnodLeft coronarya.Right auricleCircumflexbranchRight coronary aLeft marginal branchAnteriorcardiacGreatcardicvAnteriorinterventricularbranchRight marginal branchLeftventricleRight ventricleCardiac apexStemocostal surfaceCardiac apica lincisureFig. I-1-4External features and the vessels of the heart (anterior view)DR扫描全能王创建口

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ANGIOLOGY·198·PARTⅢIAortic archSuperiorvenacavaLeft pulmonaryaRight pulmonarya.LeftpulmonaryvvRight pulmonaryvv.Great cardiac vCircumflexbr.ofInferiorvena cavaleft coronarya.BranchofatrioventricularCoronarysinusSmall cardiac v.Right ventricleMiddlecardiacvFig.II-1-5External features and the vessels of the heart (posterior view)by the left auricle. It descends from the left auricleThe sternocostal surface of the heart faces for-to the cardiac apex. The right border separates theward and upward so it is also called the anterior sur-sternocostal surface and cardiac base. Correspondingface.About one-fourth of the surfacemadeupbto the right atrium, its profile is slight convex to thethe left auricle and ventricle and threrthsbytheright atrium and ventricle.A large part of the surfaceright.The inferiorborderseparates the sternocostaland diaphragmatic surfaces, it is sharp and nearlyis covered by the pleura and the anterioredgesofthelungs,asmallpartisseparatedfromthelowerpartofhorizontal.Theborderismainlyformedbytherightthe sternum and the left fourth to sixth costal carti-ventricle,with a small contribution from the left ven-lages bythepericardium.Therefore,the intracardiactricle near the apex. It extends from the lower end ofinjection can be performed at the left fourth intercos-the rightborderto the apex.tal space near the sternum to avoid the damage of theThe coronary sulcus is also known as the atrio-pleura and lung. The pulmonary trunk and ascendingventricular groove completely encircles between theaorta arisefrom theupper part of the sternocostal sur-atria and ventricles, it is oblique. The section whichface.The diaphragmatic surface faces the diaphragm,includes the coronary groove is at about 45° to thealso known as the inferior surface. It is largely hori-sagittal plane. It approximately traverse the lines ofzontal,sloping down and forwardsa littletowards theattachment of the atrioventriclar valves and those ofapex. Of the diaphragmatic surface, about two-thirdstheaortic and pulmonaryvalves.is made up by the left ventricle and one-third by theThe anterior interventricular groove, seen on theright ventricle. The left surface faces up, back and tosternocostal surface, is near and almost parallel to thethe left.Itconsistsmainlyoftheleftventricle,buthaslef border. It descends from the coronary groove toa small part of the left atrium contributing superiorly.the cardiac apical incisure, which is about 2 cm to theThe left border of the heart separates the sterno-right of the cardiac apex. The posterior interventricu-costal and left surfaces.It is mainly formedby the leftlar groove, seen on the diaphragmatic surface, extendsventricle but, to a slight extent superiorly, is formedfrom the coronary groove to the cardiac apical inci-口R扫描全能王创建a

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Chapter 1 Cardiovascular System ·199 .urodhiarsrotation to the left on its long axis. The interventric-ular and interatrial septa are aligned obliqucly 45° toaerordperorgthe left of the midline.With the planes of the septadirected approximately from the right scapula to thedirnagoovesonanhbeelenipple.Thereforc, the entireright sideoftheheartand the adipose tissue.is to the right ofthis plane,placing mostof the rightTheinteratrial groove isverical andright toori-atrium anterior to the lef atrium and most of the righteesorih puyiorpoeieraialdsaraestheldrgventricle anterior to the left ventricle.stmassalwaexending betweenhrightsidesoftheopeningsRight atriumftsuandroaaaventricularcuxithointfjunctionofcoronaryThe right atrium (Fig. II-1-6) can be divided intointeratrialand posterior interventiculargroovesthe sinus venarum cavarum and the atrium properIntemayat ths junctontheieratrial sumjnswith the crista terminalis,This smooth, musculartheintervent ricularseptumTheright coronary artyridge begins on the upper part of the septal surfacethat crosses thisregion makesasharpinward turnatand, passing anterior to the orifice of the superiorthe crux and originates the artery to the atrioventric-vena cava, runs to the right side of the orifice of theular node.At the crux, the middle and small cardiacinferior vena cava. It corresponds externally to theveins join the coronary sinus.sulcus terminalis.The medial wall of the right atriumistheinteratrial septum.1) sinus venarum cavarum The sinus venarumI.Chambers of Heartcavarum islocated posteriortothe atriumproper,anddeveloped from the sinus venarum. Its inner surfaceDuring development, the heart undergoes a slightAorticarchRight auricleSuperiorvenacarPulmonary trunkTorusaorticusPulmonary vy,Right ventricleTendonoftodaroFossa ovalisIttricuspidvalveValve of inferior vena cavOrifice ofcoronarysinusInferior vena cavFig. II-1-6 Right atriumfront of the orifice of inferior vena cava.It becomesissmoothThesuperiorandinfriorvenaecavaencontinuous with the crista terminalis laterally andtrthright atriumatitssuperiorandinferioraspects.withthevalve of coronary sinus medially.The valveTheorificeofsuperiorvenacavausualyhasnoofinferior vena cava islargeduringfetal life,when itvalve.The valveofinferiorvena cavapassesinthe可口扫描全能王创建可

