Surgical Anatomy of the Heart - Cambridge

Cambridge University Press

1841100285 - Surgical Anatomy of the Heart

Benson R. Wilcox, Andrew C. Cook and Robert H. Anderson

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Surgical Anatomy of the Heart

Benson R. Wilcox

Professor of Surgery

University of North Carolina

Chapel Hill, NC

USA

Andrew C. Cook

British Heart Foundation Lecturer

Cardiac Unit

Institute of Child Health

University College London

London, UK

Robert H. Anderson

Professor of Paediatric Cardiac Morphology, Cardiac Unit

Institute of Child Health

University College London

London, UK

? Cambridge University Press



Cambridge University Press

1841100285 - Surgical Anatomy of the Heart

Benson R. Wilcox, Andrew C. Cook and Robert H. Anderson

Frontmatter

More information

P U B L I S H E D B Y T H E P R E S S S Y N D I C AT E O F T H E U N I V E R S I T Y O F C A M B R I D G E

The Pitt Building, Trumpington Street, Cambridge, United Kingdom

CAMBRIDGE UNIVERSITY PRESS

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? Cambridge University Press 2004

This book is in copyright. Subject to statutory exception and

to the provisions of relevant collective licensing agreements,

no reproduction of any part may take place without the

written permission of Cambridge University Press.

First published 2004

Printed in the United Kingdom at the University Press, Cambridge

Typeface: Ehrhardt MT 10/12pt System: QuarkXpress?

A catalog record for this book is available from the British Library

Library of Congress Cataloging in Publication data

ISBN 1 841 10028 5

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Every effort has been made in preparing this book to provide accurate and

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publisher can make no warranties that the information contained herein is

totally free from error, not least because clinical standards are constantly

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publisher therefore disclaim all liability for direct or consequential

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? Cambridge University Press



Cambridge University Press

1841100285 - Surgical Anatomy of the Heart

Benson R. Wilcox, Andrew C. Cook and Robert H. Anderson

Frontmatter

More information

Contents

Preface

Acknowledgments

v

vii

Surgical approaches to the heart

1

Anatomy of the cardiac chambers

11

Surgical anatomy of the valves of the heart

45

Surgical anatomy of the coronary circulation

83

Surgical anatomy of the conduction system

99

Analytic description of congenitally malformed hearts

113

Lesions with normal segmental connections

131

Lesions in hearts with abnormal segmental connections

215

Abnormalities of the great vessels

275

Positional anomalies of the heart

307

Index

? Cambridge University Press

315



Cambridge University Press

1841100285 - Surgical Anatomy of the Heart

Benson R. Wilcox, Andrew C. Cook and Robert H. Anderson

Frontmatter

More information

Preface

The books and articles devoted to

technique in cardiac surgery are legion.

This is most appropriate, since the success

of cardiac surgery is greatly dependent

upon excellent operative technique. But

excellence of technique can be dissipated

without a firm knowledge of the

underlying cardiac morphology. This is as

true for the ¡®normal heart¡¯ as for those

hearts with complex congenital lesions. It

is the feasibility of operating upon such

complex malformations that has

highlighted the need for a more detailed

understanding of the basic anatomy in

itself. Thus, in recent years surgeons have

come to appreciate the necessity of

avoiding damage to the coronary vessels,

often invisible when working within the

cardiac chambers, and particularly to

avoid the vital conduction tissues, invisible

at all times. Although detailed and

accurate descriptions of the conduction

system have been available since the time

of their discovery, only rarely has its

position been described with the cardiac

surgeon in mind. At the time the first

edition of this volume was published, to

the best of our knowledge, there had been

no other books that specifically displayed

the anatomy of normal and abnormal

hearts as perceived at the time of

operation. We tried to satisfy this need in

the first volume by combining the

experience of a practicing cardiac surgeon

with that of a professional cardiac

anatomist. We added significantly to the

illustrations in the second edition, whilst

seeking to retain the overall concept, since

feedback from those who had used the

first edition was very positive.

