The inferior pyramidal space of the heart is an area filled with epicardial adipose tissue at the backside or diaphragmatic side of the heart immediately beneath the crux cordis.
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Gross anatomy
The inferior pyramidal space is a pyramid-shaped fibrofatty structure between the two septal atrial walls and the crest of the interventricular septum with its base on the diaphragmatic surface of the heart and its apex is located right near the central fibrous body of the atrioventricular septum close to the noncoronary sinus of the aortic root. From the diaphragmatic side, it can be seen at the crossing of the left and right inferior atrioventricular and interatrial grooves to which it is continuous 1-3.
The inferior pyramidal space holds sections of different important cardiac vessels and nerves, among them the atrioventricular nodal artery, which runs right through this space from the base to its apex. The coronary sinus takes its path at the base of the inferior pyramidal space 1-3.
History and etymology
The inferior pyramidal space has been described by the Canadian cardiovascular surgeon and anatomist Wallace Arnold McAlpine in 1975 4.
Clinical importance
Many important vascular structures traverse the inferior pyramidal space among them the coronary sinus and the atrioventricular nodal artery 1-3.
Related pathology
The inferior pyramidal space can form a route for the spread of infections or malignancies e.g. after valve replacement surgery or lymphoma spread 3.
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