1. Arterial supply and venous drainage of heart.

Mention nerve supply and applied

as-pects. [if question comes as 10 marker just draw diagrams ONLY]

ARERIAL SUPPLY

RIGHT CORONARY ARTERY

Origin
The right coronary artery arises from the anterior aortic sinus of the ascending aorta,
immediately above the aortic valve.

Course
After arising from the ascending aorta, the right coronary artery first runs forwards between the
pulmonary trunk and the right auricle, and then it descends almost vertically in the right
atrioventricular groove (right anterior coronary sulcus) up to the junction of the right and the
inferior borders of the heart. At the inferior border of the heart, it turns posteriorly and runs in the
posterior atrioventricular groove (right posterior coronary sulcus) up to the posterior
interventricular groove where it terminates by anastomosing with the left coronary artery.
Branches and Distribution
1. Right conus artery: It supplies the anterior surface of the pulmonary conus (infundibulum of
the right ventricle).

2. Atrial branches: They supply the atria. One of the atrial branches—the artery of sinuatrial
node (also called sinuatrial nodal artery) supplies the SA node in 60% cases. In 40% of
individuals it arises from the left coronary artery.
3. Anterior ventricular branches: They are two or three and supply the anterior surface of the
right ventricle.The marginal branch is the largest and runs along the lower margin of the
sternocostal surface to reach the apex.

4. Posterior ventricular branches: They are usually two and supply the diaphragmatic surface of
the right ventricle.

5. Posterior interventricular artery: It runs in the posterior interventricular groove up to the apex.
It supplies the:
(a) posterior part of the interventricular septum,
(b) atrioventricular node (AV node) in 60% of the cases, and
(c) right and left ventricles.

N.B. In 10% individuals, the posterior interventricular artery arises from the left coronary
artery.

LEFT CORONARY ARTERY

Origin
The left coronary artery arises from the left posterior aortic sinus of the ascending aorta,
immediately above the aortic valve.

Course
After arising from ascending aorta, the left coronary artery runs forwards and to the left between
the pulmonary trunk and the left auricle. It then divides into an anterior interventricular and
circumflex artery. The anterior interventricular artery (left anterior descending/LAD) runs
downwards in the anterior interventricular groove to the apex of the heart. It then passes
posteriorly around the apex of the heart to enter the posterior interventricular groove to
terminate by anastomosing with the posterior interventricular artery—a branch of the right
coronary artery.
The circumflex artery winds around the left margin of the heart and continues in the left posterior
coronary sulcus up to the posterior interventricular groove where it terminates by anastomosing
with the right coronary artery.

Branches and Distribution

1. Anterior interventricular artery/left anterior descending (LAD) artery: It supplies
(a) anterior part of interventricular septum
(b) greater part of the left ventricle and part of right ventricle
(c) a part of left bundle branch (of His).
2. Circumflex artery: It gives a left marginal artery that supplies the left margin of the left
ventricle up to the apex of the heart.
3. Diagonal artery: It may arise directly from the trunk of the left coronary artery.
4. Conus artery: It supplies the pulmonary conus.
5. Atrial branches: They supply the left atrium.

VENOUS DRAINAGE

NERVE SUPPLY

The heart is supplied by the sympathetic and parasympathetic fibres via the superficial and
deep cardiac plexuses formed by the parasympathetic and sympathetic fibres.

The parasympathetic fibres are derived from vagus nerves. They are cardioinhibitory; hence
their stimulation causes slowing of the heart rate and constriction of the coronary arteries.

The sympathetic fibres are derived from upper 3–5 thoracic spinal segments. They are
cardioacceleratory, hence their stimulation increase the heart rate and causes the dilatation of
the coronary arteries. The sympathetic fibres also cause dilatation of the coronary arteries.
 2. Define bronchopulmonary segments. Name the bronchopulmonary segments of
both lungs. Discuss the applied aspects.

The bronchopulmonary segments are well-defined, wedge- shaped sectors of the lung, which
are aerated by tertiary (segmental) bronchi

APPLIED ASPECT
Segmental resection of the lung:Since each segment is an independent functional unit having its
own bronchovascular supply and potential planes of separation exist between the segments.
Localized chronic disease, such as tuberculosis, bronchiectasis or benign neoplasm is restricted
to one segment; it is, therefore, possible to dissect out and remove the diseased segment
leaving the surrounding tissue intact

3. Right atrium - External features, internal features, development, developmental

anoma-lies.

