Anatomy is at the core of the studies in the formation of the physician to safely practice medicine. This is especially true in the study of cardiac anatomy, which has become crucial to the understanding of cardiac pathophysiology and the latest clinical-instrumental imaging such as echocardiography, computed tomography and magnetic resonance imaging, all diagnostic tools that have completely revolutionized the study of cardiac anatomy. Anatomy itself is one of the oldest branches of medicine, perhaps the first studied by man, analyzed by describing the various structures in relation to their anatomical position within the body. However, this approach no longer applies to the heart, which, in the past, was studied in the classic and erroneous orientation with the tip down and the atria up, determining the so-called “Valentine” positioning. As matter of fact, despite it is possible to section the heart in the autopsy room retaining its appropriate anatomical position, when revealing the internal cardiac features there is a concomitant degree of distortion. Therefore, the denomination of the anterior and posterior descending coronary arteries is improper because these arteries run on the upper and lower surfaces of the heart, respectively. Gross anatomy of the heart is a very extensive subject and, as often taught, is far from the anatomy that the student will handle in clinical practice. The aim of this textbook is to focus the cardiac anatomy in the light of the most advanced diagnostic technologies and in accordance with the most recent scientific studies. The various aspects of the multiple anatomical structures involved are highlighted, performing a precise analysis of the images presented and facilitating their identification in order to clearly understand their relationships and pathophysiology.
Illustrated Clinical Anatomy Of The Heart
di Antonino Massimiliano Grande
“Cor primum movens et ultimum moriens”
“The heart, the first to move and the last to die”
The heart, as the ancients believed, is the first organ to move in fetal life and the last to die. The cessation of the heartbeat implied, and still implies unless the most recent ventricular assist devices are used, the inevitable death of the whole organism. The heart contracts approximately 108,00 times in one day, 39 million in one year and 3 billion in 75 years, pumping simultaneously 70 ml per each beat, about 5 liters every minute, 7,200 liters a day and, practically, about 2.6 million liters every year within about 100,000 km of vessels2. This flow rate, then, must be doubled if we consider that the heart has two ventricles that work in parallel and pump the same amount of blood. The performance of this vital function is based on: a) the integrity of the anatomical structure, which guarantees the systolic output, b) the regular functioning of the heart valves that ensure the unidirectional flow, and c) the complex intervention of of neurohormonal mechanisms capable of modulating blood flow in accordance with individual metabolic needs. Cardiac anatomy is a cornerstone for the understanding of the physiological mechanisms of this organ, whose functioning has not yet been fully unrevealed, and, subsequently, of the physiopathological and surgical aspects of the heart. In fact, the study of the anatomy of the various cardiac structures alone is absolutely not sufficient as it must be accom¬panied by the knowledge of physiopathology, which is critical for understanding and appropriately interpreting the clinical-instrumental data acquired: from auscultation to electrocardiography, from echocardiography to chest X-ray, from computed tomography and nuclear magnetic resonance to myocardial scintigraphy.
Considering the enormous progress made in all scientific fields, the current conceptions of the pha¬ses of the cardiac cycle have paradoxically progressed very little compared to the studies of William Harvey, who attested that the heart expels blood as a result of constriction and fills up by passive ex¬pansion. These concepts are, in fact, the basis of the universally accepted mechanism of the cardiac function, but they do not explain the torsion phenomena observed during cardiac surgery and that are also documented by MRI and speckle tracking echocardiography. In a modest attempt to fill this gap, the monograph presents the innovative, but not widely recognized, theory of Francisco Torrent-Guasp, an eminent Spanish cardiologist and anatomist. His studies enabled, through the discovery of the helical ventricular myocardial band, to explain many aspects of myocardial structure, architecture and cardiac pathophysiology with actual clinical and instrumental results. In addition, sequential con¬traction of the helical ventricular myocardial band would explain the ventricular volumetric changes and the reason why the diastole should no longer be considered as a simple passive process of filling in the cardiac cycle, but as a completely active one, since it is driven by the contraction of a particular section of the helical myocardial structure.
The purpose of this volume is, therefore, to emphasize and illustrate the cardiac anatomy in the light of the most advanced diagnostic technologies and in accordance with the most recent scientific studies. The various aspects of the multiple anatomical structures involved are highlighted, perfor¬ming a precise analysis of the images presented and facilitating their identification in order to clearly understand their relationships and pathophysiology.