Anatomy of the heart and great vessels

A. Normal morphology and structure
	1. Embryology
	Developmental anatomy of the heart and the embryological basis for cardiac defects Lawrence M. Witmer, PhD
	16.1 Outer form and position of the heart
	Embryology and congenital heart disease P Angelini Tex Heart Inst J. 1995; 22(1): 1–12. PMCID: PMC325204
	2. Fetal circulation
	The formation of the ventricular loop – the U-shaped heart
	16.9 Embryo-fetal circulation system – changes at birth (Website Module www.embrology.ch)
	3. Normal cardiac and peri-cardiac structures to include
		a) Eustachian valve
		Valve of inferior vena cava Wikipedia, the free encyclopedia
		Giant Eustachian Valve with Echocardiographic Appearance of Divided Right Atrium Turhan Yavuz, MD, Cem Nazli, MD, Ozan Kinay, MD, and Ali Kutsal, MD Tex Heart Inst J. 2002; 29(4): 336–338.
		b) Thebesian valve/coronary sinus
		Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures Gary S. Mak, Alexander J. Hill, Florin Moisiuc, and Subramaniam C. Krishnan Europace (2009) 11(9): 1188-1192 first published online July 8, 2009 doi:10.1093/europace/eup179
		Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation Andre Plass, Ines Valenta, Oliver Gaemperli, Philipp Kaufmann, Hatem Alkadhi, Gregor Zund, Jürg Grünenfelder, and Michele Genoni Eur J Cardiothorac Surg (2008) 33(4): 583-589 doi:10.1016/j.ejcts.2007.12.041
		c) Right and left atrial appendages
		Anatomy of Right Atrial Structures by Real-Time 3D Transesophageal Echocardiography Faletra, Francesco F., Ho, Siew Y., Auricchio, Angelo J Am Coll Cardiol Img 2010 3: 966-975
		Right atrial appendage pacing: radiographic considerations BS Hertzberg, C Chiles, and CE Ravin AJR July 1, 1985 145:31-33
		Right Atrial Appendage: Forgotten Part of the Heart in Atrial Fibrillation (Abstract) Orhan Ozer, Ibrahim Sari, and Vedat Davutoglu CLIN APPL THROMB HEMOST April 2010 16: 218-220, first published on October 7, 2008 doi:10.1177/1076029608323088
		Longitudinal Follow-Up of a Right Atrial Appendage Aneurysm by Cardiac Magnetic Resonance Imaging Ankur Gulati, Radu Gheta, Cheuk F. Chan, Nizar A. Ismail, Mary N. Sheppard, Philip J. Kilner, and Alan G. Magee Circulation. 2011;123:2289-2291, doi:10.1161/CIRCULATIONAHA.110.010363
		Cardiac CT Assessment of Left Atrial Accessory Appendages and Diverticula Suhny Abbara, Jorge A. Mundo-Sagardia, Udo Hoffmann, and Ricardo C. Cury AJR September 2009 193:807-812; doi:10.2214/AJR.08.2229
		Left atrial appendage: structure, function, and role in thromboembolism N M Al-Saady, O A Obel, A J Camm Heart 1999;82:5 547-554 doi:10.1136/hrt.82.5.547
		d) Moderator band
		Anatomy of the Heart at Multidetector CT: What the Radiologist Needs to Know James P. O’Brien, MD, MBA, Monvadi B. Srichai, MD, Elizabeth M. Hecht, MD, Daniel C. Kim, MD and Jill E. Jacobs, MD Radiographics November-December 2007 27:6 1569-1582; doi:10.1148/rg.276065747
		Anatomic Pitfalls of the Heart and Pericardium Lynn S. Broderick, Gregory N. Brooks, and Janet E. Kuhlman Radiographics March-April 2005 25:2 441-453; doi:10.1148/rg.252045075
		Anatomical observations of the moderator band (Abstract) Marios Loukas, Zachary Klaassen, R. Shane Tubbs, Trevor Derderian, Dan Paling, Drin Chow, Shilpa Patel, Robert H. Anderson Clinical Anatomy Volume 23, Issue 4, pages 443–450, May 2010 DOI: 10.1002/ca.20968