This third edition now seeks to expand

and improve still further on the changes we

made in the second edition. In our second

edition, we added an entirely new chapter

on cardiac valvar anatomy, and greatly

expanded our treatment of coronary

vascular anatomy. We have retained the

format adopted in that edition, since we

were gratified that, as hoped, readers were

able to find a particular subject more easily.

This third edition now contains still more

new illustrations. We have retained our

approach of orientating these illustrations,

where appropriate, as seen by the surgeon

working in the operating room, albeit that

for most of the pictures of specimens we

have reverted to anatomical orientation. So

as to clarify the various orientations of each

individual illustration, we have continued

to include a set of axes showing the

directions of superior (S), inferior (I),

anterior (A), posterior (P), left (L), right

(R), apex (a) and base (b). All our accounts

are based on the anatomy as it is observed

and, except in the case of malformations

involving the aortic arch and its branches,

they owe nothing to speculative

embryology. As with the first two editions,

it is our hope that the third edition will

continue to be of interest not only to the

surgeon, but also to the cardiologist,

anaesthesiologist and surgical pathologist.

All of these practitioners ideally should

have some knowledge of cardiac structures

and their exquisite intricacies, particularly

those cardiologists who increasingly treat

lesions that previously were the province

of the surgeon. The major change in this

third edition, nonetheless, is the addition

of Andrew Cook to the editorial team. In

the time that has passed since we produced

the second edition, the senior author has

retired from active surgery, whilst the

time grows ever closer that the other

initial author will be hanging up his

morphological ¡°shooting boots¡±. We are

confident that Andrew Cook will ensure

that, if supply demands, the book will pass

through still further editions, hopefully

improving with each version.

Benson R. Wilcox, Andrew C. Cook &

Robert H. Anderson

London and Chapel Hill

May 2004

? Cambridge University Press



Cambridge University Press

1841100285 - Surgical Anatomy of the Heart

Benson R. Wilcox, Andrew C. Cook and Robert H. Anderson

Frontmatter

More information

Acknowledgments

A good deal of the material displayed in

these pages, and the concepts espoused,

are due in no small part to the help of our

friends and collaborators. A major change

since we produced the second edition

has been the translocation of Robert H.

Anderson from Royal Brompton Hospital

in London to Great Ormond Street

Children¡¯s Hospital. This has enabled

many new hearts to be specifically

photographed for this new edition. We

continue, nonetheless, to owe a particular

debt to Anton Becker of the University of

Amsterdam, and Bob Zuberbuhler of

Pittsburgh Children¡¯s Hospital,

Pennsylvania, United States of America,

both of whom permitted us to use material

from the extensive collections of normal

? Cambridge University Press

and pathological specimens held in their

centres. We have acknowledged our other

friends at the appropriate point in the text,

but here we would like to thank

particularly Siew Yen Ho, of the National

Heart and Lung Institute, now part of

Imperial College in London. Yen

produced many of the original drawings

from which we prepared our artwork.

The photographs and surgical artwork

could not have been produced without

the considerable help given by the

Department of Medical Illustrations and

Photography, University of North

Carolina. For this edition, however, we

have prepared a completely new series of

cartoons. These have been expertly

produced by Gemma Price, and we thank

her sincerely for her hard work over and

above the call of duty. We also thank Vi

Hue Tran, who helped photograph the

new hearts from Great Ormond Street,

and took great care in labelling the

numerous illustrations. We are again

indebted to Christine Anderson and

Peacelyn Jeyaratnam for their help during

the preparation of the manuscript.

Finally, it is a pleasure to acknowledge

the support of Greenwich Medical Media,

now incorporated as part of Cambridge

University Press, who have taken over as

our new publishers, and have ensured that

all the good parts of the previous editions

were retained. In particular, we thank

Gavin Smith for all his help during the

preparation of the book for publication.



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