MDCT ANATOMY OF HEART

MDCT ANATOMY OF HEART
Dr. Muhammad Bin Zulfiqar

PGR IV FCPS Services Institute of
Medical Sciences / Hospital
radiombz@gmail.com
Scheme
• Technique
– Heart planes
– Projections
– Views / Projections
• On basis of chambers
• On basis of views
• Anatomy
– Cardiac Chambers Morphology
– Valve Morphology
– Aorta Morphology
– Coronary Arteries Anatomy
– Cardiac Veins Anatomy
– Anatomy of Pericardial Sinuses
• Major Anomalies of Coronary Circulation
Anatomy of Heart
• The heart is pyramidal in shape and lies obliquely
in the chest.
• Its square-shaped base points posteriorly and the
elongated apex to the left and inferiorly.
• The left atrium forms the base or posterior part,
with the superior and inferior pulmonary veins
draining into its four corners.
• The right atrium forms the right border, with
superior and inferior vena cava draining into its
upper and lower parts.
• The apex and left border are formed by the left
ventricle.
Anatomy of Heart
• The right ventricle forms the anterior part.
• The inferior (diaphragmatic) part of the heart is
formed by both ventricles anteriorly and a small
part of right atrium posteriorly where the IVC
enters this chamber.
• The oblique orientation of the heart causes the
ventricles to lie anterior and inferior to the atria.
• The heart is also rotated in a clockwise fashion
about its axis, so that the right atrium and
ventricle are at a slightly higher level than their
left counterparts.
Anatomy of Heart
• The interatrial and interventricular septa are said
to lie in the left anterior oblique plane. This
means that the long axis of the septa runs
anteriorly to the left.
• The tricuspid and mitral valves, which separate
the right and left atria and ventricles respectively,
are roughly vertically oriented. The plane of the
valves is also inclined inferiorly and to the left.
This means that the transverse axis of the pair of
valves runs to the right and anteriorly, and they
are said to lie in the right anterior oblique plane.
Standard Versus heart body planes
• Standard body (a) versus heart planes

(b). The heart may be viewed in three
standard anatomic planes: transaxial (Ax),
coronal (Cor), and sagittal (Sag). The
three major planes of the heart include
short axis (SAX), horizontal long axis
(four chamber, 4ch), and vertical long axis
(two chamber, 2ch). Although these planes
are perpendicular to one another, the body
planes transect the heart obliquely, while
the heart planes transect the body Revisiting Cardiac Anatomy
obliquely. A Computed-Tomography-Based Atlas and Reference
Continued
• Standard body (a) versus heart planes (b). The heart may
be viewed in three standard anatomic planes: transaxial
(Ax), coronal (Cor), and sagittal (Sag). The three major
planes of the heart include short axis (SAX), horizontal long
axis (four chamber, 4ch), and vertical long axis (two
chamber, 2ch). Although these planes are perpendicular to
one another, the body planes transect the heart obliquely,
while the heart planes transect the body obliquely.
Revisiting Cardiac Anatomy

A Computed-Tomography-Based Atlas and Reference Continued
• Standard body (a) versus heart planes (b). The heart may
be viewed in three standard anatomic planes: transaxial
(Ax), coronal (Cor), and sagittal (Sag). The three major
planes of the heart include short axis (SAX), horizontal long
axis (four chamber, 4ch), and vertical long axis (two
chamber, 2ch). Although these planes are perpendicular to
one another, the body planes transect the heart obliquely,
while the heart planes transect the body obliquely.
Revisiting Cardiac Anatomy
A Computed-Tomography-Based Atlas and Reference
Radiographic Projections in MDCT
CA
• Radiographic projections are shown. All images are obtained with a

64-slice MDCT with three-dimensional reconstruction.
Postprocessing is performed to show the relationship of the heart to
the thoracic cage. Angiographic projections show the relation of the
coronary arteries to the cardiac chambers. LAO, left anterior oblique
projection; RAO, right anterior oblique projection.
CA

CA

CA

CA
• Radiographic projections are shown. All images are

obtained with a 64-slice MDCT with three-dimensional
reconstruction. Postprocessing is performed to show the
relationship of the heart to the thoracic cage. Angiographic
projections show the relation of the coronary arteries to the
cardiac chambers. LAO, left anterior oblique projection;
RAO, right anterior oblique projection.
CT Angiography Views /
Projections
• CT angiography views. The ventricular surfaces are shown is

