11/7/2016 HeartAnatomy:Overview,CardiacChambers,GreatVesselsandSepti

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HeartAnatomy
Author:MaryCMancini,MD,PhD,MMMChiefEditor:StuartBerger,MDmore...

Updated:Jul21,2015

Overview
Intraoperatively,theanatomyoftheheartisviewedfromtherightsideofthesupine
patientviaamediansternotomyincision.Thestructuresinitiallyseenfromthis
perspectiveincludethesuperiorvenacava,rightatrium,rightventricle,pulmonary
artery,andaorta.Medialdisplacementoftherightsideoftheheartexposestheleft
atriumandrightpulmonaryveins.Medialrotationfromtheleftexposestheleft
ventricleapex,leftpulmonaryveins,andleftatrium.(Seetheimagesbelow.)

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11/7/2016 HeartAnatomy:Overview,CardiacChambers,GreatVesselsandSepti

Heart,anteriorview.

Heart,posteriorview.

Theoverallshapeandpositionoftheheartmayvaryaccordingtotherelativesize
andorientationofeachofitsparts.Forexample,alargerightventriclemayallow
exposureofonlyashortsegmentofaortathisisbecauseofthenarrowconfinesof
themiddlemediastinalspace.

CardiacChambers
Rightatrium

Thesuperiorvenacavaandinferiorvenacavadrainsystemicvenousbloodintothe
posteriorwalloftherightatrium.Theinternalwalloftherightatriumiscomposed
ofasmoothposteriorportion(intowhichthevenacavaeandcoronarysinusdrain)
andaridgelike,muscularanteriorportion.Thecoronarysinusdrainscoronary
venousbloodintotheanteroinferiorportionoftherightatrium.Thethebesianvalve
islocatedattheorificeofthecoronarysinus.Thelimbusofthefossaovalisis
locatedonthemedialwalloftherightatriumandcircumscribestheseptumprimum
ofthefossaovalisanteriorly,posteriorly,andsuperiorly.(Seetheimagebelow.)

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Heart,sectionedview.

Therightauricleisseparatedfromtherightatriumbyashallowposteriorvertical
indentationontherightatrium(ie,thesulcusterminalis)and,internally,byavertical
crest(ie,thecristaterminalis).Thecristaterminalisseparatestherightatriuminto
trabeculatedandnontrabeculatedportions.

Congenitalanomaliesofrightatrialcomponentscanbeassociatedwithclinically
significantcardiacmalformations.Forexample,inpatientswithtricuspidatresia,
theeustachianandthebesianvalvesmaybesoenlargedthattheyphysically
separatetherightatriuminto2distinctsections.Othervariationsinclude
juxtapositionofbothatrialappendagesandmalpositioningofbothappendages.

Leftatrium

The4pulmonaryveinsdrainintotheleftatrium.Theflapvalveofthefossaovalis
islocatedontheseptalsurfaceoftheleftatrium.Theappendageoftheleftatrium
isconsistentlynarrowandlongrecognitionofthisappendageisthemostreliable
waytodifferentiatetheleftatriumfromtherightatrium.Theleftatrialappendageis
theonlytrabeculatedstructureintheleftatriumbecause,unliketherightatrium,
theleftatriumhasnocristaterminalis.

Rightventricle

Therightventriclereceivesbloodfromtherightatriumacrossthetricuspidvalve,
whichislocatedinthelargeanterolateral(ie,sinus)portionoftherightventricle.
Therightventricledischargesbloodintothepulmonaryarteryacrossthepulmonic
(semilunar)valvelocatedintheoutflowtract(infundibulum).Theinflowtract(sinus)
andoutflowtract(infundibulum)oftherightventriclearewidelyseparated.
Internally,thesinusareaandinfundibulumcontaincoarsetrabeculations.

Theseptalportionoftherightventriclehas3components:(1)theinflowtract,
whichsupportsthetricuspidvalve(2)thetrabecularwall,whichtypifiestheinternal
appearanceoftherightventricleand(3)theoutflowtract,whichitselfissubdivided
into3components,namely,theconalseptum,septalbanddivision,andtrabecular
septum.Ofthese3subdivisions,theconalseptumisclinicallysignificantbecauseit
canbemalpositionedinpatientswithcongenitaldisorders(eg,doubleoutletright
ventricle).

