hi let's talk about the ascending aorta and the coronary arteries
so as i've discussed there are certain landmarks that i look to in trying to figure out
exactly what i'm looking at when i see an angle of the heart
so let me share with you some of what i see here so this is the ascending aorta
and it's going into the arch of the aorta this is the pulmonary trunk
my first giveaway that this is the ascending aorta and not the pulmonary trunk is that i can see
the coronary arteries originating from it the coronary arteries are going to come from the
ascending aorta they are the only branches of the ascending aorta so look for them
in terms of branching patterns this one here is the lca i can see a very distinct anterior
interventricular artery and then a circumflex branch going that way over here i can see the rca
originating and going down and i can see some veins kind of jumping over it or bridging
over it so those are going to be anterior cardiac veins so if this is the anterior interventricular
artery coming down that way here's the anterior interventricular sulcus here's the
article of the right atrium here's the coronary sulcus going down
so this is more of an anterosuperior view of the heart if we look to the left here this is
almost a superior view of the heart with the atria removed and so let's go back to our good
friend our dear friend the ascending aorta we can see there are two vessels
originating from it so that makes that the pulmonary trunk and we can see how the
right coronary artery is going to come down and wrap around throughout the pulmonary
i'm sorry the coronary sulcus and then here's the left it's kind of going that way and then
down around that way and so we're going to have our tricuspid valve there and
our bicuspid valve there and let's really get into the the granular details of these branches
so the origins of the coronary arteries
are the aortic sinuses the aortic sinuses are the most inferior part of the root of the aorta
and they are the spaces above the right and left and posterior or non-coronary
cusps of the aortic valve these sinuses fill up with blood during diastole
therefore the coronary arteries fill with blood during diastole here is the pulmonary trunk
here is the right auricle there is the superior vena cava opening here's the base of the heart
and we can see that it's been incised there and so there's the left atrium
and here's the article of the left atrium right atrium is going to be over here
so we really have a sense for for which way is up so to speak let's start our study with
the left coronary artery or the lca that left coronary artery has two branches sometimes there
is a nice trunk coming from the ascending aorta sometimes not this first branch that we can see
here coming down and around this is the anterior interventricular branch of the lca the anterior
interventricular branch of the lca is sometimes also called the left anterior descending artery
and sometimes because it is a main contributor to the interventricular septum it might be called the
widowmaker which is a very
sexist and unempathetic way to refer to a vessel so
if you hear it in the clinic that's what they're talking about but i might encourage you to uh
to adopt a nomenclature of greater inclusivity and empathy the other branch is the circumflex
circumflex because it's going to wrap around it will wrap around to the diaphragmatic surface of
the heart here we can see the pulmonary trunk has been reflected down there's the ascending aorta
still and i can see coming from that circumflex branch around a nice left marginal artery
so here is the anterior interventricular branch there is the circumflex branch and then there is
the left marginal artery the only branch named artery of all of the coronary artery branches
so the right coronary artery here let's start with our view from above that's going to begin in the
right aortic sinus of valsalva here's our right oracle and we can see kind of a quick branching
pattern here too this is a nice robust s a nodal branch sinu atrial nodal branch going out to the
sa node there is our superior vena cava there is our incised base of the heart pulmonary trunk
still for our orientation and here we can see that rca heading down in the coronary sulcus so we take
more of an anterior view here that yes a nodal artery is heading that way towards the sa node
and then the rca dives down through the coronary sulcus sending out a couple of branches along the
way these are feeding the right ventricle and then one branch that i'd like us to stop and mention
the right marginal branch right marginal branch that's heading out along the inferior
border of the heart then we can see the rca wrapping about in that coronary sulcus
it's heading this way here we can see the opening for the inferior vena cava
the rca heads out across there i can see that right marginal there's the right marginal branch
and then heading down here to that very special region the crux of the heart
and then we have a branching this is the posterior interventricular branch
also known as the
posterior descending artery pda not public display of affection posterior descending artery
and then the atrioventricular nodal branch av nodal branch so if we can jump over here for a
second here's that right aortic sinus here we go in the coronary sulcus this is one of the
reasons i absolutely love this specimen we get to the crux approximately there and then we can see
this av nodal branch heading on in that way so here is our tricuspid valve
that av nodal branch is going to be found going to the av node which is kind of at the nexus of the
atrioventricular septum as well as the interatrial septum so approximately right
about there so these are the coronary arteries and their branches thank you very much for your time