Anatomi Jantung dan Rongga dada

By
dr. Abdul Malik Setiawan, M.Infect.Dis.
Objective
1. Describe the boundaries of the thoracic inlet and outlet and the
structures that pass through them and their relations.
2. Describe the arrangement and contents of the superior, anterior,
middle and posterior parts of the mediastinum.
3. Demonstrate the surface markings of the heart and great vessels
4. Describe the origin, course and main branches of the left and right
coronary arteries
5. Identify the major anatomical features of each chamber of the heart
and explain their functional significance.
6. Describe the structure and position of the atrio-ven- tricular,
pulmonary and aortic valves
Thoracic Inlet
• The thoracic inlet is essentially a hole surrounded by a bony ring
• Important structures pass through the Thoracic Inlet
• Boundaries of The thoracic inlet :
Posterior : Vertebrae Thoracalis 1 (T1)
Lateral : The first pair of ribs
Anterior : Superior border of Manubrium sterni
• Structure pass through the thoracic Inlet : Trachea, oesophagus, Arteri
Carotis communis, arteri subclavia, ect.
Thoracic Outlet
• The thoracic outlet is the lower opening of the thoracic cavity
• The Thoracic outlet is closed by the diaphragm
• It separates the thoracic cavity from the abdominal cavity
• Boundaries of The thoracic outlet :
Posterior : Vertebrae Thoracalis 12 (T12)
Lateral : The 11th and 12th pairs of ribs
Anterior : Cartilago Costalis
• Structure pass through the thoracic Outlet : Vena cava inferior,
esophagus, Aorta Abdominalis
Quiz !!
1. Apakah struktur yang membentuk pintu masuk rongga thorax
(thoracic inlet) ?
a. Corpus Sternum pada bagian anterior
b. Vertebrae thoracalis 1 pada bagian lateral
c. Angulus sternalis pada bagian anterior
d. Costa 1 pada bagian lateral
e. Manubrium sterni pada bagian posterior
Thoracic Cavity (Cavum Thorax)

• Thoracic Cavity is the chamber of

the body that is protected by the
thoracic wall (Ribs, muscle, and
skin)
• Thorax cavity can be divided into
Three Parts;
1. Left and Right Pleural Cavity
2. Mediastinum
Mediastinum
• The mediastinum is the central compartment of the thoracic
cavity, located between the two pleural sacs.
• It contains most of the thoracic organs.
• The mediastinum is divided into two parts by an imaginary line that
runs from the sternal angle to the T4 vertebrae:
1. Superior mediastinum : The superior thoracic aperture – Line
between sternal angle and T4 Vertebrae.
2. Inferior mediastinum : Line between sternal angle and T4 Vertebrae
- The diaphragm. It is further subdivided into the anterior
mediastinum, middle mediastinum and posterior mediastinum.
Border of Superior Mediastinum
• Superior – Thoracic inlet.
• Inferior – Continuous with the
inferior mediastinum at the level of
the sternal angle.
• Anterior – Manubrium of the
sternum.
• Posterior – Vertebral bodies of T1-4.
• Lateral – Pleurae of the lungs.
 Contents of Superior Mediastinum
The superior mediastinum contains :
• Great Vessels : Arcus Aorta, Vena
Cava Superior
• Nerves : Nervus Vagus,
Nervus Phrenicus, Cardiac Nerves,
• Organs : Thymus, Trachea,
Thoracic duct
Arch of Aorta
The three major branches of the
aortic arch :
• Brachiocephalic artery –
supplying the right side of the
head & neck and the right upper
limb.
• Left Common carotid artery – to
the left side of the head & neck.
• Left Subclavian artery – to the
left upper limb.
Superior Vena Cava
The following tributaries of the superior vena cava are located within
the superior mediastinum:
• Brachiocephalic veins – draining blood from the upper body.
• Left superior intercostal vein – collects blood from the left 2nd and
3rd intercostal vein.
• Supreme intercostal vein – drains the vein from first intercostal space
directly into the brachiocephalic veins.
• Azygos vein – receiving blood from the right posterior intercostal
veins. It forms Azygos vein system.
Nervus Vagus
In the superior mediastinum, the vagus nerve has two distinctive paths:
• Right vagus nerve – runs parallel to the trachea and passes posteriorly
to the superior vena cava and the right primary bronchus.
• Left vagus nerve – enters the superior mediastinum between the left
common carotid and the left subclavian arteries. It descends anteriorly
to the aortic arch, before travelling posterior to the left bronchus.
• N. Laryngeus recurrens arises from the vagus nerve to innervate
Larynx
Other Nerves
• Nervus Phrenicus is a nerve that originates in the neck (C3-C5) and
passes down between the lung and heart to reach the diaphragm. It is
important for breathing.
• Cardiac nerves – originate from the superior, middle and inferior
cardiac ganglion and form the superficial and deep cardiac plexuses
in the superior mediastinum.
• Sympathetic trunk – runs bilaterally to the vertebral bodies along the
entire length of the vertebral column.
 Anterior Mediastinum
• The anterior mediastinum
contains no major structures.
• In infants and children, the
thymus extends inferiorly into
the anterior mediastinum.
• The thymus recedes during
puberty and is replaced by
adipose tissue in the adult.
Middle Mediastinum

