Anatomical Basis for the Cardiac Interventional Electrophysiologist

Figure 11

(a) Specimen viewed from a left posterolateral perspective to show the course of the esophagus and descending aorta relative to the left atrium. (b) This dissection of a cadaver viewed from the front shows the course of the right and left phrenic nerves. (c) Dissection of the left vagus nerve and its branch the left recurrent laryngeal which descends onto the roof of the left atrium. (d) Histological sections (Masson’s trichrome stain) through the right superior pulmonary vein and superior cava vein. The right phrenic nerve is adherent to the fibrous pericardium. Note the short distance between the endocardium of these veins and the right phrenic nerve. (e) This dissection of a cadaver viewed from the front shows the transverse (double-headed yellow broken line) and oblique sinuses following removal of the heart. Note that we have opened a window on the oblique sinus to show the close anatomic relationship of the esophagus with the posterior left atrial wall. (f, g) Transillumination of the roof of the left atrium and posterior interatrial groove showing the acetylcholinesterase stained epicardial ganglionated nerves (blue arrows) extending to the superior surface of the left venoatrial junctions in (f) and intercaval region in (g). Ao = aorta, LB = left bronchus, DA = descending aorta, ESO = esophagus, ICV = inferior cava vein, LI = left inferior pulmonary vein, LRLN = left recurrent laryngeal nerve, LS = left superior pulmonary vein, LV = left ventricle, PT = pulmonary trunk, RAA = right atrial appendage, RI = right inferior pulmonary vein, RS = right superior pulmonary vein, and SCV = superior cava vein.