Andersons pediatric cardiology 68
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Abstract
Inordertounderstandtheanatomyofthecongenitallymalformedheart,it
isfirstnecessarytoappreciateallthedetailsofnormalanatomy,including
thearrangementsofthecoronaryarteriesandtheconductiontissues.We
beginbyemphasizingtheneedtodescribetherelationshipsofthecardiac
componentsastheyareseenwiththeheartnormallylocatedwithinthe
thorax.Fortoolong,anatomistsandpathologistshavedescribedtheheart
asseensubsequenttoitsremovalfromthebody,andpositionedonitsapex.
This“valentine”positioncurrentlyunderscoresthetermsusedtodescribe
structureswithintheheart,whichintheeraofthree-dimensional
reconstructionsincreasinglyusedinclinicalsituations,doesnothingbut
createconfusion.Inthischapter,therefore,wedescribethecomponentsof
theheartasseeninattitudinallyappropriatelocation,illustratingthedetails
usingimagescreatedfrommultidetectorrowcomputedtomographic
interrogationofadultsundergoinginvestigationforcoronaryarterial
disease.Wethendescribethefeaturesofthevariouschambersthat
underscoretheapproachtothecongenitalcardiacmalformationsthatare
subsequentlydescribedintheremainderofthebook.
Keywords
Anatomy;Attitudinallyappropriatenomenclature;Morphologicmethod;
Coronaryarteries;Conductiontissues;Ventricles;Atriums;Arterialtrunks
Introduction
Itisaxiomaticthattounderstandabnormalanatomy,andtodescribeit
adequately,itisnecessaryfirsttounderstandthenormalarrangement,including
therelationshipsoftheconductiontissuesandcoronaryarteriestothevarious
componentsoftheheart.Wereviewthesefeaturesinthischapterandemphasize
thesignificanceofdescribingthevariouscardiaccomponentsastheyareseen
withtheheartnormallypositionedwithinthechest,theattitudinallyappropriate
approach.1Weshowhowitisnowpossiblealsotoillustratethesignificant
featuresduringlifebyappropriateinterrogationofmultidetector-rowcomputed
tomographicdatasets.Thesignificantaspectsofabnormalanatomywillthen
receiveattentioninthevariouschapterswithinthebookconcernedwithspecific
lesions.
HeartWithintheChest
Thenormalinterrelationshipsofthechamberswithintheheart,andthelocation
oftheheartitselfwithinthechest,arenowreadilyapparenttothecliniciansince
theyarerevealedbythevariousthree-dimensionaltechniquesincreasinglyused
duringthediagnosticcascade.Theheartnormallyoccupiesthemiddle
compartmentofthemediastinum,withthelargerpartofitsbulktotheleftofthe
midline(Fig.2.1).
FIG.2.1 Reconstructeddatasetfromanadultobtainedusing
multidetector-rowcomputedtomography.Thecardiaccomponentshave
beensegmentedrelativetothecontoursofthechestcavity.Theheart
occupiesthemediastinum,withthelargerpartofitsbulktotheleftofthe
midline.Thelongaxisoftheheartismarkedlyskewedrelativetothelong
axisofthebody.Notetheanteriorlocationoftheso-calledrightchambers,
reconstructedinblue,relativetotheirleft-sidedcounterparts.
Thecardiaclongaxisshowsaconsiderableobliquityrelativetothelongaxis
ofthebody,extendingroughlyalongalinedrawnthroughtherightshoulderto
thelefthemidiaphragm.Despitethisdiscrepancybetweentheplanesofthebody
