Functional anatomy of the heart

Background

The study of the heart and great vessels has come a long way since the days of Andreas Vesalius, the great 16^th-century anatomist who recognized the impact of anatomy on the practice of medicine. During the European Renaissance, the tomographic apptoach to the study of cardiac anatomy became popular because of its artistic-based correlations. This is vividly depicted in the drawings of Leonardo da Vinei, who was called the first comparative anatomist since Aristotle. During the ensuing nearly four hundred years, however, interest in cardiac anatomy was very sporadic and limited to a few zealous and pioneering physicians, anatomists, and artists.

The 19^th century ushered in the era of anatomic dissection for the study of physiologic and pathophysiologic processes. Virchow in 1885 described the inflow-method of cardiac dissection that followed the direction of blood flow. It was quick and simple and become the dissection method of choice. The works of Virchow and Osler paved the way to understanding the pathophysiologic basic of such diseases as pulmonary embolism, endocarditic, and heart failure. Renewed interest in the study of cardiac anatomy and pathology was facilitated by the rise in autopsy rates in Europe and North America during the first half of the 20^th century. Herrick described the clinical features of coronary thrombosis. Later, Blumgart, Schlesinger, and Zoll advanced our understanding of coronary artery disease through elegant clinic pathologic correlations.

These achievements examinations. The advent of cardiac surgery in the 1950s, followed by coronary angiography, was a major impetus for promoting the study of in vivo clinic pathologic anatomic correlations. While cardiac surgeons were quick to appreciate the importance of having a detailed understanding of cardiac anatomy, clinical cardiologists were more interested in path physiology. However, with the introduction of noninvasive imaging techniques over the past two decades, the perception of cardiac anatomy and path physiology radically changed for all of medicine in general and cardiology in particular.

With increasing use of tomographic techniques in the diagnosis and management of cardiovascular diseases, there has been a corresponding decrease in the use of autopsy for anatomic correlations. The reasons for this decrease are complex and controversial and include an increased confidence in technology, lack of reimbursement for autopsies for hospital accreditation. Nonetheless, autopsy still uncovers unexpected process in about 15 percent of cases and is an invaluable tool for quality assurance programs.