The right atrium is somewhat quadrilateral chamber situated behind and to the right side of the
right ventricle. It consists of a main cavity and a small outpouching called auricle.
External Features
1. The right atrium is elongated vertically and receives superior vena cava (SVC) at its upper
end and the inferior vena cava (IVC) at its lower end.
2. The upper anterior part is prolonged to the left to form the right auricular appendage, the right
auricle. The margins of the auricle are notched. The right auricle overlaps the roots of the
ascending aorta completely and infundibulum of the right ventricle partly.
3. A shallow vertical groove called sulcus terminalis extends along the right border between the
superior and inferior vena cavae. The upper part of the sulcus contains the sinuatrial (SA) node.
Internally it corresponds to crista terminalis.
4.The vertical right atrioventricular groove lodges the right coronary artery and the small cardiac
vein.

Internal Features
The interior of the right atrium is divided into two parts:
(a) main smooth posterior part – the sinus venarum
(b) rough anterior part – the atrium proper.

The two parts are separated from each other by crista terminalis.

The interior of right atrium also presents septal wall of the right atrium. Developmentally it is
derived from septum primum and septum secundum. The septal wall when viewed from within
the right atrium presents the following features:
1. Fossa ovalis, a shallow oval/saucer-shaped depression in the lower part, formed by
septum primum. It represents the site of foramen ovale in the foetus.
2. Annulus ovalis/limbus fossa ovalis, forms the distinct upper and lateral margin of the
fossa ovalis. It represents the free edge of the septum secundum. Inferiorly the annulus
ovalis is continuous with the left end of the valve of IVC.
3. Triangle of Koch, a triangular area bounded in front by the base of septal leaflet of
tricuspid valve, behind by anterior margin of the opening of coronary sinus and above by
the tendon of Todaro—a subendocardial ridge. The atrioventricular node lies in this
triangle.
4. Torus aorticus, an elevation in the anterosuperior part of the septum produced due to
bulging of the right posterior (non-coronary) sinus of ascending aorta.

Opening into the Right Atrium

There are number of openings in the right atrium. These are as follows (Fig. 20.10):
1. Opening of SVC: The SVC opens at the upper end of the right atrium and has no valve.
It returns the blood to the heart from the upper half of the body.
2. Opening of IVC: The IVC opens at the lower end of the right atrium close to the
interatrial septum. It is guarded by a rudimentary non-functioning semilunar valve called
valve of the inferior vena cava/Eustachian valve.
3. Opening of coronary sinus: The coronary sinus, which drains most of the blood from the
heart, opens into the right atrium between the openings of IVC and right atrioventricular
orifice. It is also guarded by a rudimentary non-functioning valve, Thebesian valve.
 4. Right atrioventricular orifice (largest opening): It communicates the right atrial chamber
with the right ventricular chamber. It lies anterior to the opening of IVC and is guarded by
the tricuspid valve.
5. Many small orifices of small veins: These are the opening of venae cordis minimae
(Thebesian veins) and anterior cardiac veins.

4. Define a typical intercostal space. Name its contents. Describe a typical

intercostal nerve.

The 3rd–6th spaces are typical intercostal spaces because the blood and nerve supply of 3rd–
6th intercostal spaces is confined only to thorax.The 3rd–6th spaces are typical intercostal
spaces because the blood and nerve supply of 3rd–6th intercostal spaces is confined only to
thorax.

Each space contains the following structures :

1. Three intercostal muscles, viz.
(a) External intercostal.
(b) Internal intercostal.
(c) Innermostintercostal(intercostalisintimus).
2. Intercostal nerves.
3. Intercostal arteries.
4. Intercostal veins.
5. Intercostal lymph vessels and lymph nodes.
The typical intercostal nerves are those which remain confined to their own intercostal spaces.

5. Arch of Aorta - Extent, relations, branches, development.

Course
The arch of aorta begins at the level of the right 2nd costal cartilage and runs upwards,
backwards, and to the left, in front of the bifurcation of the trachea. Having reached the back of
the middle of the manubrium, it turns backwards and downwards behind the left bronchus up to
the level of lower border of T4 vertebra where it continues as the descending thoracic aorta.