		e) Endocardial cushion
		Pictorial Essay: Embryology and Developmental Defects of the Interatrial Septum Carlos A. Rojas, Ahmed El-Sherief, Hector M. Medina, Jonathan H. Chung, Garry Choy, Brian B. Ghoshhajra, and Suhny Abbara AJR November 2010 195:1100-1104; doi:10.2214/AJR.10.4277
		Endocardial cushion defects: embryology, anatomy, and angiography R Towbin and D Schwartz AJR January 1, 1981 136:157-162
		f) Atrioventricular valves (tricuspid and mitral)
		Cardiac Valve Assessment with MR Imaging and 64-Section Multi–Detector Row CT Jens Vogel-Claussen, Harpreet Pannu, Philip J. Spevak, Elliot K. Fishman, and David A. Bluemke Radiographics November-December 2006 26:1769-1784; doi:10.1148/rg.266065035
		CT Angiography of the Cardiac Valves: Normal, Diseased, and Postoperative Appearances Joseph J. Chen, Maria A. Manning, Aletta Ann Frazier, Jean Jeudy, and Charles S. White Radiographics September 2009 29:5 1393-1412; doi:10.1148/rg.295095002
		Evaluation of Cardiac Valvular Disease with MR Imaging: Qualitative and Quantitative Techniques James F. Glockner, Donald L Johnston, and Kiaran P McGee Radiographics January 2003 23:1 e9; Published online October 17, 2002, doi:10.1148/rg.e9

		Cardiac Valve Assessment with MR Imaging and 64-Section Multi–Detector Row CT Jens Vogel-Claussen, Harpreet Pannu, Philip J. Spevak, Elliot K. Fishman, and David A. Bluemke Radiographics November-December 2006 26:1769-1784; doi:10.1148/rg.266065035
		CT Angiography of the Cardiac Valves: Normal, Diseased, and Postoperative Appearances Joseph J. Chen, Maria A. Manning, Aletta Ann Frazier, Jean Jeudy, and Charles S. White Radiographics September 2009 29:5 1393-1412; doi:10.1148/rg.295095002
		Evaluation of Cardiac Valvular Disease with MR Imaging: Qualitative and Quantitative Techniques James F. Glockner, Donald L Johnston, and Kiaran P McGee Radiographics January 2003 23:1 e9; Published online October 17, 2002, doi:10.1148/rg.e9

		g) Sinuses of Valsalva
		Valsalva Sinus Aneurysms: Findings at CT and MR Imaging Aliye Ozsoyoglu Bricker, Bindu Avutu, Tan-Lucien H. Mohammed, Eric E. Williamson, Imran S. Syed, Paul R. Julsrud, Paul Schoenhagen, and Jacobo Kirsch Radiographics January 2010 30:99-110; doi:10.1148/rg.301095719
		Clinical anatomy of the aortic root Robert H Anderson Heart 2000;84:6 670-673 doi:10.1136/heart.84.6.670
		Pictorial Essay: Sinus of Valsalva Aneurysms: Assessment With Cardiovascular MRI Edward T. D. Hoey, Arulnithy Kanagasingam, and Mohan U. Sivananthan AJR June 2010 194:W495-W504; doi:10.2214/AJR.09.3570
		h) Coronary arteries and major branches
		Normal and Variant Coronary Arterial and Venous Anatomy on High-Resolution CT Angiography Kini, Sunil, Bis, Kostaki G., Weaver, Leroy Am. J. Roentgenol. 2007 188: 1665-1674
		Coronary artery anomalies: incidence, pathophysiology, clinical relevance and role of diagnostic imaging F. Cademartiri1,2 • G. Runza3 • G. Luccichenti4 • M. Galia3 • N.R. Mollet1 • V. Alaimo3• V. Brambilla5 M. Gualerzi5 • P. Coruzzi5 • M. Midiri3 • R. Lagalla3 La Radiologia Medica, Volume 111 / 2006 – Volume 116 / 2011 376–391 DOI 10.1007/s11547-006-0036-1
