rv-lv and epicardial anatomy in vt … · inlet-outlet ring around right av junction and outflow...
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©2012 MFMER | 3200268v1(2003)-1
Samuel J. Asirvatham, M.D.Mayo Clinic – Rochester
AF, VT, VF Summit – Chicago, IllinoisFriday, December 6, 2019: 7:50 to 8:15 a.m.
RV-LV and Epicardial Anatomy in VT
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Right Ventricular Outflow Tract VT
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26 yrs female, 25,000 PVCs on Holter 3 failed ablations
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LAO
Cardiac Vein
RVOT
LVOT
retrograde
approachLCX
LAD
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Normal HeartDirection of Great Arteries
Anterior View
RV
LV
Ao PA
• Pulmonary artery
Anterior to aorta
To left shoulder
• Ascending aorta
Posterior to PA
To right shoulder
• Aorta-PA angle
60 to 90 degrees
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Normal HeartVentricles
Long-Axis View
RVOT
LV
Ao
LA
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Normal HeartValves & Coronary Arteries
Cardiac Base
MVTV
PV
AVLCX
LADRCA
CS
Conus
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Inlet-outlet ring aroundRight AV junction and Outflow tracts
Left AV junction
Trabecular componentof right ventricle
Left ventricle
Ventricular bundle branches on apical trabecular septum
Primaryseptum
Dead-end tract
AV grove
Rightventricle
AV grove
Compact node
Penetrating bundle
Dead-end tract
Branching bundle and bundle branchesCP1041447-5
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12-lead ECG
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RVOT Anatomy LPO
Lasso in
aortic-root
I
V1
V2
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Lasso at Aortic Sinus of Valsava
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Normal HeartExternal Topography
Superior View
RAA
LAA
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©2012 MFMER | 3200268v1(2003)-27
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©2012 MFMER | 3200268v1(2003)-28
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Normal HeartTransverse Sinus
Anterior View Left Lateral View
Ao
PA
PA
Ao
LA
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Normal HeartPericardium
Opened Parietal Pericardium
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Internal Cardiac AnatomyAtrioventricular Valves
Tricuspid Valve (RV View)
S
A
P
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©2012 MFMER | 3208966-38
Internal Cardiac AnatomyVentricles
Right Ventricle (Wall Removed, Ant View)
PB
SB
IS
MB
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©2012 MFMER | 3208966-40
Internal Cardiac AnatomyAtrioventricular Valves
Mitral Valve (Opened, LA Aspect)
Anterior
Posterior
ALPM
LA
LV
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©2012 MFMER | 3208966-41Abou Ezzeddine, et al. JCE, 2010
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Moderator band VT
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©2012 MFMER | 3208966-43
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©2012 MFMER | 3200268v1(2003)-45
Samuel J. Asirvatham, M.D.Mayo Clinic – Rochester
AF, VT, VF Summit – Chicago, IllinoisFriday, December 6, 2019: 7:50 to 8:15 a.m.
RV-LV and Epicardial Anatomy in VT