Relations

Branches
1. Brachiocephalic (innominate) artery.
2. Left common carotid artery.
3. Left subclavian artery.
Development
The arch of aorta develops from the following sources:
1. Aortic sac.
2. Left horn of aortic sac.
3. Left fourth aortic arch artery.
4. Left dorsal aorta (between the attachment of the fourth
aortic arch (artery) and 7th cervical intersegmental artery.

6. Describe with the help of labelled diagrams, features & impressions on the
mediastinal surfaces of right & left lungs. Give microscopic structure of lungs.

HISTOLOGY OF LUNHGS

7. Discuss the left and right lung under: Coverings & its nerve supply, lobes

The pleura-like peritoneum is a serous membrane lined by flattened epithelium (mesothelium).

The lining epithelium secretes a watery lubricant—the serous fluid.

LAYERS OF THE PLEURA

The pleura consist of two layers: (a) visceral pleura and (b) parietal pleura. The moistened
space between the two layers is called pleural cavity (vide supra).

Visceral Pleura (Pulmonary Pleura)

The visceral pleura completely covers the surface of the lung except at the hilum and along the
attachment of the pulmonary ligament. It also extends into the depths of the fissures of the
lungs. It is firmly adherent to the lung surface and cannot be separated from it.

Parietal Pleura
The parietal pleura is thicker than the visceral pleura and lines the walls of the pulmonary cavity.
Subdivisions
divide parietal pleura, according to the surface, which it lines, covers or the region in which it
lies. Thus parietal pleura is divided into the following four parts :
1. Costal pleura.
2. Diaphragmatic pleura.
3. Mediastinal pleura.
4. Cervical pleura.

NERVE SUPPLY OF THE PLEURA

The parietal pleura is supplied by the somatic nerves and is sensitive to pain:
Costal and peripheral part of the diaphragmatic pleura is supplied by the intercostal nerves.
Mediastinal and central part of the diaphragmatic pleura is supplied by the phrenic nerve.

The visceral pleura is supplied by the autonomic (sympathetic) nerves (T2–T5) and is
insensitive to pain.

Referred pain of pleura: The pain from central diaphragmatic pleura and mediastinal pleura is
referred to the neck or shoulder through phrenic nerves (C3, C4, and C5) because skin at these
sites has same segmental supply through the supraclavicular nerves (C3, C4, and C5).
LOBES OF THE LUNGS
The right lung is divided into three lobes: superior, middle, and inferior by two fissures—(a) an
oblique fissure and (b) a horizontal fissure.

The left lung is divided into two lobes: (a) superior and (b) inferior by an oblique fissure.

8. Discuss superior mediastinum under boundaries, contents, relations and

development of arch of aorta.

Contents (Figs 19.6 and 19.7)

1. Arteries
(a) Arch of aorta.
(b) Brachiocephalic artery.
(c) Left common carotid artery.
(d) Left subclavian artery.

2. Veins
(a) Right and left brachiocephalic veins.
(b) Upper half of the superior vena cava (SVC)
(c) Left superior intercostal vein.

3. Nerves
(a) Phrenic nerves(rightandleft).
(b) Vagus nerves (right and left).
(c) Sympathetic trunks and cardiac nerves (right and left).
(d) Left recurrent laryngeal nerves.

4. Lymphoid organs and lymphatics

(a) Lymphnodes.
(b) Thoracic duct.
(c) Thymus.

5. Tubes
(a) Trachea.
(b) Esophagus.

6. Muscles
(a) Sternohyoid.
(b) Sternothyroid.
(c) Longus colli.

9. Discuss nerve supply of heart under following: Sites of cardiac plexuses,

components of superficial cardiac plexus, components of deep cardiac plexuses,
Clinical importance.
The heart is supplied by the sympathetic and parasympathetic fibres via the superficial and
deep cardiac plexuses formed by the parasympathetic and sympathetic fibres.

The parasympathetic fibres are derived from vagus nerves. They are cardioinhibitory; hence
their stimulation causes slowing of the heart rate and constriction of the coronary arteries.

The sympathetic fibres are derived from upper 3–5 thoracic spinal segments. They are
cardioacceleratory, hence their stimulation increase the heart rate and causes the dilatation of
the coronary arteries. The sympathetic fibres also cause dilatation of the coronary arteries.