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·200·PARTIⅢIANGIOLOGYnaserves to direct blood through the oval foramen intoeectmayccurwhenthermaryatriasepuathe left atrium. The orifice of coronary sinus is locat-owithmusulgFrthalved between the orifice of inferior vena cava and theiright atrioventricular orifice. It is often guarded by theatrialseptumbetwetheorfofthcoroayvalve of the coronary sinus.nusand theoval fossa.ThetriangleofKoch is found2)AtriumproperTheatriumproperdevelopedbetwentheattachmentoftheseptalleafletofthefrom the primitive atrium. Anteromedially, the righttruspdalv theantermedialmginthorifauricleprotrudesfromtherightatriumand overlapsayidadienthe aortic root.The inner surface of the atrium properTodoroTheatrioventricularnodeislocated intheis trabeculated.Thepectinate muscles,almostparalleltriangle of Koch.muscular ridges, extend anterolaterally from the cristaVenous blood returns to theright atrium via theterminalis and reach into the auricle,where theyformmultiple trabeculations. The right atrioventricularsuperior and inferior venae cavae and the coronarysiorificetakestheplaceof anteriorwall oftheatriumnus, where it is stored during right ventricular systoleproper, through which the right atrium communicatesDuring ventricular diastole, the blood fows from thewith the right ventricle. Viewing from the right atri-right atrium into right ventricle.um, it is roughly triangular. Its circumference is about11. 4 cm in males and 10.8 cm in females.2. Right ventricle3) Interatrial septum Near the center of theinteratrial septum there is a shallow depression, theThe right ventricle (Fig. II1-7) is somewhat coni.oval fossa, which is found above and to the left of thecal. On the transverse section, it has a crescent-shapedorifice of the inferior vena cava.The rim of the ovalchamber. It ascends to the left to become the conusfossa most distinct above and in front of the fossa,arteriosus.The inlet and the outlet of the ventricle areusuallybeing deficient inferiorly.After birth the pul-guarded by the tricuspid valve and pulmonary valvemonary circulation is established and the oval fora-Aortic archPulmonarytrunkSuperior vena cavaValve of pulmonary trunkRight auricleSupraventricular crestSeptal papillary m._Ventricular septumTricuspid valve二Inferior vena cav-Left ventricle1SeptomarginaltrabeculaTrabeculae caFig. II-1-7 Right ventricleDRDT2扫描全能王创建口

