Topics

Topic

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Left ventricle

The left ventricle (LV) is the thick-walled, muscular chamber of the heart responsible for pumping oxygenated blood into the systemic circulation via the aorta. It has a conical shape, with a base connected to the left atrium through the mitral valve, and an apex that projects inferolaterally, forming the apex beat. Its thick myocardium, especially in the interventricular septum and free wall, generates the high pressure needed to overcome systemic vascular resistance. The LV cavity is lined by trabeculae carneae and includes papillary muscles that anchor the mitral valve via chordae tendineae, preventing prolapse during systole.

Synonyms

  • LV

  • Left cardiac ventricle

  • Systemic ventricle

Function

  • Pumps oxygenated blood from the left atrium into the aorta via the aortic valve

  • Maintains systemic circulation under high pressure

  • Supports cardiac output during both rest and exertion

  • Works synchronously with the right ventricle to maintain balanced circulation

Arterial Supply

  • Primarily from the left coronary artery (LCA), especially:

    • Left anterior descending artery (LAD): supplies the anterior wall, anterior septum, and apex

    • Left circumflex artery (LCX): supplies the lateral and posterior walls

  • Contribution from the right coronary artery (RCA): supplies the inferior wall in right-dominant circulation

Venous Drainage

  • Drains into the great cardiac vein, middle cardiac vein, and posterior vein of the left ventricle

  • Venous return ultimately flows into the coronary sinus, then the right atrium

Nerve Supply

  • Parasympathetic: vagus nerve (CN X), providing inhibitory fibers that decrease heart rate and contractility

  • Sympathetic: thoracic sympathetic trunk (T1–T4), providing excitatory fibers that increase heart rate, contractility, and conduction velocity

  • Cardiac plexus integrates both inputs to modulate ventricular activity

MRI Appearance

T1-weighted images:

  • Myocardium appears as intermediate signal intensity

  • Blood in the ventricular cavity is low signal (dark) due to flow void

  • Useful for structural assessment and myocardial thickness

T2-weighted images:

  • Myocardium appears intermediate signal

  • Edematous or ischemic myocardium appears hyperintense compared to normal muscle

  • Blood pool remains dark due to flow void

STIR (Short Tau Inversion Recovery):

  • Enhances visualization of myocardial edema or inflammation

  • Normal myocardium remains low to intermediate signal, whereas acute infarction or myocarditis appears hyperintense

T1 Post-Contrast (Gadolinium-enhanced / LGE – Late Gadolinium Enhancement):

  • Infarction, fibrosis, or scar tissue shows delayed hyperenhancement, sharply contrasting with normal myocardium

  • Gold standard for myocardial viability assessment

CT Appearance

Non-contrast CT:

  • Left ventricle visualized as a thick-walled chamber with higher density myocardium compared to fat

  • Coronary artery calcifications and mural thrombus may be seen

Contrast-enhanced CT (Cardiac CTA):

  • Cavity opacifies with contrast, showing clear definition of endocardium, myocardium, and papillary muscles

  • Useful for evaluating chamber size, wall thickness, ventricular function, thrombus, aneurysm, and coronary artery supply

  • Multiphase gated CTA allows assessment of ventricular contraction and ejection fraction

MRI images

Left ventricle anatomy MRI coronal image -img-00000-00000

CT image

Left ventricle anatomy CT axial image -img-00000-00000