Superficial Cardiac Plexus

The superficial cardiac plexus lies below the arch of aorta in front of the bifurcation of pulmonary
trunk, just to the right of ligamentum arteriosum. The cardiac ganglion (of Wrisberg) lies close to
the ligamentum arteriosum.

It is formed by the:
(a) superior cervical cardiac branch of left cervical sympathetic trunk, and
(b) inferior cervical cardiac branch of left vagus nerve.

Distribution
The superficial cardiac plexus gives branches to
(a) deep cardiac plexus
(b) right coronary artery
(c) left anterior pulmonary plexus.

Deep Cardiac Plexus (Fig. 20.26)

The deep cardiac plexus lies in front of the bifurcation of the trachea, behind the arch of the
aorta.

It is formed by:
(a) all the cardiac branches derived from three cervical and upper 4 or 5 thoracic ganglia of the
sympathetic chains except the superior cervical cardiac branch of left cervical sympathetic
chain, and
(b) all the cardiac branches of vagus and recurrent laryngeal nerves except the inferior cervical
cardiac branch of the left vagus nerve.

Distribution
The right and left halves of the plexus distributes branches to
(a) corresponding coronary arteries and pulmonary plexus
(b) separate branches to the atria.

CLINICAL IMPORTANCE
● The sensations of pain arising due to the ischemia of the heart pass through the
sympathetic fibres to reach the upper five thoracic spinal segments (T1–T5) and follow
the usual somatosensory pathway to the central nervous system.
● The pain fibres pass from thoracic ganglia to the spinal nerves
● The cell bodies of the first order sensory neurons are located in the dorsal root ganglia of
T1– T5 spinal nerves.
● Hence cardiac pain is referred mainly in the area of distribution of these nerves, i.e.,
pectoral region and medial aspect of the arm and forearm.
● Sometimes cardiac pain is referred to the neck and mandible. It is because of the
connection of sympathetic fibres with the cervical nerves.
 10. Describe azygos vein under: formation, course and tributaries, termination and
development.
FORMATION,COURSE & TERMINATION [DRAW DIAGRAM ONLY]

The tributaries of the azygos vein are as follows:

1. Lower 7th right posterior intercostal veins except first.
2. Right superior intercostal vein (formed by union of 2nd, 3rd, and 4th right posterior intercostal
veins).
3. Hemiazygos vein (at the level of T7 or T8 vertebra).
4. Accessory hemiazygos vein (at the level of T8 or T9 vertebra).
5. Right subcostal vein.
6. Right bronchial vein.
7. Right ascending lumbar vein.
8. Esophageal veins with the exception of those at its lower end.
9. Mediastinal veins.
10. Pericardialveins.

THORAX (Brief Essays)

 1. Location, formation, tributaries, termination and development of coronary sinus
Coronary sinus: It is the principal vein of the heart. Most of the venous blood from the walls of
the heart is drained into the right atrium through coronary sinus.

The coronary sinus is the largest vein of the heart and lies in the posterior part of the
atrioventricular groove (left posterior coronary sulcus).

It develops from the left horn of the sinus venosus and a part of the left common cardinal vein.

Tributaries: The coronary sinus receives the following tributaries

1. Great cardiac vein
2. Middle cardiac vein
3. Small cardiac vein:
4. Posterior vein of the left ventricle
5. Oblique vein of the left atrium (vein of Marshall):

2. Sinuses of pericardium

Transverse Sinus of Pericardium

It is a transverse recess behind the ascending aorta and pulmonary trunk and in front of
superior vena cava and superior pulmonary veins. It develops due to degeneration of dorsal
mesocardium.It is a horizontal passage between the two pericardial tubes. On each side it
communicates with the general pericardial cavity.

Oblique Sinus of Pericardium

It is a recess of serous pericardium behind the base of the heart (actually left atrium). It is
enclosed by 'J-shaped' sheath of visceral layer of serous pericardium enclosing six veins (i.e., 2
vena cavae and 4 pulmonary veins).
The oblique sinus is akin to lesser sac behind the stomach and develops as a result of
absorption of four pulmonary veins into the left atrium. The oblique sinus permits the distension
of left atrium during return of oxygenated blood in it from the lungs.
Surgical significance of transverse pericardial sinus:
During cardiac surgery, after the pericardial sac is opened anteriorly, a finger is passed through
the transverse sinus of pericardium, posterior to the aorta and pulmonary trunk
A temporary ligature is passed through the transverse sinus around the aorta and pulmonary
trunk. The tubes of heart-lung machine are inserted into these vessels and ligature is
tightened.