		i) Coronary veins including coronary sinus
		Normal and Variant Coronary Arterial and Venous Anatomy on High-Resolution CT Angiography Kini, Sunil, Bis, Kostaki G., Weaver, Leroy Am. J. Roentgenol. 2007 188: 1665-1674
		Coronary Veins: Comprehensive CT-Anatomic Classification and Review of Variants and Clinical Implications (Abstract) Farhood Saremi, Horia Muresian, and Damián Sánchez-Quintana Radiographics January-February 2012 32:1 E1-E32; doi:10.1148/rg.321115014
		Imaging of the Coronary Sinus: Normal Anatomy and Congenital Abnormalities (Abstract) Sanket S. Shah, Shawn D. Teague, Jimmy C. Lu, Adam L. Dorfman, Ella A. Kazerooni, and Prachi P. Agarwal Radiographics July-August 2012 32:4 991-1008; doi:10.1148/rg.324105220
		j) Superior vena cava and deep mediastinal veins (e.g. azygous vein)
		Venous Anomalies of the Thorax Terrence C. Demos, Harold V. Posniak, Kenneth L. Pierce, Mary C. Olson, and Mark Muscato AJR May 2004 182:1139-1150
		Multi–Detector Row and Volume-rendered CT of the Normal and Accessory Flow Pathways of the Thoracic Systemic and Pulmonary Veins Leo P. Lawler, Frank M. Corl, and Elliot K. Fishman Radiographics October 2002 22:suppl 1 S45-S60
		k) Pericardium
		Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography (Abstract) O’Leary, S M, Williams, P L, Williams, M P, Edwards, A J, Roobottom, C A, Morgan-Hughes, G J, Manghat, N E British Journal of Radiology 2010 83: 194-205
		Imaging of the Pericardium Breen, Jerome F. M.D Journal of Thoracic Imaging: January 2001 – Volume 16 – Issue 1 – pp 47-54
		Anatomy of Pericardial Recesses on Multidetector CT: Implications for Oncologic Imaging Mylene T. Truong, Jeremy J. Erasmus, Gregory W. Gladish, Bradley S. Sabloff, Edith M. Marom, John E. Madewell, Marvin H. Chasen, and Reginald F. Munden AJR October 2003 181:1109-1113
		Computed tomography of the pericardium and pericardial disease (Abstract) Prabhakar Rajiah, Jeffrey P. Kanne Journal of Cardiovascular Computed Tomography – January 2010 (Vol. 4, Issue 1, Pages 3-18, DOI: 10.1016/j.jcct.2010.01.004)
		l) Pulmonary arteries
		Continuing Medical Education: Congenital and Acquired Pulmonary Artery Anomalies in the Adult: Radiologic Overview Eva Castañer, Xavier Gallardo, Jordi Rimola, Yolanda Pallardó, Josep M. Mata, Joan Perendreu, Cesar Martin, and Damian Gil Radiographics March-April 2006 26:349-371; doi:10.1148/rg.262055092
		CT of Congenital Heart Disease: Normal Anatomy and Typical Pathologic Conditions Hyun Woo Goo, In-Sook Park, Jae Kon Ko, Yong Hwue Kim, Dong-Man Seo, Tae-Jin Yun, Jeong-Jun Park, and Chong Hyun Yoon Radiographics October 2003 23:S147-S165; doi:10.1148/rg.23si035501
		Reference Values for Normal Pulmonary Artery Dimensions by Noncontrast Cardiac Computed Tomography / Clinical Perspective : The Framingham Heart Study (Abstract) Quynh A. Truong, Joseph M. Massaro, Ian S. Rogers, Amir A. Mahabadi, Matthias F. Kriegel, Caroline S. Fox, Christopher J. O’Donnell, and Udo Hoffmann Circ Cardiovasc Imaging. 2012;5:147-154, published online before print December 16 2011, doi:10.1161/CIRCIMAGING.111.968610