relation to the thorax (body) and the heart itself. A, anterior;
dotted yellow line, interventricular groove; L, lateral; LV, left
ventricle; P, posterior; RV, right ventricle.
• Figure 1.5 The margins of the heart. The acute margin is applied
to the right ventricle (RV) only between the sternocostal (A,
anterior) and diaphragmatic (I, inferior) surfaces. In an anterior
view, the acute margin forms the lower border and the right atrium
forms the right lateral border of the heart. The term “obtuse margin”
denotes the posterolateral aspect of the left ventricle and atrium. It is
defined as the junction between the lateral (L) and posterior (P)
walls of the left ventricle (LV). In left anterior oblique (LAO)
projection view, it forms the left border of the heart. Obtuse margin
is a critical anatomic landmark, and in many instances, an artery
(obtuse marginal, a branch of the LCx artery) runs along it.
• Figure 1.5 The margins of the heart. The acute margin is applied to the
right ventricle (RV) only between the sternocostal (A, anterior) and
diaphragmatic (I, inferior) surfaces. In an anterior view, the acute margin
forms the lower border and the right atrium forms the right lateral border of
the heart. The term “obtuse margin” denotes the posterolateral aspect of the
left ventricle and atrium. It is defined as the junction between the lateral (L)
and posterior (P) walls of the left ventricle (LV). In left anterior oblique
(LAO) projection view, it forms the left border of the heart. Obtuse margin
is a critical anatomic landmark, and in many instances, an artery (obtuse
marginal, a branch of the LCx artery) runs along it.
Atrial Epicardial Views
• Atrial epicardial views. When viewed from the top
(superior), the cavity of the right atrium is
positioned to the right and anterior, while the left
atrium is situated to the left and mainly posteriorly.
On the posterior view, the anatomic boundaries of
structures arising from the sinus venosus (SV) of
the right atrium are shown (shaded area). Lower
images are right and left lateral views of the heart.
The dominant feature on the right side is a large,
triangular shaped, atrial appendage. Terminal
groove (TG) is between sinus venosus and RAA
(small arrows). Note the sinoatrial node (SAN)
artery running in this groove. The left atrial
appendage (LAA) is a small lobulated structure. It
is a potential site for deposition of thrombus owing
to its trabeculated margin and narrow neck (green
arrows). AA, ascending aorta; CS, coronary sinus;
IVC, inferior vena cava; LA, left atrium; LIPV, left
inferior pulmonary vein; LSPV, left superior
pulmonary vein; LV, left ventricle; RA, right
atrium; RAA, right atrial appendage; RIPV, right
inferior pulmonary vein; RSPV, right superior
pulmonary vein; SANa, sinoatrial node artery;
SVC, superior vena cava.
• On the posterior view, the
anatomic boundaries of
structures arising from the
sinus venosus (SV) of the
right atrium are shown
(shaded area).
• Right and left lateral views of the heart. The
dominant feature on the right side is a large,
appendage (LAA) is a small lobulated structure.
It is a potential site for deposition of thrombus
owing to its trabeculated margin and narrow
neck (green arrows). AA, ascending aorta; CS,
coronary sinus; IVC, inferior vena cava; LA,
left atrium; LIPV, left inferior pulmonary vein;
LSPV, left superior pulmonary vein; LV, left
ventricle; RA, right atrium; RAA, right atrial
appendage; RIPV, right inferior pulmonary
vein; RSPV, right superior pulmonary vein;
SANa, sinoatrial node artery; SVC, superior
vena cava.
• Right and left lateral views of the heart. The
dominant feature on the right side is a large,
appendage (LAA) is a small lobulated structure.
It is a potential site for deposition of thrombus
owing to its trabeculated margin and narrow
neck (green arrows). AA, ascending aorta; CS,
coronary sinus; IVC, inferior vena cava; LA, left
atrium; LIPV, left inferior pulmonary vein;
LSPV, left superior pulmonary vein; LV, left
ventricle; RA, right atrium; RAA, right atrial
appendage; RIPV, right inferior pulmonary vein;
RSPV, right superior pulmonary vein; SANa,
sinoatrial node artery; SVC, superior vena cava.
Cardiac Crux
• External cardiac crux is an area in the
posterior aspect of the heart where
cardiac chambers show their maximum
proximity (arrow). This area is filled
with fat. The vertical and horizontal
lines in the cardiac crux are not
perpendicular (green lines). As seen in
this inferior view of the heart, the
interatrial groove meets the left
atrioventricular groove at right angle,
and the interventricular and the right
atrioventricular grooves are
perpendicular. The right atrioventricular
(AV) groove is inferior to the left AV
groove due to inferior position of the
septal leaflet of tricuspid relative to the
mitral valve. LA, left atrium; LV, left
ventricle; RA, right atrium; RV, right
ventricle.
Cardiac
Morphology
Four Chamber View
• Four-chamber view in diastole.
• The four-chamber view is obtained in a
plane that passes through both the mitral
and tricuspid valves and demonstrates the
cardiac apex.
• The open mitral valve (arrowheads) is
identified between the left atrium (LA), and
left ventricle (LV).
• The tricuspid valve is present between the
right atrium (RA), and right ventricle (RV)
but is not well visualized because a saline
flush was used to clear contrast out of the
right side of the heart.
• The cardiac apex is formed by the tip of the
left ventricle (arrow). Although the RV
volume is slightly greater than the LV
volume, the width of the LV appears greater
on the four-chamber view.
Four Chamber View
• Four-chamber view in
systole. The ventricles
have contracted and
appear smaller. The mitral
valve is in a close position
(arrowheads).
• The atria appear larger at
end systole because atrial
filling occurs during
systole.
Three Chamber View
• Three-chamber view. (A) End diastole. The left atrium (LA), left
ventricle (LV), and proximal ascending aorta are visualized. This
projection is obtained by setting a center of rotation on the mitral–
aortic intervalvular fibrosa. The image is then rotated to demonstrate
both valves and to elongate the LV. The size of the LV chamber is
measured at the level of the chordal insertions on the mitral leaflets
Three Chamber View
• End systole. The LV has contracted. The LA is slightly

larger during systole, but it is clearly within normal
limits. The aortic and mitral valves are suboptimally
visualized because of systolic heart motion
Three Chamber View
• End diastole: The LV chamber size is measured

just below the open mitral valve. The aortic valve
is in a closed position. The aortic root is measured
above the level of the aortic valve
Three Chamber View
• End systole. The LV has now contracted, and the mitral valve is in
the closed position. A calcification is identified in the posterior
mitral annulus (arrowhead).
• Posterior mitral annular calcification is a common finding. LA size
is measured in the three-chamber view at end systole at the level of
the aortic root. The LV outflow tract (LVOT) is marked below the
level of the aortic valve (bar).
Three Chamber View
• Short-axis view of the
LVOT with
anteroposterior and
transverse
measurement (bars).
• The LVOT often has a
mildly oval shape.
Two Chamber View
• Two-chamber view obtained by setting a center of rotation on

the mitral valve and rotating the heart so that the right ventricle and
aorta are no longer visible.
• As with the four-chamber and three-chamber views, rotation is
performed to elongate the left ventricle (LV) and display the apex of
the heart.
Two Chamber View
• Two-chamber view in systole. The mitral

valve is now closed. LA, left atrium.
Five Chamber View
• Five-chamber view in
diastole. The four-
chamber view is angled
cranially to display the
root of the aorta (black
arrowhead) in addition to
the four cardiac chambers.
• Posterior mitral annular
calcification is identified
(white arrowhead).
Five Chamber View
• (B) Five-chamber
view in systole. RV,
right ventricle; RA,
right atrium; LA, left
atrium; LV, left
ventricle.
Atrial Appendages
• Atrial appendages. (A)
Surface-rendered
image in the left
anterior oblique
projection demonstrates
the left atrial appendage
(*).
• The left atrial appendage
often obscures the
underlying proximal
circumflex and left main
coronary arteries.
Atrial Appendages
• (B) Surface-
rendered view in the
anterior projection
demonstrates the right
atrial appendage (*).
The right coronary
artery is clearly
visible in this case
just below the atrial
appendage.
Atrial Appendages
• Atrial appendages.
• Left anterior oblique
surface-rendered image
demonstrates the left
atrial appendage
(arrowhead), which
overlies the origin of both
the circumflex and left
anterior descending
arteries.
Atrial Appendages
• (B) Anterior surface
rendered projection
demonstrates the
right atrial appendage
(arrowhead), which
overlies the origin of
the right coronary
artery.
Right Atrium
• Eustachian valve—valve of IVC