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Chapter1 CardiovascularSystem201.respectively.Functionally, theright ventrile can bnamed the nodule ofthe semilunar valve.Each valvepartitioned into the infow tract (sinusal part) and theand the corresponding wall of the pulmonary trunkoutfow tract (infundibular part) by the supraventric-form the pulmonary sinus. The function of the pulmo-ular crest, which arches from the anterolateral wallnary valve is preventing regurgitation of blood in theover the anteriorleafet ofthe tricuspid valve to thepulmonary trunk.septal wall.The right ventricle receives venous blood from1) Sinous part The sinous part extends fromthe right atrium during ventricle diastole and propelsthe right atrioventricular orifice nearly to the cardiacblood into the pulmonary trunk when the ventricleapexThe trabeculated appearanceisdue toiregularsystole.muscular ridges and protrusions, which are knowncollectively as trabeculae carnae. The septomarginal3.Left atriumtrabecula, through which the right bundle branchpasses, crosses from the ventricular septum to theThe left atrium (Fig. II -1-8) is roughly cuboidal.anterior wall, where it joins the anterior papillaryIt is largely formed by the proximal parts of pulmo-muscle. It is also termed the moderator band becausenary veins during development. The four pulmonaryit can prevent overdistension of the ventricle.Beingveins open into the posterolateral surfaces of the atri-single or bifid, the fingerlike papillary muscles projectum, two on each side. Though there are no valves atfrom the ventricular wall. There are three papillarythe orifices of thepulmonaryveins,atrial muscle ex-muscles in the right ventricle. The anterior papillarytendingfromthe leftatrial wall around the pulmonarymuscle originates from the septomarginal trabeculaveinsfor1or2cmmayexert apartial sphincter-likeas well as from the anterolateral ventricular wall. Theinfluence, tending to lessen reflux during atrial sys-posterior papillary muscle lies bencath the junctiontole. The left auricle is derived from the left part ofof the posterior and septal leaflets.The small septalthe embryonic atrium.It is longer,narrower and morepapillary muscle arises from the septal wall.Eachhooked than the right auricle. The pectinate musclespapillary muscle supplies the chordae tendineae toare present only in the left auricle. The interatrialthe adjacent leaflets. The tricuspid valve (right atrio-septum is smooth but may contain a central shallowventricular valve)attaches to the tricuspid annulus atarea, corresponding to the oval fossa.The left atrio-the right atrioventricular orifice. The annulus of theventricular orifice,though which the left atrium com-tricuspid valve isa fibrous structure supporting themunicates with the left ventricle, places the anteriorvalve.The leaflets of the tricuspid valve consists ofwall, and is oval in shape and smaller than the rightthe anterior leaflet, the posterior leaflet and the sep-atrioventricular orifice.Its circumference is about 9.0tal leaflet. The bases of the leaflets are connected tocminmalesand 7.0cm infemales.each other, forming the anteroseptal commissure, theThe left atrium receives blood from the pulmo-posteroseptal commissure and the antero-posteriornary veins and serves as the reservoir during left ven-commissure. The tricuspid valve closes as the righttricular systole and a conduit during left ventricularventricle ejects blood. The tricuspid annulus, the tri-filling.cuspid valve, the chordae tendineae and the papillarymuscles form the tricuspid complex. Alterations of4.Leftventricleanyone of these structures can cause tricuspid valvedysfunction.The left ventricle (Fig. II-1-8) is approximately2) Infundibular part The infundibular partellipsoidal and can be divided into the inflow tractascends to the left above the sinuous part. It looks(sinuous part)and the outflowtract(aortic vestibule)funnel-like, and its wall is smooth.The right ventriclecommunicates with the pulmonary trunk through thebythe anterior leaflet of the mitral valve.The inletorifice of pulmonary trunk which is supported by theand the outlet of the ventricle are guarded by the mi-annulus of pulmonary valve formed by three semilu-tral valve and aortic valve respectively.1)SinouspartThetrabeculae carneae of thenar fibrous rings connected each other. The pulmo-nary valve are attached to the annulus, and has threeleft ventricle arefiner and more intricate than those ofsemilunar leaflets, the anterior,left and right valves.the right ventricle. The apical portion of the left ven-Central thickening in the free margin of each valve istricle is characterized by fine trabeculations. The口.扫描全能王创建尚

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·202·PARTⅢIANGIOLOGYSuperiorvenacavaAortaRight pulmonary vv.Pulmonary trunkLeftatriumOrificeofrightcoronaryaFRight semilunarvalue of aorticvalveAorticvestibulemAnterior cusp of mitralvalvInterventricularseptumPosteriorcuspofmitral valveChordae tendineaeAnteriorpapillarym.Fig. II-1-8 Left atrium and ventricleanterior papillary muscle arises from the anterolaterallunarvalve.Theaorticvalvepreventsbackflowofwall of the left ventricle, and the posterior papillaryblood into the left ventricle.The aortic sinuses aremuscle arises from the diaphragmatic region.Eachmore prominentthan the pulmonary sinuses.Theleftpapillary muscle supplies the chordae tendineaetoand right coronary arteries originate from the left andbothleafletsofthemitral valve.Themitral valve(leftright aortic sinuses respectively.atrioventricular valve) attaches to the mitral annulusThe left ventricle receives blood from the leftatri-at the left atrioventricular orifice.The leaflets of theum during ventricle diastole and ejects blood into themitral valve are called the anterior cusp and the pos-aorta during ventricle systole.terior cusp.The anterior leaflet is interposed betweenleft atrioventricular orifice and the aortic orifice.II . Structure of HeartTheleaflets areconnectedtoeachother,formingtheanterolateralcommissureand theposteromedial com-missure.The mitral valve closes as the left ventricleejects blood.The mitral annulus,themitral valve,the.Fibrous skeleton of heartchordae tendineae and the papillary muscles form themitral complex. Alterations of anyone of these struc-Afibrous tissueframework affords a firm anchortures can causemitral valve dysfunction.for the attachments of the atrial and ventricular mus-2) Aortic vestibule The aortic vestibule as-cle and valves. Fibrous skeleton of heart includes thecends to the right above the sinous part, and its wallfibrous trigones, the fibrous annuli and the membra-is smooth.The left ventricle communicates with thenous part of the interventricular septum (Fig.II-1-9.aorta through the aortic orifice.The annulus of aortic11).valve, formed by three semilunar fibrous rings con-The fibrous trigones are the strongest part of thenected each other, is attached with the aortic valve.skeleton. The right fibrous trigone (central fibrousThere are three semilunar valves, the left, right andbody) lies between the tricuspid annulus, the mitralposterior valve. Each valve has a nodule of the semi-annulus and the fbrous ring of the posterior leaflet口口RA扫描全能王创建口

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