Heart: Arteries and Veins

1 Brachiocephalic trunk

2 Superior vena cava

3 Right atrium

4 Right coronary artery

5 Right ventricle

6 Connection of one of the bypass vessels with the

anterior interventricular artery

7 Left subclavian artery

8 Left common carotid artery

9 Ductus arteriosus (Botalli) (still open)

10 Ascending aorta with three bypass vessels implanted

11 Pulmonary trunk

12 Left atrium

13 Circumflex branch of left coronary artery

14 Anterior interventricular branch of left coronary artery

15 Left ventricle

16 Apex of heart

17 Sternum

18 Right ventricle

19 Liver

20 Spinal cord

21 Trachea

22 Aorta

23 Body of thoracic vertebrae

24 Pulmonary artery

25 Inferior vena cava

26 Hepatic vein

Sagittal section through the thoracic cavity (MRI scan,

courtesy of Prof. W. Bautz and R. Janka, M. D., University of

Erlangen, Germany).

Heart, coronary vessels after implantation of three

bypass vessels (yellow) (schematic drawing of the

specimen above).

Heart, coronary vessels after implantation of three bypass

vessels (anterior aspect). The ductus arteriosus (9) is still open.

264 Regional Anatomy of the Thoracic Organs

Thoracic organs (ventral aspect). The left clavicle and ribs have been partially removed, and the right intercostal spaces have been opened

to show the internal thoracic vein and artery.

1 Right internal jugular vein

2 Omohyoid muscle

3 Sternohyoid muscle and external jugular vein

4 Clavicle

5 Thoraco-acromial artery

6 Right subclavian vein

7 Pectoralis major muscle

8 External intercostal muscle

9 Pectoralis minor muscle

10 Body of sternum

11 Right internal thoracic artery and vein

12 Fascicles of transversus thoracis muscle

13 Internal intercostal muscles

14 Serratus anterior muscle

15 Costal margin

16 External abdominal oblique muscle

17 Anterior sheath of rectus abdominis muscle

18 Sternocleidomastoid muscle

19 Left internal jugular vein

20 Transverse cervical artery

21 Brachial plexus

22 Vagus nerve

23 Left axillary vein

24 Left internal thoracic artery and vein

25 Ribs and thoracic wall (cut)

26 Costal pleura

27 Xiphoid process

28 Superior epigastric artery

29 Diaphragm

30 Rectus abdominis muscle

Regional Anatomy of the Thoracic Organs 265

Thoracic organs, anterior mediastinum, and pleura (ventral aspect). Ribs, clavicle, and sternum have been partly removed.

Red = arteries; blue = veins; green = lymph vessels and nodes.

1 Sternothyroid muscle and its nerve

(a branch of the ansa cervicalis)

2 Right internal jugular vein

3 Right common carotid artery

4 Cephalic vein

5 Right subclavian vein

6 Right brachiocephalic vein

7 Pectoralis major muscle (divided)

8 Pectoralis minor muscle (divided)

9 Parasternal lymph nodes

10 Internal thoracic artery and vein

11 Anterior margin of costal pleura

12 Pericardium

13 Fifth and sixth ribs (divided)

and serratus anterior muscle

14 Costodiaphragmatic recess

15 External abdominal oblique muscle

16 Rectus abdominis muscle

17 Larynx (thyroid cartilage)

18 Thyroid gland

19 Trachea

20 Left vagus nerve

21 Left brachiocephalic vein

22 Left internal thoracic artery and vein

23 Thymus

24 Costal pleura

25 Costal margin

26 Superior epigastric artery

27 Margin of costal pleura

28 Diaphragm

29 Linea alba

30 Cut edge of anterior sheath of rectus

abdominis muscle

266 Regional Anatomy of the Thoracic Organs: Thymus

1 Larynx (thyroid cartilage)

2 Thyroid gland

3 Trachea

4 Internal jugular vein

5 Brachial plexus

6 Right brachiocephalic vein and common carotid

artery

7 Right phrenic nerve

8 Ascending aorta

9 Pectoralis minor muscle (divided)

10 Pulmonary trunk (covered by pericardium)

11 Costal pleura

12 Pericardium and heart

13 Serratus anterior muscle

14 Xiphoid process

15 Costal margin

16 External abdominal oblique muscle

17 Sternothyroid muscle (divided and reflected)

18 Vagus nerve

19 Left common carotid artery

20 Left sympathetic trunk

21 Left recurrent laryngeal nerve

22 Left internal thoracic artery and vein (divided)

23 Margin of costal pleura

24 Intercostal nerves and vessels

25 Superior epigastric artery

26 Rectus abdominis muscle

27 Diaphragm

28 Ansa cervicalis

29 Phrenic nerve and scalenus anterior muscle

30 External jugular vein (divided)

31 Right subclavian vein

32 Right brachiocephalic vein

33 Internal thoracic artery (divided)

34 Internal thoracic vein (divided)

35 Right lung

36 Cricothyroid muscle

37 Omohyoid muscle

38 Thymus

39 Left lung

Thoracic organs (ventral aspect). The internal thoracic

vessels have been removed, and the anterior margins of the

pleura and lungs have been slightly reflected to display the

anterior and middle mediastinum, including the heart and

great vessels.