Lateraltotheconalseptum,theparietalextensionoftheinfundibularseptumand
theinfundibularfoldcomprisethecristasupraventricularis.Ventricularseptaldefects
(VSDs)commonlyoccurintheareabetweenthesinusandtheoutlettractofthe
rightventricle.However,becausethesurfaceoftherightventricleistrabecular,
smalldefectsofthemuscularportionoftheventricularseptummaybedifficultto
see.

Thetricuspidvalveissupportedbyalargeanteriorpapillarymuscle,whicharises
fromtheanteriorfreewallandthemoderatorband,andbyseveralsmallposterior
papillarymuscles,whichattachposteriorlytotheseptalband.

Leftventricle

Theleftventriclereceivesbloodfromtheleftatriumviathemitral(ie,bicuspid)
valveandejectsbloodacrosstheaorticvalveintheaorta.Theleftventriclecanbe
dividedinto2primaryportions,namely,thelargesinusportioncontainingthemitral
valveandthesmalloutflowtractthatsupportstheaortic(semilunar)valve.Inflow
andoutflowportionsarecloselyjuxtaposed,unlikeintherightventricle,inwhichthe
tricuspidandpulmonicvalvesarewidelyseparated.

Thefreewallandapicalhalfoftheseptumcontainfineinternaltrabeculations.The
septalsurfaceisdividedintoatrabeculatedportion(sinus)andasmoothportion
(outflow).Thesinusareajustbeneaththemitralvalveistermedtheinletseptum
theremainderofthesinusareaistermedthetrabecularseptum.Theoutflowtract
islocatedanteriortotheanteriormitralleafletandispartoftheatrioventricular(AV)
septum.Boththerighthalfoftheanteriormitralvalveleafletandtherightaortic
cuspattachtotheseptum.(Intherightventricle,onlytheseptaltricuspidleaflet
attachestotheseptum.)

Thelefthalfoftheanteriormitralleafletisindirect,fibrouscontactwiththeaortic
valveattheaorticmitralannulus.Theconalseptumoftherightventricleis

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positionedoppositetheaorticvalve.Themitralvalveissupportedby2large
papillarymuscles(ie,anterolateral,posteromedial)attachedtothefreewall.The
anteriorpapillarymuscleisattachedtotheanteriorportionoftheleftventricular
wall,andtheposteriorpapillarymusclearisesmoreposteriorlyfromtheventricle's
inferiorwall. [1]

GreatVesselsandSepti
Aorta

Theaortabeginsatthebaseoftheheartandtypicallybranchestoformthe
coronaryarteriesjustdistaltotheaorticvalve.Inpatientswithcardiac
malformations,theaortaalmostalwayscanbeidentifiedbytracingitbackfromthe
brachiocephalicarteries,whichonlyveryrarelyoriginatefromthepulmonaryartery.

Pulmonaryartery

Themainpulmonaryarterybranchesintothepulmonaryarterialsystem.Inpatients
withaberrantcardiacanatomywithapatentductusarteriosus,accurate
identificationofthepulmonaryarterycanbedifficultusingangiography,because
thepulmonaryarterybecomesopaqueduringaorticinjection.Todifferentiatethe
pulmonaryarteryfromtheaorticvalve,rememberthatthepulmonaryarteryalmost
nevergivesoffbrachiocephalicbranches.

Ventricularseptum
Theventricularseptumisdividedintoamuscularsection(inferior)anda
membranoussection(superior).Themuscularportionmakesuptheleftandright
ventricularwalls.Themembranousseptum,alsotermedtheparsmembranacea,is
afibrousstructurepartiallyseparatingtheleftventricularoutflowtractfromtheright
atriumandventricle.

Atrioventricularseptum

Theatrioventricular(AV)septum,locatedbehindtherightatriumandleftventricle,
isdividedinto2portions:asuperiorportion(membranous)andaninferiorportion
(muscular).Insidetheleftventricle,themuscularcomponentmakesuppartofthe
outletseptum.TheAVnodeliesintheatrialseptum,juxtaposedtothe
membranousandmuscularportionsoftheAVseptum.