– Located at junction of IVC + RA
– Directs blood from IVC to foramen ovale in fetus
– Thin linear structure, not routinely imaged
• Crista terminalis
– Line of fusion between anterior trabeculated
portion + smooth-walled posterior portion of RA
– Vertically oriented smooth muscular ridge
Right Atrial Anatomy
• Right atrial anatomy:
crista terminalis and
pectinate muscles.
• Four-chamber view at
the level of the fossa
ovalis (arrow)
demonstrates the crista
terminalis as a ridge
along the right side of
the right atrium
(arrowhead
• Axial maximum
intensity projection
through the superior
right atrium and atrial
appendage demonstrates
continuation of the crista
terminalis (arrowhead)
to the level of the
appendage as well as
pectinate muscle
bundles (arrow) within
the appendage.
• Right ventricular (RV)
inflow view demonstrates
continuity of the crista
terminalis (arrowheads) from
the lower portion of the right
atrium adjacent to the inferior
vena cava (IVC) orifice up to
the atrial appendage.
• Unopacified blood enters the
right atrium from the IVC
(arrow).
• Endoluminal view
demonstrates the
crista terminalis
(arrowheads) as it
passes adjacent to the
superior vena cava
(SVC) and passes into
the base of the right
atrial appendage
(RAA).
Left Atrium
• Ridge of smooth muscle (±bulbous tip) at

junction of left atrial appendage and entrance
of left superior pulmonary vein
Left Atrium
• Normal left atrium measurements. (A) Three-

chamber view in systole demonstrates the proper
position to measure the left atrium at the level of
the aortic root.
Left Atrium
• Four-chamber view
demonstrating
measurement of left
atrial area in a
different patient. The
left atrium is top
normal in size.
Interatrial Septum
• Thin septum, difficult to image

– may contain small amount of fat sparing fossa
ovalis
– DDx: Lipomatous hypertrophy of interatrial
septum
• Characteristic dumbbell shape due to sparing of fossa
ovalis
• Abnormal amount of fat in older / obese adults
Interatrial Septum
demonstrates a focal
thinning of the
interatrial septum
corresponding to the
fossa ovalis (arrow).
Cardiac Valves
Cardiac Valves
• Left Heart Valves
– Aortic Valve
– Mitral Valve
• Right Heart Valves
– Tricuspid Valve
– Pulmonary Valve
Aortic Valve
• Semilunar valve with usually 3 (range, I to 4)
thin cusps
a) Right cusp: inferior to right coronary sinus
+origin of RCA
b) Left cusp: inferior to left coronary sinus + origin
of LCA
c) Posterior I noncoronary cusp
• Area: 2.5 -4.0 cm2
Aortic Valve
• Short-axis view of the
aortic valve during
diastole. The three cusps
of the aortic valve are
defined by the
commissures that separate
the right (R), left (L), and
noncoronary (N) cusps.
Aortic Valve
• Short-axis image of the
tricuspid aortic valve
during systole demonstrates
a triangular opening as the
three cusps separate along
their commissures. The
right ventricular outflow
tract crosses anterior to the
aorta at the level of the
aortic valve.
Aortic Valve
• Using a slightly
different angulation,
the right ventricular
outflow tract is
demonstrated
(arrowhead) with the
pulmonic valve
(arrow). The left
atrium (LA) is
posterior to the aortic
valve.
Mitral Valve
• Bicuspid valve anchored on mitral valve
annulus connected to LV papillary muscles by
chordae tendineae
– semicircular anterior leaflet
– crescentic posterior leaflet
• Area: 4-6 cm2
• Circumference: 10 cm
Mitral Valve
• Normal mitral valve.
• Three-chamber view of the left
ventricle during systole
demonstrates a calcified aortic
valve (arrow) with normal
closure of the mitral valve
(arrowhead).
• There is complete coaptation of
the mitral leaflets. The mitral
valve leaflets close up to the
plane of the mitral annulus but do
not extend beyond that plane into
the left atrium
Mitral Valve
• Diastolic image
demonstrates normal
opening of the
• mitral valve (arrowheads).
Papillary muscles are not
generally visible on
• the three-chamber view
through the left ventricle
and mitral valve.
Mitral Valve
• Two-chamber view during
systole demonstrates the
papillary muscles (arrows), as
well as the chordal attachments
to the mitral valve
(arrowheads). Once again, the
mitral valve closes to the
annulus but does not extend
above the plane of the mitral
annulus.
Mitral Valve
• Diastolic view
demonstrates the papillary
muscles (arrows), as well as
the open mitral leaflets
(arrowheads). The chordal
attachments are not well
visualized in this view.
• A patent stent is present in
the circumflex artery (white
arrowhead).
Mitral Valve
• Short-axis image through the mitral valve demonstrates normal

thickness of the open mitral valve. The anterior leaflet (black
arrowheads) and the posterior leaflet (white arrowheads)
demonstrate a thin undulating contour.
• A normal mitral valve area is demonstrated by planimetry with an
area of 4.6 cm2.
Right Heart Valves
• Tricuspid Valve: Right atrioventricular valve
anchored on tricuspid valve annulus+ connected to
RV papillary muscles by chordae tendineae and
composed of 3 (range, 2 to 4) leaflets
– Septal leaflet
– Anterior leaflet
– Posterior leaflet
Right Heart Valves
• Pulmonic Valve: Semilunar valve composed
of 3 cusps
– Anterior cusp
– Right cusp
– Left cusp
• Area: 2.0 cm2 / m2 of body surface area
Right Heart Valves
• Evaluation of the right-sided cardiac
valves.
• Short-axis image through the aortic
valve demonstrates the right ventricular
outflow tract as it crosses anterior to the
aorta (*).
• The tricuspid valve is at the 10 o’clock
location (arrowheads);
• the pulmonic valve is at the 2 o’clock
position (arrow).
• The right-sided valves are of normal
thickness.
• A combination of a dense contrast
material, streak artifact, and unopacified
saline in the right atrium combine to
obscure visualization of the adjacent
tricuspid valve (arrowheads).
Right Heart Valves
• Four-chamber view during
diastole demonstrates normal
opening of the mitral (arrows) and
tricuspid (arrowheads) valves.
• The tricuspid valve is poorly
visualized secondary to the
presence of a mixture of dense
contrast from the superior vena
cava and unopacified flow from the
inferior vena cava into the right
atrium. Normal trabeculations in
the right ventricle further limit
visualization of the tricuspid valve.
Tricuspid Valve
• Normal tricuspid
anatomy.
demonstrates low-level
heterogeneous
opacification of the
right side of the heart
with suboptimal
visualization of the
normal tricuspid valve
(arrowheads).
Tricuspid Valve
• Four-chamber view in a
different patient with
homogeneous
enhancement of the right
side of the heart and
excellent visualization of
the tricuspid valve
(arrowheads). This
patient has a St. Jude’s
mitral valve with a
dilated left atrium.
Left Atrium
• Conventional left atrial
anatomy (LAA).
• Surface image
demonstrates the posterior
wall of the left atrium
with associated
pulmonary veins. The
pulmonary arteries have
not been removed
(arrows) and do obscure
the pulmonary veins.
Left Atrium
• The pulmonary
arteries have been
removed, and the four
pulmonary veins are
clearly identified
(arrows
Left Atrium
• Endoluminal view
demonstrates four
pulmonary veins
(arrows).
• The ridge that separates
the two left-sided
pulmonary veins from the
left atrial appendage is
clearly defined
(arrowheads).
Left Atrium
• Conventional left
atrial anatomy.
• Surface image
demonstrates four
pulmonary veins
(arrows).
• There is a superior and
an inferior pulmonary
vein on each side.
Left Atrium
• Endoluminal view of the left side of the left atrium demonstrates