The thymus above the heart, showing its position and size.

Regional Anatomy of the Thoracic Organs: Thymus 267

Thoracic organs (ventral aspect). The pleura has been opened and the lungs exposed. Remnants of the thymus and

pericardium are seen.

1 Right internal jugular vein

2 Phrenic nerve and scalenus anterior muscle

3 Clavicle (divided)

4 Right subclavian artery and vein

5 Internal thoracic artery

6 Right brachiocephalic vein

7 Brachiocephalic trunk

8 Thymus (atrophic)

9 Upper lobe of right lung

10 Horizontal fissure of right lung (incomplete)

11 Middle lobe of right lung

12 Oblique fissure of right lung

13 Lower lobe of right lung

14 Xiphoid process

15 Diaphragm

16 Thyroid gland

17 Left internal jugular vein

18 Brachial plexus

19 Left cephalic vein

20 Left common carotid artery and

vagus nerve

21 Left brachiocephalic vein

22 Internal thoracic artery and vein (divided)

23 Ascending aorta and aortic arch

24 Upper lobe of left lung

25 Pericardium

26 Oblique fissure of left lung

27 Lower lobe of left lung

28 Costal margin

268 Regional Anatomy of the Thoracic Organs: Heart

Thoracic organs (ventral aspect). The thoracic wall, costal pleura, pericardium, and diaphragm have been partly removed.

1 Internal jugular vein

2 External jugular vein (displaced medially)

3 Brachial plexus

4 Trachea

5 Right common carotid artery

6 Clavicle (divided)

7 Right brachiocephalic vein

8 Upper lobe of right lung

9 Thymus (atrophic)

10 Horizontal fissure of right lung

11 Middle lobe of right lung

12 Pericardium (cut edges)

13 Oblique fissure of lung

14 Lower lobe of right lung

15 Diaphragm

16 Falciform ligament

17 Liver

18 Location of larynx

19 Left internal jugular vein

20 Thyroid gland

21 Omohyoid muscle (divided)

22 Vagus nerve

23 Left subclavian vein

24 First rib (divided)

25 Internal thoracic artery and vein

26 Pectoralis major and pectoralis minor muscles

(cut edges)

27 Upper lobe of left lung

28 Right ventricle

29 Cardiac notch of left lung

30 Interventricular sulcus of heart

31 Left ventricle

32 Lingula

33 Lower lobe of left lung

Regional Anatomy of the Thoracic Organs: Heart 269

Thoracic organs (ventral aspect). Position of the heart and middle mediastinum. The anterior wall of the thorax, the costal

pleura, and the pericardium have been removed and the lungs slightly reflected.

1 Thyroid gland

2 Phrenic nerve and scalenus anterior muscle

3 Vagus nerve and internal jugular vein

4 Clavicle (divided)

5 Brachial plexus and subclavian artery

6 Subclavian vein

7 Internal thoracic artery

8 Brachiocephalic trunk and right

brachiocephalic vein

9 Superior vena cava and thymic vein

10 Right phrenic nerve

11 Transverse pericardial sinus (probe)

12 Right auricle

13 Middle lobe of right lung

14 Right ventricle

15 Cut edge of pericardium

16 Diaphragm

17 Internal jugular vein

18 Trachea

19 Left recurrent laryngeal nerve

20 Left common carotid artery and

vagus nerve

21 Left brachiocephalic vein and

inferior thyroid vein

22 Left internal thoracic artery and vein

(divided)

23 Upper margin of pericardial sac

24 Ascending aorta

25 Pulmonary trunk

26 Left phrenic nerve and left peri -

cardiacophrenic artery and vein

27 Upper lobe of left lung

28 Left ventricle

270 Regional Anatomy of the Thoracic Organs: Heart

Thoracic organs (ventral aspect). Position of heart, dissection of coronary vessels in situ. The anterior wall of

thorax, costal pleura, and pericardium have been removed.

1 Intermediate supraclavicular nerve

2 Internal jugular vein

3 Right phrenic nerve

4 Right vagus nerve

5 Right common carotid artery

6 Right subclavian vein

7 Right brachiocephalic vein

8 Right internal thoracic artery

9 Superior vena cava

10 Ascending aorta

11 Right lung

12 Right atrium

13 Right coronary artery and

small cardiac vein

14 Right ventricle

15 Cut edge of pericardium

16 Diaphragm

17 Costal margin

18 Larynx (cricothyroid muscle and thyroid

cartilage)

19 Thyroid gland

20 Left common carotid artery and

left vagus nerve

21 Left recurrent laryngeal nerve

22 Trachea

23 Left internal thoracic artery and vein (divided)

24 Thymic veins

25 Margin of pericardial sac

26 Pulmonary trunk

27 Left lung

28 Left ventricle

29 Anterior interventricular artery and vein

30 Lingula

31 Liver

Regional Anatomy of the Thoracic Organs: Heart 271

Thoracic organs (ventral aspect). Heart with valves in situ. Anterior wall of thorax, pleura, and anterior portion of pericardium

have been removed. The right atrium and ventricle have been opened to show the right atrioventricular and pulmonary valves.