3. Thoracic duct
Thoracic duct drains lymph from whole of the body except the right upper quadrant of the body
which is drained by the right lymphatic duct (Fig. 23.1).

Extent: The thoracic duct extends to the upper end of cisterna chyli on the posterior abdominal
wall at the lower border of T12 vertebra to the junction of left internal jugular and left subclavian
veins at the root of the neck.

Formation,course and termination

Relations

D. AT THE ROOT OF NECK [draw diagram]

4. Major openings and development of diaphragm

DEVELOPMENT
MAJOR OPENINGS [only draw]

5. Roots of the lungs

COMPONENTS
The root of lung consists of the following structures:
1. Principal bronchus in the left lung, and eparterial and hyparterial bronchi in the right lung.
2. Pulmonary artery.
3. Pulmonary veins (two in number).
4. Bronchial arteries (one on the right side and two on the
left side).
5. Bronchial veins.
6. Lymphatics of the lung.
7. Anterior and posterior pulmonary plexuses of the
nerves.

ARRANGEMENT OF STRUCTURES IN THE ROOT OF THE LUNG AT THE HILUM

6. Thoracic part of oesophagus

The thoracic part extends from superior border of manubrium sterni to the esophageal opening
in the diaphragm.
RELATIONS OF THORACIC PART OF THE ESOPHAGUS
Anterior: From above downwards these are as follows:
1. Trachea.
2. Arch of aorta.
3. Right pulmonary artery.
4. Left principal bronchus.
5. Left atrium enclosed in the pericardium.
6. Diaphragm.

Posterior:
1. Vertebral column.
2. Right posterior intercostal arteries. 3. Thoracic duct.
4. Azygos vein.
5. Hemiazygos veins (terminal parts). 6. Descending thoracic aorta.

To the right:
1. Right lung and pleura. 2. Azygos vein.
3. Right vagus nerve.

To the left:
1. Arch of aorta.
2. Left subclavian artery.
3. Thoracic duct.
4. Left lung and pleura.
5. Left recurrent laryngeal nerve. 6. Descending thoracic aorta.

7. Draw labelled diagram of cross section of thorax at T, level

THORAX (Short Notes)

1. Ligamentum arteriosum, Ductus arteriosum
The ductus arteriosus is a normal and essential component of cardiovascular development that
originates from the distal sixth left aortic arch.

A PDA is most commonly funnel shaped with the larger aortic end (ampulla) distal to the left
subclavian artery, then narrowing toward the pulmonary end, with insertion at the junction of the
main and left pulmonary arteries
The presence of the ductus arteriosus in the fetal circulation is essential to allow right-to-left
shunting of nutrient-rich, oxygenated blood from the placenta to the fetal systemic circulation,
thereby bypassing the fetal pulmonary circuit

In the fetus, the ductus arteriosus is kept open by

• Low arterial oxygen content and
• Placental prostaglandin E2 (PGE2)

Several changes occur at birth to initiate normal functional closure of the ductus arteriosus
within the first 15 to 18 hours of life.
• Spontaneous respirations result in increased blood oxygen content.
• Prostaglandin levels decrease because of placental ligation and increased metabolism of
prostaglandins within the pulmonary circulation by prostaglandin dehydrogenase.

Generally, the ductus arteriosus is hemodynamically insignificant within 15 hours and

completely closed by 2 to 3 weeks

The ligamentum arteriosum (arterial ligament), also known as Botallo's ligament,

Harvey's ligament, and Botallo's duct, is a small ligament attaching the aorta to the
pulmonary artery.
It serves no function in adults but is the remnant of the ductus arteriosus formed within
three weeks after birth.

2. Fissures of right lung

The right lung is divided into three lobes: superior, middle, and inferior by two fissures—(a) an
oblique fissure and (b) a horizontal fissure.

1. Oblique fissure: A long oblique fissure runs obliquely downwards and forwards crossing
the posterior border about 6 cm (2 inches) below the apex and inferior border about 7.5
cm (3 inches) lateral to the midline. It separates the superior and middle lobes from the
inferior lobe
2. Horizontal fissure: A short horizontal fissure is present only in the right lung. It starts from
oblique fissure at the midaxillary line and runs horizontally forward to the anterior border
of the lung. It separates the superior and middle lobes.