ConductionSystem
Sinusnode

Thesinoatrial(SA)nodeoccupiesa1cm2areaonthelateralsurfaceofthe
junctionofthesuperiorvenacavaandrightatriumnearthecristaterminalis.The
sinusnodeisfoundsuperficiallyattheanterolateralaspectofthejunctionbetween
thesuperiorvenacavaandtherightatrialappendage.Inrarecases,theSAnode
maybefoundmediallyalongtheridgeoftheatrialcavaljunction. [2,3,4]

Internodalpathways

ThespreadofelectricalactivationfromthesinusnodeextendstowardtheAVnode
viaPurkinjelikepalecellsinatrialmusclebundles.Anterior,medial,andposterior
interatrialconductionpathwaysarisefromtheSAnode.Theanteriorandmedial
pathwaysarelocatedanteriorandposteriortotheforamenovaletheposterior
pathwayissituatedcaudaltotheforamenovale.

Atrioventricularnode

TheAVnodeissituateddirectlyontherightatrialsideofthecentralfibrousbodyin
themuscularportionoftheAVseptum,justsuperiorandanteriortotheostiumof
thecoronarysinus.Measuringapproximately0.1cmx0.3cmx0.6cm,thenodeis
flatandoval.Thenode'sleftsurfaceisjuxtaposedtothemitralanulus.

Hisbundleandbundlebranches

TheAVnodecontinuesontotheHisbundleviaacourseinferiortothecommissure
betweentheseptalandanteriorleafletsofthetricuspidvalve.Thebundlefollowsa
coursealongtheinferiorborderofthemembranousseptumand,neartheaortic
valve,givesofffibersthatformtheleftbundlebranch.TheHisbundleislocatedon
theleftsideoftheventricularseptumin80%ofpatients.Inthe20%ofpatientsin
whomthebundleisontherightsideoftheseptum,theHisbundleisconnectedto
theleftbundlebyanarrowstem.

Theleftbundlebranchfurthersubdividesintoseveralsmallerbranchesthatbeginat
theventricularseptalsurfaceandradiatearoundtheleftventricle.Therightbundle
branchoriginatesfromtheHisbundlenearthemembranousseptumandcourses
alongtherightventricularseptalsurface,passingtowardthebaseoftheanterior
papillarymuscle.

CardiacValves
Cardiacvalvesarecategorizedinto2groups,basedonfunctionandmorphology.
MitralandtricuspidvalvesmakeuptheAVgroupaorticandpulmonaryvalves
makeupthesemilunargroup.Oncrosssection,theaorticvalveislocatedina
centrallocation,halfwaybetweenthemitralandtricuspidvalves.Thepulmonary
valveispositionedanterior,superior,andslightlytotheleftoftheaorticvalve.The
tricuspidandmitralanulimergeandfusewitheachotherandwiththemembranous
septumtoformthefibrousskeletonoftheheart.(Seetheimagebelow.)

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Heartvalves,superiorview.

Mitralvalve

TheAVvalveoftheleftventricleisbicuspid.TheAVvalvehasalargeanterior
leaflet(septaloraortic)andasmallerposteriorleaflet(muralorventricular).The
anteriorleafletistriangularwithasmoothtexture.Theposteriorleaflethasa
scallopedappearance.Thechordaetendineaetothemitralvalveoriginatefromthe
2largepapillarymusclesoftheleftventricleandinsertprimarilyontheleaflet'sfree
edge.

Tricuspidvalve

TheAVvalveoftherightventriclehasanterior,posterior,andseptalleaflets.The
orificeislargerthanthemitralorificeandistriangular.Thetricuspidvalveleaflets
andchordaearemorefragilethanthoseofthemitralvalve.Theanteriorleaflet,
largestofthe3leaflets,oftenhasnotches.Theposteriorleaflet,smallestofthe3
leaflets,isusuallyscalloped.Theseptalleafletusuallyattachestothemembranous
andmuscularportionsoftheventricularseptum.

Amajorfactortoconsiderduringsurgeryistheproximityoftheconductionsystem
totheseptalleaflet.Themembranousseptumliesbeneaththeseptalleaflet,
wheretheHisbundlepenetratestherighttrigonebeneaththeinterventricular
membranousseptum.Moreover,theportionoftheseptalleafletbetweenthe
membranousseptumandthecommissuremayformaflapvalveoversome
ventricularseptaldefects(VSDs).