The middle mediastinum is the largest subdivision of the inferior

mediastinum. It contains several important structures, such as :
• Organs : Herath, Pericardium, Tracheal bifurcation, bronchi
• Vessels : Ascending aorta, Pulmonary trunk, Superior vena cava
• Nerves : Cardiac plexus, Nervus Phrenicus (left and right)
Posterior Mediastinum
Borders
• Lateral: Mediastinal pleura (part of the parietal pleural membrane).
• Anterior: Pericardium.
• Posterior: T5-T12 vertebrae.
• Roof: Imaginary line extending between the sternal angle (the angle
formed by the junction of the sternal body and manubrium) and the T4
vertebrae.
• Floor: Diaphragm.
Contents of Posterior Mediastinum

• Vessels : Thoracic Aorta, Azygos System of Veins, Thoracic Duct

• A number of branches arise from the thoracic aorta in the posterior
mediastinum. The major branches are:
➢Posterior intercostal arteries
➢Bronchial arteries
➢Oesophageal arteries
➢Superior phrenic arteries
• Organ : Oesophagus
Quiz !!
1. Tn. Budi laki-laki berusia 37 tahun dibawa ke UGD RS dr. Soepraoen Malang
dengan anak panah yang menancap di dada. Sebelum anak Panah dicabut,
dokter memerintahkan pasien untuk dilakukan foto rontgen agar mengetahui
posisi anak panah bersarang. Dari hasil rontgen didapatkan ujung anak panah
berada 1 cm di atas arcus aorta setinggi Vertebrae Thoracalis 2.
Terletak di manakah ujung anak panah bersarang ?
a. Mediastinum Superior
b. Mediastinum Anterior
c. Mediastinum Posterior
d. Mediastinum Medialis
e. Mediastinum lateralis
The Hearth

• The heart is a hollow

muscular pump, which
lies in the middle
mediastinum.
• On its surface, it has
several distinctive
features which are of
anatomical and clinical
importance.
 The Hearth
1.
2.
3.
4.
7.
8.
9.
10.
11.
14.
15.
18.
19
Orientation and Surfaces

In its typical anatomical orientation, the heart has 5 surfaces, formed by

different internal divisions of the heart:
• Anterior (or sternocostal) – Right ventricle.
• Posterior (or base) – Left atrium.
• Inferior (or diaphragmatic) – Left and right ventricles.
• Right pulmonary – Right atrium.
• Left pulmonary – Left ventricle.
Borders

Separating the surfaces of the heart are its borders. There are four
main borders of the heart:
• Right border – Right atrium
• Inferior border – Left ventricle and right ventricle
• Left border – Left ventricle (and some of the left atrium)
• Superior border – Right and left atrium and the great vessels
Great vessels of the Hearth

• Aorta :
➢Brachiocephalic trunk
➢Left common carotid artery
➢Left subclavian artery
Great vessels of the Hearth

• Pulmonary Arteries
• Pulmonary Veins :
➢Superior Vena Cava
➢Inferior Vena Cava
Chamber of the Hearth

