Henry Gray (18251861). Anatomy of the Human Body. 1918.
flattened cells resting on loose connective tissue. The heart invaginates the wall of the serous sac from above and behind, and practically obliterates its cavity, the space being merely a potential one.
The fibrous pericardium forms a flask-shaped bag, the neck of which is closed by its fusion with the external coats of the great vessels, while its base is attached to the central tendon and to the muscular fibers of the left side of the diaphragm. In some of the lower mammals the base is either completely separated from the diaphragm or joined to it by some loose areolar tissue; in man much of its diaphragmatic attachment consists of loose fibrous tissue which can be readily broken down, but over a small area the central tendon of the diaphragm and the pericardium are completely fused. Above, the fibrous pericardium not only blends with the external coats of the great vessels, but is continuous with the pretracheal layer of the deep cervical fascia. By means of these upper and lower connections it is securely anchored within the thoracic cavity. It is also attached to the posterior surface of the sternum by the superior and inferior sternopericardiac ligaments; the upper passing to the manubrium, and the lower to the xiphoid process.
The vessels receiving fibrous prolongations from this membrane are: the aorta, the superior vena cava, the right and left pulmonary arteries, and the four pulmonary veins. The inferior vena cava enters the pericardium through the central tendon of the diaphragm, and receives no covering from the fibrous layer.
The serous pericardium is, as already stated, a closed sac which lines the fibrous pericardium and is invaginated by the heart; it therefore consists of a visceral and a parietal portion. The visceral portion, or epicardium, covers the heart and the great vessels, and from the latter is continuous with the parietal layer which lines the fibrous pericardium. The portion which covers the vessels is arranged in the form of two tubes. The aorta and pulmonary artery are enclosed in one tube, the arterial mesocardium. The superior and inferior venæ cavæ and the four pulmonary veins are enclosed in a second tube, the venous mesocardium, the attachment of which to the parietal layer presents the shape of an inverted U. The cul-de-sac enclosed between the limbs of the U lies behind the left atrium and is known as the oblique sinus, while the passage between the venous and arterial mesocardiai.e., between the aorta and pulmonary artery in front and the atria behindis termed the transverse sinus.
The Ligament of the Left Vena Cava.Between the left pulmonary artery and subjacent pulmonary vein is a triangular fold of the serous pericardium; it is known as the ligament of the left vena cava (vestigial fold of Marshall). It is formed by the duplicature of the serous layer over the remnant of the lower part of the left superior vena cava (duct of Cuvier), which becomes obliterated during fetal life, and remains as a fibrous band stretching from the highest left intercostal vein to the left atrium, where it is continuous with a small vein, the vein of the left atrium (oblique vein of Marshall), which opens into the coronary sinus.
The arteries of the pericardium are derived from the internal mammary and its musculophrenic branch, and from the descending thoracic aorta.
The nerves of the percardium are derived from the vagus and phrenic nerves, and the sympathetic trunks.
4b. The Heart
The heart is a hollow muscular organ of a somewhat conical form; it lies between the lungs in the middle mediastinum and is enclosed in the pericardium (Fig. 490). It is placed obliquely in the chest behind the body of the sternum and adjoining parts of the rib cartilages, and projects farther into the left than into the right half of the thoracic cavity, so that about one-third of it is situated on the right and two-thirds on the left of the median plane.
Size.The heart, in the adult, measures about 12 cm. in length, 8 to 9 cm. in breadth at the broadest part, and 6 cm. in thickness. Its weight, in the male, varies from 280 to 340 grams; in the female, from 230 to 280 grams. The heart continues to increase in weight and size up to an advanced period of life; this increase is more marked in men than in women.
Component Parts.As has already been stated (page 497), the heart is subdivided by septa into right and left halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium, the lower the ventricle. The heart therefore consists of four chambers, viz., right and left atria, and right and left ventricles.
The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (auriculoventricular