Understanding cardiac anatomy: The prerequisite for optimal cardiac surgery

Abstract

If advances in cardiac surgery are to continue into the twenty-first century, it will be necessary to concentrate on details of matters such as the anatomy of the heart. This will be achieved best when anatomy is described as it is observed. This approach is obscured when words are used in inappropriate fashion, or else assigned a function separate from their everyday meaning. Examples of how the congenitally malformed heart and the normal heart have been described in the past are examined within the framework of using words in their vernacular meaning. Suggestions are made to improve descriptions and understanding for the 21st century. Using the example of the "univentricular heart", it is shown how conventions debarring ventricular status to discrete chambers within the ventricular mass are, of necessity, artificial. Similar examples are used to distinguish septal from parietal structures within the heart and to elucidate the structure of some congenital malformations. For values, it is shown how proper description requires assessment of these structures in their closed as well as their open positions. Understanding of cardiac anatomy, truly a prerequisite for successful cardiac surgery, will be facilitated in future if words are used in their generally accepted sense, and if artificial conventions are avoided.