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Cardiac segmentation model

Dr Craig Hacking ◉ ◈ and Dr Ayush Goel et al.

The American Heart Association (AHA) has published the nomenclature and segmentation of the left ventricular myocardium (the cardiac segmentation model), now widely used for the description of disease-affected myocardial territories and wall function.

There are 17 segments that have a reasonably consistent vascular supply from one of the three main coronary arteries (RCA, LAD and LCx), but significant anatomic variation does exist. This standard segmentation model can be used in cardiac nuclear tests, computed tomography, magnetic resonance imaging, echocardiography and coronary angiography. Having a standard model optimizes intra- and inter-modality comparison.

On this page:

Article:

Myocardial segments
Coronary artery territories
Echocardiography
Related articles
References

Images:

Cases and figures

Myocardial segments

In the long axis, the left ventricle is divided into equal thirds named the basal, mid and apical thirds. The tip of the apex forms a separate final segment. When these thirds are viewed in short axis they form rings that are numbered counterclockwise which can be further divided into equal sectors:

the basal third has six 60° sectors
- basal anterior (segment 1)
- basal anteroseptal (segment 2)
- basal inferoseptal (segment 3)
- basal inferior (segment 4)
- basal inferolateral (segment 5)
- basal anterolateral (segment 6)
the mid third has six 60° sectors
- mid anterior (segment 7)
- mid anteroseptal (segment 8)
- mid inferoseptal (segment 9)
- mid inferior (segment 10)
- mid inferolateral (segment 11)
- mid anterolateral (segment 12)
the apical third has four 90° sectors
- apical anterior (segment 13)
- apical septal (segment 14)
- apical inferior (segment 15)
- apical lateral (segment 16)
finally, the tip of the ventricular apex is its own segment
- apex (segment 17)

Coronary artery territories

LAD supplies segments 1, 2, 7, 8, 13, 14 and 17
RCA supplies segments 3, 4, 9, 10 and 15
LCx supplies segments 5, 6, 11, 12 and 16

Echocardiography

The inability to visualize the whole chamber often necessitates utilization of anatomical landmarks to delineate the thirds:

basal: mitral annulus to the tips of the papillary muscles in end-diastole
mid: along the length of the papillary muscles  
apical: below the papillary muscles to the apex

References

Anatomy: Thoracic

thoracic skeleton
- thoracic cage
  - ribs
    - typical ribs
    - atypical ribs
    - variant anatomy
      - bifid ribs
      - Srb anomaly
  - costal cartilage
  - sternum
- thoracic spine
- articulations
muscles of the thorax
spaces of the thorax
thoracic viscera
blood supply of the thorax
- arteries
  - thoracic aorta (development)
  - pulmonary trunk
    - left pulmonary artery
      - aberrant left pulmonary artery
    - right pulmonary artery
- veins
  - superior vena cava (cavoatrial junction)
  - inferior vena cava
  - coronary veins
    - cardiac veins which drain into the coronary sinus
      - great cardiac vein
      - middle cardiac vein
      - small cardiac vein
      - posterior vein of the left ventricle
      - vein of Marshall (oblique vein of the left atrium)
    - anterior cardiac veins
    - venae cordis minimae (smallest cardiac veins or thebesian veins)
  - pulmonary veins
    - bronchial veins
lymphatics
innervation of the thorax

Article information

rID: 32176

System: Cardiac

Section: Approach

Tag: refs, stub, cases

Synonyms or Alternate Spellings:

Myocardial segmentation
Myocardial segments

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Cases and figures

Figure 1Figure 1

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Figure 2Figure 2

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Figure 3: myocardial segmentsFigure 3: myocardial segments

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Figure 4: coronary arterial supplyFigure 4: coronary arterial supply

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Figure 5: basal myocardial segmentsFigure 5: basal myocardial segments

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Figure 6: mid myocardial segmentsFigure 6: mid myocardial segments

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Figure 7: apical myocardial segmentsFigure 7: apical myocardial segments

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Figure 8: apex myocardial segmentFigure 8: apex myocardial segment

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