• The heart consists of four chambers: the two atria and the two
ventricles.
• Blood returning to the heart enters the atria, and is then pumped into
the ventricles.
• From the left ventricle, blood passes into the aorta and enters the
systemic circulation.
• From the right, it enters the pulmonary circulation via the pulmonary
arteries.
Atria
• Right Atrium :receives deoxygenated blood from the superior and
inferior vena cavae, and from the coronary veins. It pumps this blood
through the right atrioventricular orifice (guarded by the tricuspid
valve) into the right ventricle.
• Interatrial Septum : The interatrial septum is a solid muscular wall that
separates the right and left atria. The septal wall in the right atrium is
marked by a small oval-shaped depression called the fossa ovalis
• Left Atrium : receives oxygenated blood from the four pulmonary veins,
and pumps it through the left atrioventricular orifice (guarded by
the mitral valve) into the left ventricle
Ventricles
• Right Ventricle : It is triangular in shape, and forms the majority of
the anterior border of the heart. Covered by a series of irregular
muscular elevations, called trabeculae carnae attached to three
tricuspid valve.
• Interventricular Septum : The interventricular septum separates the
two ventricles, and is composed of a superior membranous part and
an inferior muscular part.
• Left Ventricle : the left ventricle forms the apex of the heart, as well as
the left and diaphragmatic borders. Covered by a series of irregular
muscular elevations, called trabeculae carnae attached to two Mitral
valve.
Hearth Valves
• The valves ensure blood flows in only one direction.
• They are composed of connective tissue and endocardium (the inner
layer of the heart).
• There are four valves of the heart, which are divided into two categories:
• Atrioventricular valves: The tricuspid valve and mitral (bicuspid) valve.
They are located between the atria and ventricle.
• Semilunar valves: The pulmonary valve and aortic valve. They are
located between the ventricles and their corresponding artery.
Atrioventricular Valves
• Tricuspid valve – located between the right atrium and the right ventricle
(right atrioventricular orifice). It consists of three cusps (anterior, septal and
posterior).
• Mitral valve (Bicuspid) – located between the left atrium and the left
ventricle (left atrioventricular orifice).
• The mitral and tricuspid valves are supported by chordae tendineae to the
free edges of the valve cusps.
• The chordae tendineae attached to papillary muscles, located on the
interior surface of the ventricles
• These muscles contract during ventricular systole to prevent prolapse of
the valve leaflets into the atria.
Semilunar Valves
The semilunar valves are located between the ventricles and outflow
vessels.
They close at the beginning of ventricular relaxation (diastole),
producing the second heart sounds. There are two semilunar valves:
• Pulmonary valve – located between the right ventricle and the
pulmonary trunk (pulmonary orifice). The valve consists of three cusps
– left, right and anterior.
• Aortic valve – located between the left ventricle and the ascending
aorta (aortic orifice). The aortic valve consists of three cusps – right,
left and posterior.
• The left and right aortic sinuses mark the origin of the left and right coronary
arteries.
Vascularisation of the Hearth

Coronary Arteries
• The left coronary artery (LCA) initially branches to yield the left
anterior descending (LAD) or anterior interventricular artery. The LCA
then progresses to become the left marginal artery (LMA) and the left
circumflex artery (Cx).
• The right coronary artery (RCA) branches to form the right marginal
artery (RMA) anteriorly and the posterior interventricular artery
(PIv) posteriorly.
Cardiac veins
There are five tributaries which drain into the coronary sinus:
1. The great cardiac vein is the main tributary.
2. The small cardiac vein is also located on the anterior surface of the
heart. This passes around the right side of the heart to join the
coronary sinus.
3. The middle cardiac vein. It is located on the posterior surface of the
heart.
4. The left marginal vein.
5. The left posterior ventricular vein which runs along the posterior
interventricular sulcus to join the coronary sinus.
Quiz !!
1. Ny. Mawar, Perempuan berusia 54 tahun dibawa ke UGD RS dr.
Soepraoen Malang dengan keluhan dada berdebar. Dari pemeriksaan
auskultasi didapatkan bunyi jantung 2 tidak teratur
Struktur apakah yang menghasilkan bunyi tersebut ?
a. Katub Pulmonal
b. Katub atrioventricular
c. Katub Mitral
d. Katup Tricuspidalis
e. Katup Bicuspid
2. Jantung memperoleh vaskularisasi dari Arteri Coronaria Dextra dan
Sinistra serta percabangannya.
Pada bagian manakah pangkal dari arteri coronaria berasal ?
a. Katup Aorta
b. Katub Pulmonalis
c. Katup Mitral
d. Katup Tricuspid
e. Katub Bicuspid
THANK YOU