the left pulmonary veins (large arrows), separated from the left
atrial appendage (small arrow) by a ridge (arrowheads).
• Endoluminal evaluation of the right side of the atrium clearly
demonstrates two separate right pulmonary veins (arrows).
Left Atrium
• Relationship of pulmonary veins
to mitral annulus. (A)
Endoluminal view looking
posteriorly–inferiorly from the
anterior–superior aspect of the left
atrium demonstrates the right-
sided pulmonary veins (arrows).
• The left pulmonary veins are
blocked from view by the ridge
(arrowhead) that separates these
veins from the left atrial
appendage. The mitral valve
(MV) is located anterior–inferior
to this ridge
Left Atrium
• Endoluminal view of the
left side of the left atrium
pulmonary veins
(arrows), separated from
the left atrial appendage
(LAA) by a ridge
(arrowheads). The MV is
anterior–inferior to the
pulmonary veins and
closer to the inferior
pulmonary veins.
Left Atrium
• The left atrial
appendage and
relationship of the
pulmonary veins (PVs) to
the esophagus.
• Surface view
atrial appendage (arrows),
which is anterior to the
superior and inferior left
PVs (arrowheads).
Left Atrium
• Axial image through the left
atrium at the level of the
appendage demonstrates that
the appendage is anterior to the
upper left lobe pulmonary vein
and separated from the vein by
a thin ridge of tissue (black
arrowhead).
• The esophagus is immediately
posterior and contiguous with
the left atrium. In this case, the
wall of the esophagus is very
close to the orifice of the left
superior pulmonary vein as it
enters the left atrium.
Left Atrium
• At the level of the inferior
pulmonary veins, the
esophagus is directly posterior
to the left atrium. The wall of
the esophagus is quite close to
the orifice of both PVs as they
enter the left atrium.
• The ridge of tissue that
separates the superior
pulmonary vein from the left
atrial appendage continues
inferiorly, and although it is
smaller at this level, it is still
visualized (black arrowhead).
Aorta
ANATOMY OF AORTA
• (average diameter increases with age)

• Aortic root 3.6 cm
a) Aortic valve
b) Aortic valve annulus = firm fibrous band at
aortoventricular junction surrounding aorta +
valve leaflets
c) Aortic valve sinus = Valsalva sinus dilatation of
aortic root just above aortic valve
d) Sinotubular Junction
ANATOMY OF AORTA
• 2. Ascending aorta (1 cm proximal to arch)

3.5 cm
• Location: aortic root origin of right
brachiocephalic artery
• Diameter: always <4 cm at any age
– Mid ascending aorta = midpoint between
sinoaortic junction + proximal aortic arch
•
ANATOMY OF AORTA
• Aortic arch 2.9 cm

• Location: right brachiocephalic artery attachment of
ligamentum arteriosum
• Proximal aortic arch: right brachiocephalic artery left
subclavian artery
• aorta @ origin of brachiocephalic trunk
• Midaortic arch just distal to left CCA
• Distal arch= aortic isthmus:
• left subclavian artery attachment of ligamentum
arteriosum
ANATOMY OF AORTA
• Descending thoracic aorta

– Location: attachment of ligamentum arteriosum to
aortic hiatus at diaphragm
• Diameter: always <3 cm at any age
a) Proximal descending aorta: ........... 2.6 cm
– 2 cm distal to left subclavian artery
b) Middescending aorta: .....................2.5 cm
c) Distal descending aorta: .......... . .....2.4 cm
• @ diaphragm= 2 cm above celiac axis origin
Aorta
• Segments of the thoracic aorta.
• The aortic root is visualized with
three sinuses of Valsalva and the
origin of the right coronary artery
from the anterior sinus (arrow).
• The ascending aorta extends from
the sinotubular junction to the
origin of the innominate artery.
• The arch is divided into a proximal
segment that extends to the origin
of the left subclavian artery and a
distal segment that extends to the
ligamentum arteriosum.
• The mild dilatation of the
descending aorta beyond the aortic
isthmus is known as the aortic
spindle. PA, pulmonary artery
Aorta
• The normal proximal aorta
demonstrates a tapered waist at the
sinotubular junction (black arrowhead).
Measurements of the proximal aorta
include the diameter of the annulus at
the level of the aortic valve (white
arrowhead), the diameter of the root at
the sinuses of Valsalva (white arrow),
and the diameter of the aorta at the
sinotubular junction (black arrowhead).
• Although the coronary arteries
normally originate just below the
sinotubular junction, the origin of the
left coronary artery in this patient
(black arrow) is just superior to the
sinotubular junction.
Aorta
• Measurements of the
aortic root are
demonstrated at the
aortic annulus (27.6
mm), the aortic root
(34.4 mm), and the
sinotubular junction
(26.5 mm).
Aorta
• Measurements of the
aortic root and ascending
aorta in a different
patient demonstrate a top
normal-size root (38.5
mm) and a mildly dilated
ascending aorta (42.3
mm). A tapered diameter
is measured at the
(35.4 mm).
Aorta
• Short-axis measurement
of the ascending aorta in
the same previous patient
demonstrates aneurismal
dilatation to 4.3 4.4 cm.
Inset in the bottom right
corner demonstrates
angulation used to obtain
short-axis measurement.
Aortic Root
• Aortic root, including aortic
valve, sinuses of Valsalva, and
sinotubular junction.
• Sagittal maximum intensity
projection (MIP).
• There is a normal dilatation of
the aortic root related to the
sinuses of Valsalva (arrows).
The sinotubular junction is
marked by a caliber change
just above the aortic root
(arrowheads).
Aortic Root
• Axial MIP at the level of the aortic
valve. The root demonstrates a
cloverleaf shape with three sinuses
of Valsalva named for their coronary
arteries: R, right, L, left, and N,
noncoronary.
• The commissures of the aortic valve
are visible (black arrowheads) as is
the pulmonary valve (white
arrowhead).
• The commissure between the right
and left aortic leaflets is aligned
with an adjacent commissure in the
pulmonic valve.
Aortic Root
• Axial MIP at a slightly
higher level again
demonstrates the
cloverleaf shape of the
aortic root.
Aortic Root
• Axial MIP just below
the sinotubular
junction demonstrates
normal origins of the
coronary arteries from
the center of the right
(white arrow) and left
(black arrow)
coronary sinuses.
Aortic Root
• Slab MIP in the left
anterior oblique
projection. The right
(RCA) and left (LCA)
coronary arteries
originate from the sinuses
of Valsalva, just below
the level of the
(arrows).
Aortic Root
• The coronary origins in a
different patient
demonstrate a shepherd’s
crook curvature of the
proximal RCA (arrowhead).
• A shepherd’s crook proximal
RCA is a common variation
(approximately 5%) that
may present as a technical
challenge during angioplasty
Aortic Root
• Slab MIP of the
RCA in another
patient with a more
obvious shepherd’s
crook (arrowhead).
Aortic Root
• Axial MIP in a patient
with independent origins of
the conus artery (black
arrowhead) and RCA
(white arrow). The origin
of the RCA is shifted
toward the right.
• While the conus artery and
the LCA (black arrow)
originate from the center of
their respective sinuses.
Aortic Root
• Axial MIP in a patient
with bicuspid aortic
valve. Only two sinuses
of Valsalva are present.
Both coronary arteries
arise from the anterior-
left sinus. The RCA
(white arrow) originates
at an acute angle from
the aortic root.
•
Coronary Arteries
Anatomy of Coronary Arteries
• Right Coronary Artery: Arises from anterior
right coronary sinus; travels within right
atrioventricular sulcus; rounds the acute
margin of the heart
• Left Coronary Artery: Arises from left
posterior coronary sinus
• Left main coronary artery (LM) 0.5-2.0 cm
short stem before bi / trifurcation
17 Segment Classification by AHA
Right Coronary Artery Anatomy
AHA American Heart Association