Aorticvalve

Theaorticvalvehas3leafletscomposedoffragilecuspsandthesinusesof
Valsalva.Thus,thevalveapparatusiscomposedof3cuplikestructuresthatarein
continuitywiththemembranousseptumandthemitralanteriorleaflet.Thefreeend
ofeachcusphasastrongerconsistencythanthecusp.Themidpointofeachfree
edgecontainsthefibrousnodulusarantii,whichbisectsthethincrescentshaped
lunulaoneitherside.

TheaorticsinusesofValsalvaare3dilationsoftheaorticrootthatarisefromthe3
closingcuspsoftheaorticvalve.Therightandleftsinusesgiverisetotherightand
leftcoronaryarteriesthenoncoronarysinushasnocoronaryartery.Thesinusof
Valsalvawallsaremuchthinnerthantheaorticwall,whichisafactorofsurgical
significancetherefore,aortotomiesaretypicallyperformedawayfromthisregion.

Theaorticannulusissituatedanteriorlytothemitralvalveannulusandtheanterior
leafletofthemitralvalve.Thecranialportionoftheleftatriumisinterposed
betweentheaorticandmitralvalves.Anteriorly,theaorticannulusisrelatedtothe
ventricularseptumandrightventricularoutflowtract.TheHisbundlecourses
beneaththerightandnoncoronaryaorticvalvecuspsofthemembranousventricular
septum.Thus,incisionoftheaorticannulusorseptalmyocardiumanteriortothe
rightcoronarysinusshouldnotinterferewiththeconductionsystem.

Pulmonaryvalve

Aswiththeaorticvalve,thepulmonaryvalvehas3cusps,withamidpointnoduleat
thefreeendandlunulaeoneithersideasinusislocatedbehindeachcusp.
Comparedwiththeaorticvalve,thepulmonaryvalvehasthinnercusps,no
associatedcoronaryarteries,andnocontinuitywiththecorresponding(anterior)
tricuspidvalveleaflet.Thetermusedforeachcuspreflectsitsrelationshiptothe
aorticvalve,namely,right,left,andnonseptal. [1]

CoronaryArteries
The2maincoronaryarteriesaretherightandleft.However,fromasurgical
standpoint,4mainarteriesarenamed:theleftmain,theleftanteriordescending,
andtheleftcircumflex(LCX)arteries(whichareallbranchesoftheleftcoronary
artery)andtherightcoronaryartery(RCA).TheRCAandLCXsformacirclearound
theAVsulci.Theleftanteriordescendingandposteriordescendingarteriesforma
loopatrightanglestothiscirclethesearteriesfeedtheventricularseptum.The
LCXgivesoffseveralparallel,obtuse,marginalarteriesthatsupplytheposteriorleft
ventricle.Thediagonalbranchesoftheleftanteriordescendingarterysupplythe
anteriorportionoftheleftventricle.

Thetermdominanceisusedtorefertotheoriginoftheposteriordescendingartery
(PDA).WhenthePDAisformedfromtheterminalbranchoftheRCA(>85%of
patients),itistermedarightdominantheart.Aleftdominantheartreceivesits
PDAbloodsupplyfromaleftcoronarybranch,usuallytheLCX.Thisisoften
referredtoasaleftposterolateral(LPL)branch.

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Leftmaincoronaryartery

Theleftmaincoronaryartery(LCA)originatesfromtheostiumoftheleftsinusof
Valsalva.TheLCA,whichcoursesbetweentheleftatrialappendageandthe
pulmonaryartery,typicallyis12cminlength.WhenitreachestheleftAVgroove,
theLCAbifurcatesintotheleftanteriordescending(LAD)andtheLCXbranches.
TheLCAsuppliesmostoftheleftatrium,leftventricle,interventricularseptum,and
AVbundles.TheLCAarisesfromtheleftaorticsinusandcoursesbetweentheleft
auricleandthepulmonarytrunktoreachthecoronarygroove.

Leftanteriordescendingartery

Afteroriginatingfromtheleftmainartery,theLADarteryrunsalongtheanterior
interventricularsulcusandsuppliestheapicalportionofbothventricles.TheLAD
arteryismostlyepicardialbutcanbeintramuscularinplaces.Animportant
identifyingcharacteristicoftheLADarteryduringangiographyistheidentificationof
46perpendicularseptalbranches.Thesebranches,approximately7.5cminlength,
supplytheinterventricularseptum.