		Congenital and Acquired Pulmonary Artery Anomalies in the Adult: Radiologic Overview Eva Castañer, Xavier Gallardo, Jordi Rimola, Yolanda Pallardó, Josep M. Mata, Joan Perendreu, Cesar Martin, and Damian Gil Radiographics March-April 2006 26:2 349-371; doi:10.1148/rg.262055092
		m) Pulmonary veins
		Multi–Detector Row CT of the Left Atrium and Pulmonary Veins before Radio-frequency Catheter Ablation for Atrial Fibrillation Joan M. Lacomis, William Wigginton, Carl Fuhrman, David Schwartzman, Derek R. Armfield, and Karen M. Pealer Radiographics October 2003 23:S35-S48; doi:10.1148/rg.23si035508
		CT of Congenital Heart Disease: Normal Anatomy and Typical Pathologic Conditions Hyun Woo Goo, In-Sook Park, Jae Kon Ko, Yong Hwue Kim, Dong-Man Seo, Tae-Jin Yun, Jeong-Jun Park, and Chong Hyun Yoon Radiographics October 2003 23:S147-S165; doi:10.1148/rg.23si035501
	4. Common variants
	Multi–Detector Row CT of the Left Atrium and Pulmonary Veins before Radio-frequency Catheter Ablation for Atrial Fibrillation Joan M. Lacomis, William Wigginton, Carl Fuhrman, David Schwartzman, Derek R. Armfield, and Karen M. Pealer Radiographics October 2003 23:S35-S48; doi:10.1148/rg.23si035508
	Continuing Medical Education: Congenital and Acquired Pulmonary Artery Anomalies in the Adult: Radiologic Overview Eva Castañer, Xavier Gallardo, Jordi Rimola, Yolanda Pallardó, Josep M. Mata, Joan Perendreu, Cesar Martin, and Damian Gil Radiographics March-April 2006 26:349-371; doi:10.1148/rg.262055092
		a) Anomalous coronary artery
		Coronary artery anomalies: incidence, pathophysiology, clinical relevance and role of diagnostic imaging F. Cademartiri1,2 • G. Runza3 • G. Luccichenti4 • M. Galia3 • N.R. Mollet1 • V. Alaimo3• V. Brambilla5 M. Gualerzi5 • P. Coruzzi5 • M. Midiri3 • R. Lagalla3 La Radiologia Medica, Volume 111 / 2006 – Volume 116 / 2011 376–391 DOI 10.1007/s11547-006-0036-1
		Cardiac Imaging: Part 2, Normal, Variant, and Anomalous Configurations of the Coronary Vasculature (Abstract) Phillip M. Young, Thomas C. Gerber, Eric E. Williamson, Paul R. Julsrud, and Robert J. Herfkens AJR October 2011 197:816-826; doi:10.2214/AJR.10.7249
		b) Left superior vena cava
		Persistent Left Superior Vena Cava Freedom, Culham and Moes, Angiography of Congenital Heart Disease, 1984 Copyright © 2003 LearningRadiology.com
		Venous Anomalies of the Thorax Terrence C. Demos, Harold V. Posniak, Kenneth L. Pierce, Mary C. Olson, and Mark Muscato AJR May 2004 182:1139-1150
		c) Azygous continuation of the IVC
		Venous Anomalies of the Thorax Terrence C. Demos, Harold V. Posniak, Kenneth L. Pierce, Mary C. Olson, and Mark Muscato AJR May 2004 182:1139-1150
		Cardiac Imaging: Part 2, Normal, Variant, and Anomalous Configurations of the Coronary Vasculature Phillip M. Young, Thomas C. Gerber, Eric E. Williamson, Paul R. Julsrud, and Robert J. Herfkens AJR October 2011 197:816-826; doi:10.2214/AJR.10.7249

B. Segmental anatomy of the heart
Segmental Approach to Imaging of Congenital Heart Disease Chantale Lapierre, Julie Déry, Ronald Guérin, Loïc Viremouneix, Josée Dubois, and Laurent Garel Radiographics March 2010 30:2 397-411; doi:10.1148/rg.302095112
	1. Atrial situs
	Segmental Approach to Imaging of Congenital Heart Disease Chantale Lapierre, Julie Déry, Ronald Guérin, Loïc Viremouneix, Josée Dubois, and Laurent Garel Radiographics March 2010 30:2 397-411; doi:10.1148/rg.302095112
