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5.1.9 Pericardial sac, great vessels

TRANSCRIPT

(3.01)

So far we've been looking at the heart by itself, with the major vessels that leave and enter it divided. To see where those vessels go, and also to see the pericardial sac around the heart, we'll look at a dissection in which the anterior chest wall has been removed, from the first rib, to the eighth rib.

The diaphragm is here. On each side the lungs are quite collapsed. If they were fully expanded they'd be out to here. Here's the heart, hidden within its protective sac of pericardium. In the intact body the front of the pericardial sac is attached to the back of the sternum by this strip of mediastinal fat, all of which we'll remove.

All this is the pericardial sac. The only major vessels we can see at this point are the aorta emerging from the pericardial sac here, and the superior vena cava entering it here. 2

22.06

To see more, we'll remove this much of the pericardium. Here's the heart, well covered with epicardial fat. The ventricles are freely mobile within the pericardial sac. Below, the pericardium is reflected onto the upper surface of the diaphragm, to which it's densely adherent. To right and left, the pericardium lies back to back with the parietal pleura.

Here's the root of the aorta, and of the pulmonary trunk. Here's the superior vena cava, entering the right atrium from above. Each of the great vessels passes through an adherent cuff of pericardium as it enters or leaves the pericardial sac.

Here's the inferior vena cava coming up through the diaphragm. Here are the left pulmonary veins, and the left pulmonary artery, passing through the pericardium separately.

On the right, the pulmonary vessels are harder to see because they leave through a continuous cuff of percardium ...

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(3.01)

So far we've been looking at the heart by itself, with the major vessels that leave and enter it divided. To see where those vessels go, and also to see the pericardial sac around the heart, we'll look at a dissection in which the anterior chest wall has been removed, from the first rib, to the eighth rib.

The diaphragm is here. On each side the lungs are quite collapsed. If they were fully expanded they'd be out to here. Here's the heart, hidden within its protective sac of pericardium. In the intact body the front of the pericardial sac is attached to the back of the sternum by this strip of mediastinal fat, all of which we'll remove.

All this is the pericardial sac. The only major vessels we can see at this point are the aorta emerging from the pericardial sac here, and the superior vena cava entering it here. 2

22.06

To see more, we'll remove this much of the pericardium. Here's the heart, well covered with epicardial fat. The ventricles are freely mobile within the pericardial sac. Below, the pericardium is reflected onto the upper surface of the diaphragm, to which it's densely adherent. To right and left, the pericardium lies back to back with the parietal pleura.

Here's the root of the aorta, and of the pulmonary trunk. Here's the superior vena cava, entering the right atrium from above. Each of the great vessels passes through an adherent cuff of pericardium as it enters or leaves the pericardial sac.

Here's the inferior vena cava coming up through the diaphragm. Here are the left pulmonary veins, and the left pulmonary artery, passing through the pericardium separately.

On the right, the pulmonary vessels are harder to see because they leave through a continuous cuff of percardium that they share with the inferior vena cava. Here are the pulmonary veins, the artery is out of sight up here.

Once we've understood the heart in three dimensions, understanding the great vessels that enter and leave it becomes straightforward. The superior and inferior vena cava, and the aorta, are shown in Tape 3 of this atlas; and we'll see more of the pulmonary artery and veins later in this section.

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