ThefirstbranchoftheLADarteryistermedtheramusintermedius.Infewerthan
1%ofpatients,theLCAisabsent,andtheLADandLCXarteriesoriginatefromthe
aortavia2separateostia.AstheLADarterypassesalongtheanterior
interventriculargroovetowardtheapex,itturnssharplytoanastomosewiththe
posteriorinterventricularbranchoftheRCA.AstheLADarterycoursesanteriorly
alongtheventricularseptum,itsendsoffdiagonalbranchestothelateralwallofthe
leftventricle.CongenitalLADarteryvariationsmayincludeitsduplicationas2
parallelarteries(4%incidence)andlengthvariations(prematureordelayeddistal
termination).

Leftcircumflexartery

TheLCAgivesofftheLCXarteryatarightanglenearthebaseoftheleftatrial
appendage.TheLCXarterycoursesinthecoronarygroovearoundtheleftborderof
thehearttotheposteriorsurfaceofthehearttoanastomosetotheendofthe
RCA.IntheAVgroove,theLCXarteryliesclosetotheannulusofthemitralvalve.
Theatrialcircumflexartery,thefirstbranchofftheLCXartery,suppliestheleft
atrium.TheLCXarterygivesoffanobtusemarginal(OM)branchattheleftborder
oftheheartnearthebaseoftheleftatrialappendagetosupplytheposterolateral
surfaceoftheleftventricle.ThecolorcontrastbetweentheyelloworangeOMand
theadjacentredbrownmyocardiummaybethemostreliablewaytoidentifythis
arteryintraoperatively.Inpatientswithaleftdominantheart,theLCXartery
suppliesthePDA.ManyvariationsintheoriginandlengthoftheLCXarteryare
noted.Infewerthan40%ofpatients,thesinusnodearterymayoriginatefromthe
LCXartery.

Rightcoronaryartery

TheRCAisasinglelargearterythatcoursesalongtherightAVgroove.TheRCA
suppliestherightatrium,rightventricle,interventricularseptum,andtheSAandAV
nodes.TheRCAarisesfromtherightaorticsinusandcoursesinthecoronary(AV)
groovebetweentherightauricleandtherightventricle.In60%ofpatients,thefirst
branchoftheRCAisthesinusnodeartery.AstheRCApassestowardtheinferior
borderoftheheart,itgivesoffarightmarginalbranchthatsuppliestheapexofthe
heart.Afterthisbranching,theRCAturnslefttoentertheposteriorinterventricular
groovetogiveoffthePDA,whichsuppliesbothventricles.

TheAVnodearteryarisesfromthe"Uturn"oftheRCAatthecrux(ie,thejunction
oftheAVseptumwiththeAVgroove).Atthispoint,thePDAfeedstheseptal,
rightventricular,andleftventricularbranches.ThePDAcoursesovertheventricular
septumonthediaphragmaticsurfaceoftheheart.Unliketheseptalbranchesoff
theLADartery,theseptalbranchesfromtheRCAtypicallyareshort(<1.5cm).
TerminalbranchesoftheRCAsupplytheposteromedialpapillarymuscleoftheleft
ventricle.(TheLADarterysuppliestheanterolateralpapillarymuscleoftheright
ventricle.)Neartheapex,thePDAanastomoseswiththeanteriorinterventricular
branchoftheLCA.

CommonvariationsinvolvingRCAanatomyincludethefollowing:

AnRCAoriginatingfromtherightsinusofValsalva
ThesinusnodearteryoriginatingfromtheRCA
Theacutemarginal(AM)arterycrossingtheinferioraspectoftheright
ventricletosupplythediaphragmaticinterventricularseptum

CoronaryVeins
Thecoronarysinusisashort(approximately2cm)andwidevenouschannelthat
runsfromlefttorightintheposteriorportionofthecoronarygroove.Theopeningof
thecoronarysinusislocatedbetweentherightAVorificeandtheinferiorvenacava
orifice.Thecoronarysinusdrainsallvenousbloodfromtheheartexcepttheblood
carriedfromtheanteriorcardiacveins.Thecoronarysinusreceivesoutflowfromthe
greatcardiacveinontheleftandfromthemiddleandsmallcardiacveinsonthe
right.

Thegreatcardiacveinisthemaintributaryofthecoronarysinusanddrainsareas
oftheheartsuppliedbytheLCA.Itbeginsattheapexoftheheart,ascendsinthe
anteriorinterventriculargroovewiththeLADartery,andenterstheleftendofthe
coronarysinus.