	2. Ventricular loop
	Segmental Approach to Imaging of Congenital Heart Disease Chantale Lapierre, Julie Déry, Ronald Guérin, Loïc Viremouneix, Josée Dubois, and Laurent Garel Radiographics March 2010 30:2 397-411; doi:10.1148/rg.302095112
	3. Identification of great vessels
	Segmental Approach to Imaging of Congenital Heart Disease Chantale Lapierre, Julie Déry, Ronald Guérin, Loïc Viremouneix, Josée Dubois, and Laurent Garel Radiographics March 2010 30:2 397-411; doi:10.1148/rg.302095112
	4. Assess pulmonary arteries and veins
	Segmental Approach to Imaging of Congenital Heart Disease Chantale Lapierre, Julie Déry, Ronald Guérin, Loïc Viremouneix, Josée Dubois, and Laurent Garel Radiographics March 2010 30:2 397-411; doi:10.1148/rg.302095112
	5. Identify systemic venous return
	Segmental Approach to Imaging of Congenital Heart Disease Chantale Lapierre, Julie Déry, Ronald Guérin, Loïc Viremouneix, Josée Dubois, and Laurent Garel Radiographics March 2010 30:2 397-411; doi:10.1148/rg.302095112
C. Normal adult heart measurements
	1. Left ventricular wall thickness, diameter, fractional shortening, end-diastolic volume, end-systolic volume indexes
	Normal Human Left and Right Ventricular and Left Atrial Dimensions Using Steady State Free Precession Magnetic Resonance Imaging Hudsmith, Lucy E., Petersen, Steffen E., Francis, Jane M., Robson, Matthew D. and Neubauer, Stefan Journal of Cardiovascular Magnetic Resonance, 7: 5, 775 — 782, First published on: 01 October 2005
	Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A, Weinsaft JW, Shaw LJ, Berman DS, Callister TQ, Min JK. JACC Cardiovasc Imaging. 2008 Nov;1(6):782-6.
	Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. Maceira AM, Prasad SK, Khan M, Pennell DJ. J Cardiovasc Magn Reson. 2006;8(3):417-26. PubMed PMID:16755827
	Gender differences and normal left ventricular anatomy in an adult population free of hypertension: A cardiovascular magnetic resonance study of the Framingham Heart Study Carol J Salton, BA; Michael L Chuang, ScM; Christopher J O’Donnell, MD, MPH, FACC; Michelle J Kupka, MA; Martin G Larson, ScD; Kraig V Kissinger, BS, RT, (MR) (R); Robert R Edelman, MD; Daniel Levy, MD, FACC; Warren J Manning, MD, FACC J Am Coll Cardiol. 2002;39(6):1055-1060. doi:10.1016/S0735-1097(02)01712-6
		a) Left atrium size
		Normal Human Left and Right Ventricular and Left Atrial Dimensions Using Steady State Free Precession Magnetic Resonance Imaging Hudsmith, Lucy E., Petersen, Steffen E., Francis, Jane M., Robson, Matthew D. and Neubauer, Stefan Journal of Cardiovascular Magnetic Resonance, 7: 5, 775 — 782, First published on: 01 October 2005
		Reference left atrial dimensions and volumes by steady state free precession cardiovascular magnetic resonance Alicia M Maceira, Juan Cosín-Sales, Michael Roughton, Sanjay K Prasad and Dudley J Pennell Journal of Cardiovascular Magnetic Resonance 2010, 12:65 doi:10.1186/1532-429X-12-65
		Determination of normal gender-specific left atrial dimensions by cardiovascular magnetic resonance imaging. Sievers B, Kirchberg S, Franken U, Bakan A, Addo M, John-Puthenveettil B,Trappe HJ. J Cardiovasc Magn Reson. 2005;7(4):677-83. PubMed PMID: 16136858.