17 Segment Classification by AHA
Left Coronary Artery Anatomy
Right Coronary Artery
1. Conus artery (CB)
– First branch from RCA (in 50% directly from aorta) to supply RVOT
2. Sinoatrial node artery (SANA)
– 2nd branch from RCA (in >50%)
3. Acute / RV marginal branches (Ml, M2, etc)
– Have an anterior course
4. Posterior descending artery (PDA)
– Originates from RCA near crux or from a distal acute marginal
branch; supplies posterior third of ventricular septum +diaphragmatic
segment of LV; supplies blood to posteromedial papillary muscle
5. Atrioventricular node artery (AVNA)
– Small branch to AV node
6. Posterolateral segment arteries (PLSA)
– Supplies posterolateral wall of LV
Right Coronary Angiogram
• Surface image in a
shallow left anterior
oblique (LAO)
projection
coronary artery (RCA)
(black arrowhead)
coursing along the
right atrioventricular
(AV) groove.
• MIP image in the LAO
the RCA (black
arrowhead), coursing in a
classic “C” shape toward
the crux of the heart.
• In this patient, the RCA
bifurcates into the
posterior descending
artery and a posterior left
ventricular branch
proximal to the crux.
• Globe MIP
demonstrates the
RCA (black
arrowhead) within
the AV groove
adjacent to the right
atrium.
• Right coronary artery
(RCA) and posterior
descending artery (PDA)
in surface rendered image.
• The RCA courses in the
right atrioventricular
groove (arrow) to the crux
of the heart.
• The PDA arises from the
RCA at the crus and
courses down the posterior
interventricular groove
(arrowhead).
• Right coronary artery (RCA)
and posterior descending artery
(PDA) in maximum intensity
projection (MIP).
• The classic “C” shape of the
RCA is demonstrated in a
curved MIP LAO projection.
The vessel narrows in caliber at
the crux of the heart (arrow),
where it bifurcates into the PDA
(arrowhead) and posterior left
ventricular branches (not
shown).
• Orthogonal MIP image
demonstrates the RCA
throughout its course to
the PDA.
Anatomy of Left Coronary Artery
(LCA)
• Arises from left posterior coronary sinus
• Left main coronary artery (LM)
– 0.5-2.0 cm short stem before bi- / trifurcation
• Left anterior descending (LAD)
– travels within anterior interventricular groove, gives
blood supply to anterolateral papillary muscle
• (a) Diagonal branches (Dl, D2, etc)
– arise from LAD and course over anterolateral wall of
LV
• (b) Septal branches (S)
– for anterior interventricular septum
Anatomy of Left Coronary Artery
(LCA)
• Left circumflex artery (LCx)
– travels within left atrioventricular sulcus;
terminates at obtuse margin of heart
• (a) Obtuse marginal branches (OMl, OM2, etc)
for lateral wall of LV
• (b) Left atrial circumflex artery (LACX) for
atrium
Right and Left Coronary Angiogram
Left Coronary Artery
• Left coronary artery anatomy.
Volumetric surface rendering
demonstrates the course of the
left main coronary artery
between the right ventricular
outflow tract (RVOT) and left
atrium (LA).
• The left main coronary artery
bifurcates into the left anterior
descending (LAD) (black arrow)
and circumflex (white arrow)
arteries.
• A diagonal branch (black
arrowhead) arises from the LAD.
The circumflex terminates as an
obtuse marginal branch (white
arrowhead).
• Globe MIP
demonstrates the LAD
in the anterior
interventricular groove
and the circumflex in
the left atrioventricular
groove.
• Curved MIP
demonstrates the entire
length of the LAD as it
courses along the anterior
interventricular groove to
the apex of the left
ventricle.
Coronary Artery Territory
• Septum LAD
• anterior wall LAD
• lateral wall LCx
• posterior wall RCA
• inferior / diaphragmatic wall RCA
• apex + inferolateral wall watershed areas
Coronary Artery Dominance
• determined by the artery that crosses the crux

