Right atrium of the human heart: analysis of contemporary concepts of typical and variant anatomy

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Abstract

This review summarizes and systematizes published data on the normal (typical and variant) anatomy of the human right atrium.

Most researchers agree that the right atrium consists of the sinus venarum cavarum, the atrial body, the right atrial appendage, and the vestibule of the tricuspid valve with the cavotricuspid isthmus. The dimensions and shape of the atrial body and appendage exhibit individual and typological variability; however, in the reviewed scientific sources, no data were found regarding the dependence of these parameters on sex or age. Various patterns of the internal surface features of the right atrial walls have been described, but existing classifications are largely based on subjective criteria, which reduces their accuracy and reproducibility. The true interatrial septum is represented only by the floor and the limbus of the fossa ovalis rather than the entire medial wall of the atrium. In 15%–35% of heart specimens from patients who died of noncardiac causes, an interatrial communication is present anterior to the fossa ovalis. A review of the scientific data showed that publications on the anatomy of the normal human right atrium are, for the most part, devoted to individual aspects of the structure of its parts and components, whereas comprehensive studies of the typological and variant anatomy of the walls and subdivisions of this cardiac chamber are few. Studies aimed at developing features of the normal structure of the right atrium, substantiated from the standpoint of morphometry and ontogeny and based on the methodology of evidence-based anatomy, are currently relevant.

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About the authors

Andrei A. Iakimov

Ural State Medical University; Ural Federal University named after the first President of Russia B.N. Yeltsin

Author for correspondence.
Email: ayakimov07@mail.ru
ORCID iD: 0000-0001-8267-2895
SPIN-code: 8618-2991

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Ekaterinburg; Ekaterinburg

Anton Ya. Shayuk

Ural Federal University named after the first President of Russia B.N. Yeltsin

Email: shayuk.a.ya@gmail.com
ORCID iD: 0009-0004-8242-9130
Russian Federation, Ekaterinburg

Anton A. Gaponov

Ural State Medical University; Ural Federal University named after the first President of Russia B.N. Yeltsin

Email: gagaponov@gmail.com
ORCID iD: 0000-0002-6681-7537
SPIN-code: 2841-6740
Russian Federation, Ekaterinburg; Ekaterinburg

Anna M. Korneva

Ural Federal University named after the first President of Russia B.N. Yeltsin

Email: korneva2000122@gmail.com
ORCID iD: 0009-0004-9162-8780
Russian Federation, Ekaterinburg

Eugeniya G. Dmitrieva

Ural State Medical University; Ural Federal University named after the first President of Russia B.N. Yeltsin

Email: anmayak@mail.ru
ORCID iD: 0000-0002-2973-3481
SPIN-code: 7966-8133
Russian Federation, Ekaterinburg; Ekaterinburg

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2. Fig. 1. Three-dimensional reconstruction of the human heart based on multislice computed tomography coronary angiography, right view: 1, left atrium; 2, superior vena cava; 3, sinus venarum cavarum; 4, orifice of the inferior vena cava; 5, right atrial appendage; 6, right ventricle; 7, aorta. The image was provided by I.D. Ufimtseva and is published with her permission.

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3. Fig. 2. Atria of the adult human heart: atrial cavities filled with silicone; superficial myocardial bundles dissected; posterior and slightly right view: 1, superior vena cava; 2, inferior vena cava; 3, sinus venarum cavarum; 4, sulcus terminalis; 5, right atrial appendage; 6, interatrial groove (Waterston’s groove); 7, body of the left atrium.

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4. Fig. 3. Right atrium of the adult human heart: silicone cast of the cavity; posterior and inferior view: 1, superior vena cava; 2, inferior vena cava; 3, sinus venarum cavarum; 4, body of the right atrium; 5, right atrial appendage; 6, coronary sinus; 7, posteroinferior part of the right atrium (subthebesian sinus).

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5. Fig. 4. Adult human heart: coronary projection in the frontal plane: 1, pulmonary trunk; 2, aorta; 3, superior vena cava; 4, orifice of the inferior vena cava; 5, sinus venarum cavarum; 6, vestibule of the right atrioventricular valve; 7, inferior pyramidal space; 8, left ventricle. The arrow indicates the atrioventricular component of the membranous part of the interventricular septum. The image was provided by I.D. Ufimtseva and is published with her permission.

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6. Fig. 5. Medial wall of the right atrium of the adult human heart: 1, orifice of the superior vena cava; 2, insertion of the crista terminalis into the anterosuperior angle of the right atrium (anterosuperior buttress of the right atrium); 3, fossa ovalis; 4, orifice of the coronary sinus; 5, posteroinferior part of the right atrium (subthebesian sinus); 6, triangle of Koch (its superior border is shown by a white line, projection of the tendon of the inferior pyramidal space [tendon of Todaro]); 7, vestibule of the right atrioventricular valve; ant–post, anteroposterior direction; sup–inf, superoinferior direction with the heart in situ in the orthograde position.

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