ThemiddleandsmallcardiacveinsdrainmostoftheheartsuppliedbytheRCA.
Themiddlecardiacveinbeginsattheapex,ascendsintheposteriorinterventricular
groovewiththeposteriorinterventricularartery,andemptiesintotherightsideof
thecoronarysinus.Thesmallcardiacveinrunsinthecoronarygroovealongwith
themarginalbranchoftheRCAthisveinusuallyemptiesintothecoronarysinus
butmayemptydirectlyintotherightatrium.

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Coronaryveinsoftherightventricledraindirectlyintotherightatriumthebesian
veinsdrainintotherightventricle.Theleftventriclevenousreturndrainsintothe
coronarysinuslocatednexttotheseptalportionofthetricuspidvalveannulus.

ContributorInformationandDisclosures
Author
MaryCMancini,MD,PhD,MMMProfessorandChiefofCardiothoracicSurgery,DepartmentofSurgery,
LouisianaStateUniversitySchoolofMedicineinShreveport

MaryCMancini,MD,PhD,MMMisamemberofthefollowingmedicalsocieties:AmericanAssociationfor
ThoracicSurgery,AmericanCollegeofSurgeons,AmericanSurgicalAssociation,SocietyofThoracicSurgeons,
PhiBetaKappa

Disclosure:Nothingtodisclose.

SpecialtyEditorBoard
MaryLWindle,PharmDAdjunctAssociateProfessor,UniversityofNebraskaMedicalCenterCollegeof
PharmacyEditorinChief,MedscapeDrugReference

Disclosure:Nothingtodisclose.

MaryCMancini,MD,PhD,MMMProfessorandChiefofCardiothoracicSurgery,DepartmentofSurgery,
LouisianaStateUniversitySchoolofMedicineinShreveport

MaryCMancini,MD,PhD,MMMisamemberofthefollowingmedicalsocieties:AmericanAssociationfor
ThoracicSurgery,AmericanCollegeofSurgeons,AmericanSurgicalAssociation,SocietyofThoracicSurgeons,
PhiBetaKappa

Disclosure:Nothingtodisclose.

ChiefEditor
StuartBerger,MDMedicalDirectorofTheHeartCenter,Children'sHospitalofWisconsinAssociateProfessor,
DepartmentofPediatrics,SectionofPediatricCardiology,MedicalCollegeofWisconsin

StuartBerger,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,American
CollegeofCardiology,AmericanCollegeofChestPhysicians,AmericanHeartAssociation,Societyfor
CardiovascularAngiographyandInterventions

Disclosure:Nothingtodisclose.

AdditionalContributors
JonahOdim,MD,PhD,MBASectionChiefofClinicalTransplantation,TransplantationBranch,Divisionof
Allergy,Immunology,andTransplantation,NationalInstituteofAllergyandInfectiousDiseases(NIAID),National
InstitutesofHealth(NIH)

JonahOdim,MD,PhD,MBAisamemberofthefollowingmedicalsocieties:AmericanCollegeofCardiology,
AmericanCollegeofChestPhysicians,AmericanAssociationforPhysicianLeadership,AmericanCollegeof
Surgeons,AmericanHeartAssociation,AmericanSocietyforArtificialInternalOrgans,AmericanSocietyof
TransplantSurgeons,AssociationforAcademicSurgery,AssociationforSurgicalEducation,International
SocietyforHeartandLungTransplantation,NationalMedicalAssociation,NewYorkAcademyofSciences,
RoyalCollegeofPhysiciansandSurgeonsofCanada,SocietyofCriticalCareMedicine,SocietyofThoracic
Surgeons,CanadianCardiovascularSociety

Disclosure:Nothingtodisclose.

References

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2.SaffitzJE.Connexins,conduction,andatrialfibrillation.NEnglJMed.2006Jun22.354(25):27124.
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3.SeemannG,HoperC,SachseFB,etal.Heterogeneousthreedimensionalanatomicaland
electrophysiologicalmodelofhumanatria.PhilosTransactAMathPhysEngSci.2006Jun15.
364(1843):146581.[Medline].

4.GollobMH,JonesDL,KrahnAD,etal.Somaticmutationsintheconnexin40gene(GJA5)inatrial
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MedscapeReference2011WebMD,LLC

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