and serves as origin of the posterior
descending artery (PD), which supplies the
inferior portion of LV:
– from RCA in 85% (=right dominance)
– from LCx in 8% (=left dominance)
– RCA+ LCA = codominance I balanced supply
(7%)
Right Dominant Circulation
Normal Dominant RCA
• Normal right-dominant
coronary circulation.
• Surface-rendered image
in a steep left anterior
oblique (LAO) projection
demonstrates the
bifurcation of the left main
coronary artery (white
arrow) into the left
anterior descending
• (black arrow) and
circumflex (black
arrowhead) arteries.
Continued
Normal Dominant RCA
• Right anterior oblique
the right coronary artery
(RCA) (arrow) as it
courses in the right
atrioventricular groove.
The proximal portion of
the RCA is obscured by
the overlying right atrial
appendage (white
arrowhead).
• A small acute marginal
branch of the RCA is
demonstrated (black
arrowhead).
Continued
Normal Dominant RCA
• The heart is rotated
further so that the crus is
visible. The distal RCA
bifurcates into the
artery (black arrow),
which courses in the
posterior interventricular
groove
• posterior left ventricular
branch (white arrow).
• An acute marginal
branch is again identified
Dominant RCA
• Surface rendering at the
crux of the heart
demonstrates the bifurcation
of the right coronary artery
(white arrow) into a
posterior descending artery
(black arrow) and posterior
left ventricular branches
(black arrowheads).
• These branches arise from
the right coronary artery in a
right-dominant circulation.
Continued
Dominant RCA
crux of the heart
demonstrates the
bifurcation of the right
arrow) into a duplicated
artery (black arrows) and
• a large posterior left
ventricular branch
(black arrowhead)
Continued
Dominant RCA
crus of the heart in a third
patient demonstrates the
bifurcation of the right
arrow) into a duplicated
(black arrows) and
• a large posterior left
ventricular branch (black
arrowhead)
Left Dominant Circulation
Dominant Left Coronary Artery
• Surface-rendered image in
the left anterior oblique
projection demonstrates the
circumflex artery as it
courses through the left
atrioventricular (AV) groove
(white arrow).
• A ramus medianus (white
arrowhead) supplies the
lateral wall of the left
ventricle.
• The left anterior descending
artery (black arrow) courses
around the apex of the heart.
Continued
• The heart is rotated further so that
the crux is visible. The distal
circumflex artery (white arrow)
continues around the AV groove.
• The posterior wall of the left ventricle
is supplied by a posterolateral branch of
the circumflex (black arrowhead).
• The circumflex artery (white arrow)
terminates as a short posterior
descending artery (white arrowhead),
which supplies the basal inferoseptum.
• Termination of the circumflex artery as
the posterior descending artery is the
most common form of left-dominant
circulation.
• In this patient, a wraparound left
anterior descending artery (black
arrow) continues in the posterior
interventricular groove to supply the
distal posterior descending artery.
Continued
in the left anterior oblique
projection demonstrates a
large left anterior
descending artery (white
arrow) that courses
around the apex of the
heart. A small circumflex
artery is visible (white
arrowhead)
Continued
of the undersurface of
the heart demonstrates
that the left anterior
descending artery (white
arrow) wraps around the
apex and continues in the
posterior interventricular
groove as the posterior
descending artery.
• Neither the circumflex
nor the right coronary
artery is visible near the
crux of the heart
Continued
• Extracted tree view of the coronary
circulation in a steep left anterior
oblique projection demonstrates the
large left anterior descending artery
(white arrow), which wraps around
the apex of the heart.
• The right coronary artery origin is
visible (white arrowhead) with
several small branches. In this
uncommon variation of a left
dominant circulation, the left anterior
descending artery supplies the entire
posterior descending artery territory.
Co Dominant Circulation
Balanced Co Dominant Circulation
• Fig. 3.8 Balanced (co-
dominant) coronary
circulation.
• Surface rendered view in the
anteroposterior projection
demonstrates the left anterior
descending artery (white arrow)
as it courses in the anterior
interventricular groove. The
right coronary artery
(arrowhead) has a large conus
branch that supplies the free
wall of the right ventricle.
Continued
Balanced Co Dominant Circulation
• Posterior views of the left ventricle and the crux of the heart
demonstrate terminal branches of the circumflex artery, which supply
the inferolateral left ventricular wall (black arrowheads) as well as the
inferior wall (white arrowhead). The posterior descending artery
(arrow) arises from the right coronary artery.
Pericardial Sinuses and Recesses
• Extensions of pericardial cavity

A. Recesses of pericardial cavity proper
1. Postcaval recess . ..... . .. . .. . .. .. . .. . .. 23%*
behind and right lateral to SVC
2. Right pulmonic vein recess .... . .. . .. . . 29%*
3. Left pulmonic vein recess .. . ..... . ..... . 60%*
B. Transverse sinus posterior to ascending aorta and

pulmonary trunk+ above left atrium ........................
95%*
1. Superior aortic recess along ascending aorta; may be
divided into anterior, posterior, right lateral portion DDx:
aortic dissection on NECT
2. Left pulmonic recess below left pulmonary artery +
posterolateral to proximal right pulmonary artery
3. Right pulmonic recess below right pulmonary artery +
above left atrium
4. Inferior aortic recess between ascending aorta+ inferior
SVC / right atrium extending down to level of aortic
valve
C. Oblique sinus .............................. 89%*

– behind left atrium+ anterior to esophagus separated
from transverse sinus by double reflection of
pericardium (and fat) between right+ left superior
pulmonic veins
• Posterior pericardia! recess .... ........ ........ .. 67%*
– behind distal right pulmonary artery + medial to
bronchus intermedius
• DDx: lymph nodes, esophageal / thymic process,
vascular abnormality, pericardia] cyst I tumor
* =percentages give depiction on HRCT

• (Right) The anterior view of the heart with drawing of the fibrous (parietal) pericardium
around it (purple). (b) Drawing of the visceral pericardial sac (in red) around large vessels at
their cardiac origin after removal of heart. Superior attachment of the parietal pericardium is
again shown (in purple). The ascending aorta (AA) and main pulmonary artery (MPA) are
enclosed in one tube. The superior vena cava (SVC), inferior vena cava (IVC), and pulmonary
veins (PVs) are enclosed in other tube. Transverse sinus (T) is complex interconnecting
passage between these two tubes. Double layer of serous pericardium (arrow) separates
transverse sinus and oblique sinus. Components of the superior aortic recess anterior (1),
lateral (2), and posterior (3) to the aorta are shown. The oblique sinus (O) is located behind
the left atrium. Retrocaval recess (yellow star) is located between the SVC and the right
superior PV (RSPV). The left and right lateral recesses (green stars) are formed between
superior and inferior PVs.
LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RA, right atrium; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein;
RV, right ventricle.
Oblique Sinus
• The right lateral view
of the heart
demonstrates the
oblique sinus separated
from the transverse
sinus (T) by two layers
of pericardial
reflections that run
between the left and
right superior
pulmonary veins.
AA, ascending aorta; CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LIPV, left inferior pulmonary vein; LPA,
left pulmonary artery; LSPV, left superior pulmonary vein; RAA, right atrial appendage; RIPV, right inferior pulmonary vein;
RPA, right pulmonary artery; RSPV, right superior pulmonary vein; SVC, superior vena cava.
• Axial images of the heart at the level of the transverse sinus are shown.
Components of the superior aortic recess anterior (1), lateral (2), and posterior (3)
to the ascending aorta (AA) are evident. The left pulmonic recess (LPR) of the
transverse sinus is seen anterior to the left superior pulmonary vein (LSPV). Fold of
the ligament of Marshall (LOM) is seen deep in the LPR. A small retrocaval recess
(RCR) and the superior portion of oblique sinus (OS) are also seen. MPA, main
pulmonary artery; RPA, right pulmonary artery; RSPV, right superior pulmonary
vein; SVC, superior vena cava.
Coronary Venous Anatomy
Coronary Venous Anatomy
• Figure 20. (a) VR image shows the great cardiac vein (arrowheads)
coursing in the left AV groove. (b) VR image shows the CS (arrowheads)
coursing along the inferior surface of the heart and emptying into the RA.
In this case, the posterior vein of the LV (white arrow) is prominent and the
left marginal vein is absent. Black arrow indicates the posterior
interventricular vein. LA left atrium, RV right ventricle.
Coronary Artery Anomalies
• Anomaly of Origen
• Anomaly of Course
• Anomaly of Termination
Anomaly of Origin
1. High takeoff (6%) = origin of RCA I LCA above the

