The right ventricle forms the largest part of the anterior surface of the heart, a small part of the diaphragmatic surface,
and almost the entire inferior border of the heart. Superiorly it tapers into an arterial cone, the conus arteriosus (infundibulum), which leads into the pulmonary trunk. The interior of the right ventricle has irregular
muscular elevations (trabeculae carneae). A thick muscular
ridge, the supraventricular crest, separates the ridged muscular wall of the inflow part of the chamber from the smooth
wall of the conus arteriosus, or outflow part. The inflow part
of the ventricle receives blood from the right atrium through the right AV (tricuspid) orifice, located posterior to the body of the sternum at the level of the 4th and
5th intercostal spaces. The right AV orifice is surrounded by
one of the fibrous rings of the fibrous skeleton of the heart. The fibrous ring keeps the caliber of the orifice
constant (large enough to admit the tips of three fingers),
resisting the dilation that might otherwise result from blood
being forced through it at varying pressures.
The tricuspid valve guards the right
AV orifice. The bases of the valve cusps are attached to the fibrous ring around the orifice. Because the fibrous ring maintains the caliber of the orifice, the attached valve cusps contact
each other in the same way with each heartbeat. Tendinous cords (Latin chordae tendineae) attach to the free edges and ventricular surfaces of the anterior, posterior, and septal cusps,
much like the cords attaching to a parachute. The
tendinous cords arise from the apices of papillary muscles,
which are conical muscular projections with bases attached to
the ventricular wall. The papillary muscles begin to contract
before contraction of the right ventricle, tightening the tendinous cords and drawing the cusps together. Because the cords
are attached to adjacent sides of two cusps, they prevent separation of the cusps and their inversion when tension is applied
to the tendinous cords and maintained throughout ventricular
contraction (systole) - that is, the cusps of the tricuspid valve
are prevented from prolapsing (being driven into the right
atrium) as ventricular pressure rises. Thus, regurgitation of blood (backward flow of blood) from the right ventricle back
into the right atrium is blocked during ventricular systole by
the valve cusps.
Three papillary muscles in the right ventricle correspond
to the cusps of the tricuspid valve:
1. The anterior papillary muscle, the largest and most
prominent of the three, arises from the anterior wall of the
right ventricle; its tendinous cords attach to the anterior
and posterior cusps of the tricuspid valve.
2. The posterior papillary muscle, smaller than the anterior
muscle, may consist of several parts; it arises from the inferior wall of the right ventricle, and its tendinous cords attach
to the posterior and septal cusps of the tricuspid valve.
3. The septal papillary muscle arises from the interventricular septum, and its tendinous cords attach to the anterior and septal cusps of the tricuspid valve.
The interventricular septum (IVS), composed of muscular and membranous parts, is a strong, obliquely placed
partition between the right and left ventricles, forming part of the walls of each. Because of the much
higher blood pressure in the left ventricle, the muscular
part of the IVS, which forms the majority of the septum, has
the thickness of the remainder of the wall of the left ventricle
(two to three times as thick as the wall of the right ventricle) and bulges into the cavity of the right ventricle. Superiorly
and posteriorly, a thin membrane, part of the fibrous skeleton
of the heart, forms the much smaller membranous part of the IVS. On the right side, the septal cusp of
the tricuspid valve is attached to the middle of this
membranous part of the fibrous skeleton. This means that
inferior to the cusp, the membrane is an interventricular septum, but superior to the cusp it is an atrioventricular septum,
separating the right atrium from the left ventricle.
The septomarginal trabecula (moderator band) is a
curved muscular bundle that traverses the right ventricular chamber from the inferior part of the IVS to the base of the
anterior papillary muscle. This trabecula is important because
it carries part of the right branch of the AV bundle, a part
of the conducting system of the heart to the anterior papillary muscle. This "shortcut" across the chamber
seems to facilitate conduction time, allowing coordinated
contraction of the anterior papillary muscle.
The right atrium contracts when the right ventricle is
empty and relaxed; thus blood is forced through this orifice
into the right ventricle, pushing the cusps of the tricuspid
valve aside like curtains. The inflow of blood into the right
ventricle (inflow tract) enters posteriorly; and when the
ventricle contracts, the outflow of blood into the pulmonary trunk (outflow tract) leaves superiorly and to the left. Consequently, the blood takes a U-shaped path
through the right ventricle, changing direction about 140°.
This change in direction is accommodated by the supraventricular crest, which deflects the incoming flow into the
main cavity of the ventricle, and the outgoing flow into the
conus arteriosus toward the pulmonary orifice. The inflow
(AV) orifice and outflow (pulmonary) orifice are approximately 2 cm apart. The pulmonary valve at the apex of the conus arteriosus is at the level of the
left 3rd costal cartilage.