SURGICAL ANATOMY OF THE HEART

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apex turned downwards, leftwards and to the front. The basis 
is formed by right and left atriums and their posterosuperior 
surfaces. V. cava superior and inferior end by the right atrium 
of heart basis; the left and right pulmonary veins end by the 
left atrium. They form together radix cordis and fix the basis 
together. The apex of the heart is formed by the left ventricle 
and slightly by the right one. The apex of the heart and two 
ventricles are located intrapericardially (completely in 
pericardial cavity). The ascending part of aorta, truncus 
pilmonalis, and left and right atrial auricles are located in the 
pericardial cavity. 
Vv. cavae and the both atrial auricles are covered by 
pericardium from 3 sides, i. e. – they are located 
mesopericardially, as their dorsal side is not covered by 
pericardium. 
Pulmonary veins and two pulmonary arteries are located 
extrapericardially, that is pericardium covers only their anterior 
walls. 
We can distinguish such surfaces of the heart as: anterior, 
sternocostal surface (facies sternocostalis), inferior, diaphragmal 
surface (facies diaphragmatica) and pulmonary one. The anterior 
and pulmonary surfaces form the blunt edge (margo obtusus) 
directed to the left, and anterior and inferior surfaces form the 
acute edge (margo acutus) directed to the right. 
There are two compartments in the heart: upper (or 
superior-right), and inferior (or inferior-left). Atrioventricular 
sulcus (coronary sulcus of the heart – sulcus coronarius) is the 
border between the segments. The sulcus passes from left to 
right, and from up to down. There is the auricle of right atrium 
which covers v. cava superior and ascending part of aorta. 
Upwards and leftwards the sulcus coronarius passes under 
arterial cone which is a part of ventricles passing in aorta (left 

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ventricle) and trunkus pulmonalis (right ventricle), and passes 
to the dorsal surface. Truncus pulmonalis is the continuation 
of arterial cone which penetrates under the inferior surface of 
ascending part of aorta in the place of its transition into the 
arch (Fig. A.11). 
There 
is 
anterior 
interventricular 
sulcus 
(sulcus 
interventricularis anterior), which is located to the left from 
the arterial cone and goes along the heart to its top. Turning 
backwards and upwards it passes into the posterior 
interventricular sulcus (sulcus interventricularis posterior) 
which joins coronary sulcus on the top.
The main source of blood supply is the left and right 
coronary arteries (a. coronaria dextra et a. coronaria sinistra). 
They originate in the Valsalva sinus at the level of upper layers 
of left and right semilunar valve. In the phase of systole their 
holes are closed by aortic valve, that is the heart receives 
blood during diastole when aortic valves are closed.
The left coronary artery (a. coronaria sinistra) goes from the 
left aortic sinus to the left part of coronary sulcus and is 
divided 
into 
anterior 
interventricular 
branch 
(r. 
interventricularis anterior) and circumflex branch (r. 
circumflexus).
The anterior interventricular branch is located in the 
anterior interventricular sulcus and goes to the apex of the 
heart (cardiac apex) alongside v. cordis magna. At the apex of 
the heart it anastomoses with the posterior interventricular 
branch from the right coronary artery.
The circumflex branch of the left coronary artery is the 
continuation of its main trunk, it rounds the heart from the 
left and is observed in the left part of coronary sulcus and on 
the posterior surface it anastomoses with the right coronary 
artery.
The right coronary artery (a. coronaria dextra) originates in the 

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right Valsava sinus and passes between the pulmonary trunk and 
right auricle, rounds the heart along the right coronary artery, 
passes into posterior surface of the heart and anastomoses with 
circumflex branch of the left coronary artery. The largest branch of 
right coronary artery is r. interventricularis posterior which is located 
in the right coronary artery and goes to the apex of the heart 
alongside v. cordis media. 
Each coronary artery and their branches have their 
branchings. Branches of the left coronary artery supply with 
blood the left pulmonary atrium, anterior and most part of 
posterior wall of the left ventricle, part of anterior wall of the 
right ventricle and anterior part of interventricular septum. 
The right coronary artery supplies with blood the right 
atrium, the conducting system of the heart, posterior wall of 
right and left ventricles, posterior part of interventricular 
septum, m. papillaris posterior of the left ventricle.
The branches of left and right coronary arteries anastomose 
with each other and form in the heart two arterial circles: 
lateral arterial circle located in the coronary sulcus and 
longitudinal arterial circle which is located in the anterior and 
posterior interventricular sulcus. 
There are three types of blood supply of the heart: right 
coronary circulation in (90 % of people), left coronary 
circulation and balanced circulation. In balanced circulation 
both coronary arteries are developed and two posterior
interventricular branches are be observed. In right coronary 
circulation the branches of right coronary arteries prevail and 
in left coronary circulation – branches of left coronary artries. 
Knowing types of blood circulation helps surgeons to choose 
correct way in surgical treatment of coronary insufficiency.

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