junctional zone between sinus + tubular part
2. Multiple ostia (a) RCA +conus branch arise
separately (b) LAD+ LCx arise separately without
LCA (0.41%)
3. Single coronary artery (0.0024-0.044%)
4. Anomalous origin from the pulmonary artery
5. Origin of coronary artery from opposite sinus /
noncoronary sinus
– RCA arising from left coronary sinus (0.03-0.17%)
– LCA arising from right coronary sinus (0.09-0.11%)
LCx / LAD arising from right coronary sinus (0.32-0.67%)
Continued
Anomaly of Origin
6. LCA / RCA arising from noncoronary sinus

• may take the following course:
– Interarterial (between aorta+ pulmonary trunk)
with a high risk of sudden cardiac death
– retroaortic
– prepulmonic
– septal (subpulmonic I beneath RVOT
Anomaly of Coronary Artery Course
1. Myocardial bridging = band of myocardial

muscle overlying a segment of a coronary
artery
2. Duplication of arteries, eg., LAD
Anomaly of Termination
1. Coronary artery fistula (0.1-0.2%) = communication

between coronary artery (RCA in 60%, LCA in 40%,
both in <5%) and cardiac chamber (RV in 45%, RAin
25%) I pulmonary artery (in 15%) / coronary sinus /
SVC
2. Coronary arcade = angiographically demonstrable
communication between RCA and LCA in the absence
of a coronary artery stenosis (prominent straight
connection near crux DDx: tortuous collateral vessel)
3. Extracardiac termination
– Cause: atherosclerotic CAD
– Receiver: bronchial, internal mammary,
pericardia!,anterior mediastinal, superior I inferior
phrenic, intercostal arteries
Ramus medianus
• Ramus medianus. (A)
Surface-rendered view
of the left coronary
circulation demonstrates a
trifurcation of the left
main coronary artery
(black arrow).
• The additional branch
that rises between the left
anterior descending artery
and the circumflex artery
is the ramus medianus
(white arrow).
Continued
Ramus medianus
• Globe maximum
demonstrates the
trifurcation of the left
main coronary artery
into the left anterior
descending artery,
circumflex, and ramus
(arrow).
Continued
Ramus medianus
• Surface- rendered
image at the crux
demonstrates that
the right coronary
artery supplies the
artery (black arrow).
Variations of left anterior
descending (LAD) anatomy.
• Absent distal LAD. Surface-
rendered view in the left anterior
oblique (LAO) projection
demonstrates the LAD (large arrow)
in the proximal anterior
interventricular groove. A large first
diagonal branch (arrowhead) arises
from the LAD and extends around
the cardiac apex.
• LAD persists as a small vessel
(small arrow) in the anterior
interventricular groove, but it
terminates proximal to the cardiac
apex. In this variation of normal
anatomy, the apex of the left
ventricle is supplied by a large
diagonal branch rather than the LAD
Continued
• Wraparound LAD in a
different patient. Tracked
maximum intensity
projection view of the LAD
demonstrates a normal
course of the LAD in the
anterior interventricular
groove (arrow). This vessel
continues around the apex
to supply the distal
(arrowhead).
• Fig. 3.11 Proximal
termination of the left
(LAD) related to extensive
atherosclerotic disease.
• The LAD (arrow) terminates
proximal to the cardiac apex
secondary to extensive
atherosclerotic disease in the
midportion of this vessel
(arrowhead). There is an
associated infarct of the left
ventricular apex. A septal
perforator branch is identified
(small arrow).
• Globe maximum
intensity potential
confirms extensive
calcification along the
LAD (large arrow) and
again demonstrates a
large septal branch
(small arrow).
Variant anatomy of the posterior
descending artery.
• Surface-rendered image in
an anteroposterior projection
coronary artery (RCA) in the
right atrioventricular groove
(arrow).
• A large proximal acute
marginal artery originates
from the RCA and courses
over the free wall of the right
ventricle (arrowhead).
Continued
Variant anatomy of the posterior
descending artery.
• Surface view of the distal
right coronary circulation
demonstrates the origin of the
(PDA) from the distal RCA at
the crux of the heart (arrow).
A second PDA is present in
the more distal posterior
interventricular groove,
originating from the acute
marginal branch of the RCA
(arrowhead).
Conus Artery
• Conus artery: Surface-
rendered image in an right
anterior oblique projection
coronary artery (RCA) in the
right atrioventricular (AV)
groove (white arrow).
• A small conus branch
• (black arrows) arises from
the proximal portion of the
RCA and courses across the
right ventricular outflow
tract.
Continued
Conus Artery
• (B) An independent
origin of the conus artery
(black arrow) is
immediately adjacent to
the RCA origin (white
arrow).
• The RCA courses into the
right AV groove below an
overlying venous structure
(arrowhead).
Continued
Conus Artery
• Maximum intensity
projection (MIP) view of
the RCA in the left
anterior oblique
projection.
• An independent origin of
the conus branch is
adjacent to the RCA
origin (black asterisk).
• The conus branch courses
superiorly from its origin
(arrow).
Continued
Conus Artery
• Globe MIP again
demonstrates the
independent origin of the
conus branch (black
asterisk) as well as the
short course of this vessel
over the right ventricular
outflow tract (arrow).
Continued
Conus branch intercoronary
communication.
• Surface rendered image in the
anteroposterior projection
demonstrates two small branches
crossing anterior to the right
ventricular outflow tract (arrows). This
intercoronary communication connects
the proximal right coronary artery and
the proximal left anterior descending
artery.
• Although this type of communication
is often associated with collateral flow
in the setting of coronary artery
disease, this patient had no significant
coronary disease.
Conus branch intercoronary
communication.
• Surface rendered image in the
anterior oblique projection
demonstrates two small branches
crossing anterior to the right
ventricular outflow tract (arrows).
This intercoronary communication
connects the proximal right coronary
artery and the proximal left anterior
descending artery.
• Although this type of communication
is often associated with collateral
flow in the setting of coronary artery
disease, this patient had no
significant coronary disease.
SA nodal artery
• Slab maximum intensity
projection (MIP) through
the aortic root demonstrate
• Proximal right coronary
artery (RCA) (arrow) as it
enters the right
• The artery to the SA node
arises from the RCA just
before it enters the groove
(arrowhead) but beyond the
origin of the conus artery.
Continued
SA nodal artery
• Slab maximum intensity
projection (MIP) through
the aortic root demonstrate
• Proximal right coronary
artery (RCA) (arrow) as it
enters the right
• The artery to the SA node
arises from the RCA just
before it enters the groove
(arrowhead) but beyond the
origin of the conus artery.
Continued
SA nodal artery
• Slab MIP in two additional
patients demonstrates the SA
nodal artery (arrowhead)
arising from the circumflex
artery (arrow).
• This artery courses between
the aortic root and the left
atrium to the interatrial
septum.
• The short left main coronary
arteries bifurcate just beyond
their origins.
Continued
SA nodal artery
• Slab MIP in two additional
patients demonstrates the
SA nodal artery
(arrowhead) arising from
the circumflex artery
(arrow).
• This artery courses between
the aortic root and the left
atrium to the interatrial
septum.
• The short left main coronary
arteries bifurcate just
beyond their origins.
Absent left main coronary artery
• Surface rendering
demonstrates two
arteries, the left
anterior descending
(LAD) and the
circumflex, originating
independently from the
left sinus of Valsalva
Continued
• Globe maximum
(MIP) confirms
independent origins of
the LAD and circumflex
arteries from the aorta
(arrows).
Continued
• Surface-map MIP
flattens out the globe
display and again
demonstrates
the LAD and circumflex
arteries (arrows).
Continued
• Slab MIP image demonstrates independent