1 Omohyoid muscle

2 Pyramidal lobe of thyroid gland

3 Internal jugular vein

4 Thyroid gland

5 Right subclavian vein

6 Brachiocephalic trunk

7 Right brachiocephalic vein

8 Right internal thoracic artery

9 Right phrenic nerve

10 Superior vena cava

11 Pulmonary vein

12 Branches of pulmonary artery

13 Right auricle

14 Right atrium

15 Right atrioventricular (tricuspid) valve

16 Right lung

17 Posterior papillary muscle

18 Diaphragm

19 Left vagus nerve

20 Left phrenic nerve

21 Scalenus anterior muscle

22 Brachial plexus

23 Thyrocervical trunk

24 Left common carotid artery

25 Left subclavian artery

26 Left internal thoracic artery

27 Apex of left lung

28 Left recurrent laryngeal nerve

29 Cut edge of pericardium

30 Pulmonary trunk (fenestrated)

31 Pulmonic valve

32 Supraventricular crest

33 Anterior papillary muscle

34 Left ventricle

272 Regional Anatomy of the Thoracic Organs: Pericardium

Thoracic organs (ventral aspect). Pericardium and mediastinum. Anterior wall of thorax and heart have been removed and the

lungs slightly reflected. Note probe within transverse pericardial sinus.

1 Right internal jugular vein and

right vagus nerve

2 Right phrenic nerve and scalenus anterior muscle

3 Right common carotid artery

4 Brachial plexus

5 Right subclavian artery and vein

6 Right brachiocephalic vein

7 Right internal thoracic artery (divided)

8 Brachiocephalic trunk

9 Upper lobe of right lung

10 Superior vena cava

11 Transverse pericardial sinus (probe)

12 Right phrenic nerve and right

peri cardiacophrenic artery and vein

13 Right pulmonary veins

14 Oblique sinus of pericardium

15 Inferior vena cava

16 Diaphragmatic part of pericardium

17 Diaphragm

18 Costal margin

19 Thyroid gland

20 Trachea

21 Left recurrent laryngeal nerve and

inferior thyroid vein

22 Left common carotid artery and left vagus nerve

23 Left internal thoracic artery and vein (divided)

24 Vagus nerve at aortic arch

25 Cut edge of pericardium

26 Ascending aorta

27 Pulmonary trunk (divided)

28 Left pulmonary veins

29 Left phrenic nerve and left

pericardiacophrenic artery and vein

30 Contour of esophagus beneath pericardium

31 Contour of aorta beneath pericardium

32 Pericardium (cut edge)

Regional Anatomy of the Thoracic Organs: Epicardium 273

1 Internal thoracic vein

2 Superior vena cava

3 Oblique sinus of pericardium

4 Right pulmonary veins

5 Esophagus

6 Branches of right vagus nerve

7 Mesocardium

8 Inferior vena cava

9 Middle lobe of right lung

10 Diaphragm

11 Upper lobe of left lung

12 Ascending aorta

13 Pulmonary trunk

14 Transverse pericardial sinus

15 Left pulmonary veins

16 Descending aorta and left vagus nerve

17 Left lung (adjacent to pericardium)

18 Pericardium

19 Left subclavian artery

20 Vagus nerve

21 Left recurrent laryngeal nerve

22 Descending aorta

23 Pulmonary artery

24 Left atrium

25 Left ventricle

26 Coronary sinus

27 Left common carotid artery

28 Brachiocephalic trunk

29 Azygos arch

30 Right atrium

31 Right ventricle

32 Aortic arch

Pericardial sac (ventral aspect). The heart has been removed, and the

posterior wall of the pericardium has been opened to show the adjacent

esophagus and aorta.

Heart with epicardium (posterior aspect). Arrows: oblique sinus. Heart with epicardium (anterior aspect).

Arrow: pericardial reflection.

274 Posterior Mediastinum: Mediastinal Organs

Mediastinal organs after removal of heart and pericardium (ventral aspect). Both lungs have been slightly reflected.

1 Supraclavicular nerves

2 Internal jugular vein

3 Omohyoid muscle

4 Right vagus nerve

5 Right common carotid artery

6 Right subclavian artery

7 Brachiocephalic trunk

8 Right brachiocephalic vein

9 Superior cervical cardiac branch

of vagus nerve

10 Inferior cervical cardiac branches

of vagus nerve

11 Azygos arch (divided)

12 Bifurcation of trachea

13 Right pulmonary artery

14 Right pulmonary veins

15 Right lung

16 Esophagus and branches

of right vagus nerve

17 Inferior vena cava

18 Pericardium

19 Larynx (thyroid cartilage, cricothyroid muscle)

20 Thyroid gland

21 Internal jugular vein

22 Esophagus and left recurrent

laryngeal nerve

23 Trachea

24 Left vagus nerve

25 Left common carotid artery

26 Aortic arch

27 Left recurrent laryngeal nerve

branching off from vagus nerve

28 Left pulmonary veins

29 Thoracic aorta and left vagus nerve

30 Left lung

31 Left phrenic nerve (divided)

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