3. Trensversus thoracis
 4. Pleural recesses
in areas of pleural reflection on to the diaphragm and mediastinum, the space between the
parietal and visceral pleura is greatly expanded. These expanded regions of pleural cavity are
called pleural recesses. They are essential for lung expansion during deep inspiration. Thus
pleural recesses serve as reserve spaces of pleural cavity for the lungs to expand during deep
inspiration. The recesses of pleura are as follows:

1. Costodiaphragmatic recess : It is located inferiorly between the costal and

diaphragmatic pleurae. Vertically it measures about 5 cm and lies opposite the 8th–10th
ribs along the midaxillary line. The costodiaphragmatic recesses are the most dependent
parts of the pleural cavities, hence the fluid of pleural effusion first collect at these sites.

2. Costomediastinal recess : It is located anteriorly between the costal and mediastinal

pleurae and lies between sternum and costal cartilages. The right costomediastinal
recess is possibly occupied by the anterior margin of the right lung even during quiet
breathing. The left costomediastinal recess is large due to the presence of cardiac notch
in the left lung. Its location can be confirmed clinically by percussion (tapping) of the
chest wall. As one moves during tapping from the area of underlying lung tissue to the
area of left costomediastinal recess unoccupied by lung tissue, a change in tone, from
resonant to dull, is noticed. This is called the area of superficial cardiac dullness.

5. Pulmonary ligament
The pleura surround the root of the lung similar to the cuff (sleeve) of the jacket around the wrist
It extends down as a fold called pulmonary ligament.
The pulmonary ligament extends from the root of the lung as far down as the diaphragm
between the lung and the mediastinum.

The fold is filled with loose areolar tissue and contain few lymphatics.

Functions
1. It provides a dead space into which the pulmonary veins can expand during increased
venous return as during exercise.
2. It allows the descent of the root of the lung with the descent of diaphragm during
inspiration. As a result, the apex of lung comes down from the tough suprapleural
membrane leaving an empty space below the membrane.
Now the apex of lung can expand into this empty space.

6. Sternal angle
The manubrium makes a slight angle with the body at this junction called sternal angle or angle
of Louis. It is recognized by the presence of a transverse ridge on the anterior aspect of the
sternum.

7. Ist rib
Distinguishing Features
1. It is shortest, broadest, and most acutely curved.
2. Its shaft is flattened above downwards so that it has upper and lower surfaces, and outer and
inner borders.
3. Its head is small, rounded, and bears a single circular articular facet to articulate with the side
of first thoracic vertebra.
4. Its angle and tubercle coincide.
5. It has no costal groove on its inner surface.
6. Its neck is rounded and elongated. It is directed upwards, backwards and laterally.
7. Its anterior end is larger and thicker.
 8. Interatrial septum
The interior of right atrium also presents septal wall of the right atrium. Developmentally it is
derived from septum primum and septum secundum. The septal wall when viewed from within
the right atrium presents the following features:
● Fossa ovalis, a shallow oval/saucer-shaped depression in the lower part, formed by
septum primum. It represents the site of foramen ovale in the foetus.
● Annulus ovalis/limbus fossa ovalis, forms the distinct upper and lateral margin of the
fossa ovalis. It represents the free edge of the septum secundum. Inferiorly the annulus
ovalis is continuous with the left end of the valve of IVC.
● Triangle of Koch, a triangular area bounded in front by the base of septal leaflet of
tricuspid valve, behind by anterior margin of the opening of coronary sinus and above by
the tendon of Todaro—a subendocardial ridge. The atrioventricular node lies in this
triangle.
● Torus aorticus, an elevation in the anterosuperior part of the septum produced due to
bulging of the right posterior (non-coronary) sinus of ascending aorta.

9. Brachycephalic vein

There are two brachiocephalic veins: (a) right and (b) left. Each of them is formed behind the
sternoclavicular joint by the union of corresponding internal jugular and subclavian veins. They
unite to form SVC. Both are devoid of valves.

Differences between the right and left brachiocephalic veins

 10. Great cardiac vein
It accompanies anterior interventricular and circumflex arteries to join the left end of the
coronary sinus.

11. Intercostal muscles