origins of the circumflex and LAD vessels
(arrows).
Independent origins of the left anterior
descending (LAD) and circumflex
arteries.
• Globe maximum
image demonstrates
the LAD and
circumflex vessels
(arrows).
Myocardial bridge of the left
(LAD).
• Curved maximum
intensity projection of
the LAD demonstrates
a short bridged segment
that courses below the
surface of the
myocardium (arrow).
Continued
Myocardial bridge of the left
(LAD).
• Short-axis images demonstrates the bridged

segment of the LAD (arrow) surrounded by
myocardium.
Myocardial bridge of the mid-left
anterior descending artery (LAD)
• Myocardial bridge of the mid-left anterior descending artery (LAD) with

physiologic narrowing. (A) Long-axis slab maximum intensity projection (MIP)
of the LAD demonstrates a bridged segment of the mid-LAD (arrow) that appears
narrowed relative to the more proximal and distal segments of the LAD.
Continued
Myocardial bridge of the mid-left
anterior descending artery (LAD)
• Orthogonal slab MIP again demonstrates narrowing

of the bridged segment of the LAD (arrow) with no
evidence of atherosclerotic disease.
Shallow myocardial bridge of the
left anterior descending artery
(LAD).
• Curved maximum
(MIP) of the LAD
demonstrates a short
bridged segment that
courses below a thin
layer of myocardium
(arrows).
Continued
(LAD).
• (B) Slab MIP
image again
demonstrates the
bridged segment of
the LAD (arrows).
The diameter of the
LAD is slightly
decreased by the
bridge.
•
(LAD).
Shallow myocardial bridge of
the left anterior descending
artery (LAD) on orthogonal
curved maximum intensity
projection (MIP) images. The
myocardial bridge presents as a
straightened segment along the
surface of the left ventricle
(arrows). Short-axis images of
the LAD in this segment
demonstrate a thin layer of
myocardium anterior to the
vessel (arrowheads),
confirming the diagnosis of a
myocardial bridge.
Diseased left anterior
descending artery (LAD) with a
myocardial bridge.
• Slab maximum intensity projection (MIP) of the LAD in the long

axis of the left ventricle demonstrates a myocardial bridge (arrows).
The LAD is calcified both proximal and distal to the bridge, but
there is no atherosclerotic disease within the bridged segment. A
small amount of myocardium is appreciated overlying this portion
of the LAD (arrowheads).
Continued
Diseased left anterior
descending artery (LAD) with a
myocardial bridge.
• Slab MIP in a slightly
oblique axial projection
again demonstrates the
bridged segment (arrows),
which appears smaller in
diameter but free of
• Bridged segments of the
coronary arteries may be
protected from
References
• Clinical Cardiac CT Anatomy and Function
Ethan J. Halpern, MD
• Revisiting Cardiac Anatomy A Computed
Tomography-Based Atlas and Reference
Farhood Saremi, MD
• Radiology Review Manual Wolfgang Dahnert,
M.D.

MDCT ANATOMY OF HEART

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MDCT ANATOMY OF HEART

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MDCT ANATOMY OF HEART

Dr. Muhammad Bin Zulfiqar

• Standard body (a) versus heart planes

Revisiting Cardiac Anatomy

• Radiographic projections are shown. All images are obtained with a

• Radiographic projections are shown. All images are obtained with a

• Radiographic projections are shown. All images are obtained with a

• Radiographic projections are shown. All images are obtained with a

• Radiographic projections are shown. All images are

• CT angiography views. The ventricular surfaces are shown is

• End systole. The LV has contracted. The LA is slightly

• End diastole: The LV chamber size is measured

• Two-chamber view obtained by setting a center of rotation on

• Two-chamber view in systole. The mitral

• Eustachian valve—valve of IVC

• Ridge of smooth muscle (±bulbous tip) at

• Normal left atrium measurements. (A) Three-

• Thin septum, difficult to image

• Short-axis image through the mitral valve demonstrates normal

• Endoluminal view of the left side of the left atrium demonstrates

• (average diameter increases with age)

• 2. Ascending aorta (1 cm proximal to arch)

• Aortic arch 2.9 cm

• Descending thoracic aorta

AHA American Heart Association

• determined by the artery that crosses the crux

• Extensions of pericardial cavity

B. Transverse sinus posterior to ascending aorta and

C. Oblique sinus .............................. 89%*

* =percentages give depiction on HRCT

1. High takeoff (6%) = origin of RCA I LCA above the

6. LCA / RCA arising from noncoronary sinus

1. Myocardial bridging = band of myocardial

1. Coronary artery fistula (0.1-0.2%) = communication

• Slab MIP image demonstrates independent

• Short-axis images demonstrates the bridged

• Myocardial bridge of the mid-left anterior descending artery (LAD) with

• Orthogonal slab MIP again demonstrates narrowing

• Slab maximum intensity projection (MIP) of the LAD in the long

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