Revisiting the Anatomy of the Living Heart

An understanding of the complexity of cardiac anatomy is required by all who seek, in the setting of cardiac disease, to interpret the images confronting them. Although the mysteries of cardiac structure have been extensively addressed, significant gaps continue to exist between the descriptions provided by morphologists and by those working in the clinical setting. In part, this reflects the limitations in providing 3D visualization of such a complicated organ. Current 3D imaging technology now permits visualization of the cardiac components using datasets obtained in the living individual. These advances, furthermore, demonstrate the anatomy in the setting of the heart as imaged within the thorax. It has been failure to describe the heart as it lies within the thorax that remains a major deficiency of many morphologists relying on the dissecting room to provide the gold standard. Describing the heart in attitudinally appropriate fashion, a basic rule of clinical anatomy, creates the necessary bridges between anatomists and clinicians. The rapid progression of cardiac interventional techniques, furthermore, emphasizes the need to revisit cardiac anatomy using a multidisciplinary approach. In this review, therefore, we illustrate the advantages of an attitudinally correct approach to cardiac anatomy. We then focus on the morphology of the arterial roots, revealing the accuracy that can now be achieved by clinicians using datasets obtained during life.