		Normal systolic and diastolic functions of the left ventricle and left atrium by cine magnetic resonance imaging Tseng WY, Liao TY, Wang JL. J Cardiovasc Magn Reson. 2002;4(4):443-57. PubMed PMID: 12549232.
		Atrial dimensions in health and left ventricular disease using cardiovascular magnetic resonance Anderson JL, Horne BD, Pennell DJ. J Cardiovasc Magn Reson. 2005;7(4):671-5. PubMed PMID: 16136857.
		b) Right ventricular wall thickness and size
		Normal Human Left and Right Ventricular and Left Atrial Dimensions Using Steady State Free Precession Magnetic Resonance Imaging Hudsmith, Lucy E., Petersen, Steffen E., Francis, Jane M., Robson, Matthew D. and Neubauer, Stefan Journal of Cardiovascular Magnetic Resonance, 7: 5, 775 — 782, First published on: 01 October 2005
		Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance Alicia M. Maceira, Sanjay K. Prasad, Mohammed Khan, and Dudley J. Pennell Eur Heart J first published online November 6, 2006 doi:10.1093/eurheartj/ehl336
		Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A, Weinsaft JW, Shaw LJ, Berman DS, Callister TQ, Min JK. JACC Cardiovasc Imaging. 2008 Nov;1(6):782-6.
		c) Right atrial size
		Reference right atrial function determined by steady-state free precession cardiovascular magnetic resonance Sievers B, Addo M, Breuckmann F, Barkhausen J, Erbel R. J Cardiovasc Magn Reson. 2007;9(5):807-14. PubMed PMID:17891619
		Right atrial function: still underestimated in clinical cardiology L. H. B. Baur Int J Cardiovasc Imaging. 2008 October; 24(7): 711–712. Published online 2008 May 30. doi: 10.1007/s10554-008-9322-4PMCID: PMC2522296 d) Diameter of the thoracic aorta


		Current Perspective: Coronary Anomalies: Incidence, Pathophysiology, and Clinical Relevance Paolo Angelini, José Antonio Velasco, and Scott Flamm Circulation. 2002;105:2449-2454, doi:10.1161/01.CIR.0000016175.49835.57
		Aortic root measurement by cardiovascular magnetic resonance: specification of planes and lines of measurement, and corresponding normal values Elisabeth D. Burman, Jennifer Keegan, and Philip J. Kilner Circ Cardiovasc Imaging. 2008;CIRCIMAGING.108.768911published online before print July 30 2008, doi:10.1161/CIRCIMAGING.108.768911
		Normal Thoracic Aorta Diameter on Cardiac Computed Tomography in Healthy Asymptomatic Adult; Impact of Age and Gender Song Shou Mao, MD, Nasir Ahmadi, MPH, Birju Shah, M.B.B.S, Daniel Beckmann, BS, Annie Chen, BS, Luan Ngo, BS, Ferdinand R Flores, BS, Yan lin Gao, MD, and Matthew J Budoff, M.D. Acad Radiol. 2008 July; 15(7): 827–834. doi: 10.1016/j.acra.2008.02.001 PMCID: PMC2577848
		Assessment of the thoracic aorta by multidetector computed tomography: Age- and sex-specific reference values in adults without evident cardiovascular disease (Abstract) Fay Y. Lin, Richard B. Devereux, Mary J. Roman, Joyce Meng, Veronica M. Jow, Avrum Jacobs, Jonathan W. Weinsaft, Leslee J. Shaw, Daniel S. Berman, Amanda Gilmore, Tracy Q. Callister, James K. Min Journal of Cardiovascular Computed Tomography – September 2008 (Vol. 2, Issue 5, Pages 298-308, DOI: 10.1016/j.jcct.2008.08.002)

Anatomy of the heart and great vessels

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