Cambridge Core - Cardiovascular Medicine - Wilcox's Surgical Anatomy of the Heart - by Robert H. Anderson. PDF; Export citation. Contents. pp v-vi. Access. Wilcox's Surgical Anatomy of the Heart Fourth edition. Downloaded from Cambridge Books Online by IP on Fri Sep 13 WEST Request PDF on ResearchGate | Wilcox's surgical anatomy of the heart, fourth edition | The revised fourth edition of this classic textbook on cardiac anatomy.
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Wilcox's Surgical Anatomy of the Heart 4th Edition PDF eBook Free Download. Edited By Robert H. Anderson, Diane E. Spicer, Anthony M. renamed this fourth edition 'wilcox's surgical anatomy of the heart'. we dedicate this anatomy of the heart - lionandcompass - free download** wilcox s surgical . Wilcox's Surgical Anatomy of the Heart 4th Edition [PDF]. Wilcox's Surgical Anatomy of the Heart 4th Edition [PDF]. MB PDF.
As indicated in our preface, the major change since we produced the third edition has been the sad passing of our founding surgical editor, Benson R. We have renamed this fourth edition Wilcoxs Surgical Anatomy of the Heart. We dedicate this edition to his eternal memory. A further change has been the retirement of Robert H. Retirement, however, has permitted him to establish new connections, not least with the newest additions to our team of authors. This has permitted many new hearts to be specically photographed for this new edition, not only of autopsy specimens, but also in the operating room.
In addition, it has created the collaboration that permits the inclusion of wonderful images obtained using computed tomography and magnetic resonance imaging. Jay Fricker of University of Florida, Gainesville, Florida, United States of America, all of whom permitted us to use material from the extensive collections of normal and pathological specimens held in their centres.
Yen produced many of the original drawings from which we prepared our artwork, and photographed many of the hearts in the Brompton archive. The initial 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. As with the third edition, we owe an equal debt of gratitude to Gemma Price, who has continued to improve our series of cartoons.
For both the third edition and this edition, she has worked over and above the call of duty. We are again indebted to Christine Anderson for her help during the preparation of the manuscript, and thank the team supporting Carl Backer at Lurie Childrens of Chicago, in particular Pat Heraty and Anne E. Sutton JP 3rd. Int J Cardiol Lavender S.
Sweeney LJ. Sherf L. Clinical anatomy of the atrial septum with reference to its developmental components.
Radiological Investigation and Surgical Treatment. Feldt RH. McGoon DC. An Anatomical Atlas for Clinical Diagnosis.
McAlpine WA. Ochsner JL.
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Often named the semilunar valves. Knowledge of the surgical anatomy of the valves themselves. In both of Sup. This requires understanding of. Left ventricle Aorta Left atrium Fig. Arterial valve Apex Base Inf. The atrioventricular valves are best analysed in terms of the valvar complex. This information must be supplemented by attention to their relationships with other structures that the surgeon must avoid. All of these components must work in harmony so as to achieve valvar competence1.
It is still possible. The cut clearly shows how. In the right ventricle. The arterial valves are also a combination of complex anatomical parts. These features were described in the previous chapter. The other obvious anatomical ring is the sinutubular junction.
For this chapter. As in the pulmonary root. Sinutubular junction Arterial root Valvar leaflets Virtual proximal ring Sup.
Base Apex Inf. Tendinous cords Papillary muscles Attachments at annulus Ventricular musculature Valvar sinuses taken from the long axis section illustrated in Figure 3. Apex Base Valvar leaflets Inf. Surgical anatomy: When comparisons are made between the overall arrangement of the atrioventricular and arterial valvar complexes.
The semilunar hinges. Distal attachments at sinutubular junction Continuity with mitral valve Fig. Note how these hinges cross the circular anatomical junction between the muscular infundibulum and the walls of the pulmonary valvar sinuses white dashed line.
As we have already discussed. The distal attachments. There are three such zones of apposition to be found in the arterial valves Figure 3.
As can be seen. It would be optimal if the entrance to the roots was simply described as the valvar diameter. The arterial sinuses of the pulmonary valve are supported exclusively by ventricular muscle. Consensus is now growing.
This discrepancy must harbour the potential for confusion4. In the mitral valve. These structures. More distally. The aortic valve is centrally located relative to its neighbours. These differences. When considered as a unit.
When considered in attitudinally appropriate fashion. When used anatomically. The photograph was taken by Dr Van S. Mural leaflet Pulmonary valve Aortic valve Mitral valve Sup.
Tricuspid valve valves within the muscular cylinder forming the base of the ventricular mass. This wall of the aortic root. See also Figure 3. The base of the triangle is formed by the interventricular component of the membranous septum. Apex Fig. The white asterisks show the cut edge of the ventriculoinfundibular fold. Apex Left fibrous trigone Right fibrous trigone Fig.
The most apical part of the removed triangle. The arterial roots. The most obvious anatomical ring. When the triangle is removed. True uniplanar rings. Rather than being hinged in uniplanar circular fashion. The extent of this support. Apex Base Mitral valve Inf. The triangle is seen to extend superiorly to the level of the aortic sinutubular junction. Tip of interleaflet triangle Right Fig. Note the position of the septal perforating arteries.
The triangle itself has been removed. It is formed by joining together the most proximal parts of the valvar hinges Figure 3. As now suggested by the German Working Group concerned with surgical treatment of the aortic valve3.
The virtual ring. Membranous septum Right Left Inf. There is minimal extension. As discussed Fig. In normal valves. The atrial myocardium inserts for varying distances between the endocardium and the spongy layer.
It is the exception rather than the rule. Atrial myocardium Fibroadipose tissue Ventricular myocardium Tricuspid valvar leaflet Histologically. These cordal attachments are the third feature common to both tricuspid and mitral valves. On rare occasions. Yet it has been suggested that this valve is best considered as having four9. The skirt itself is divided into discrete components. For the atrioventricular valves. In addition to the fan-shaped cord. Surgeons usually take the commissures as the peripheral attachments of a breach in the skirt of valvar tissue.
The star marks the site of the atrioventricular node. As was indicated by Frater11 when discussing the exquisitely complex categorisation of cords proposed by the group from Toronto Some of the cords to the rough zone are particularly prominent in the mitral valve. It is thus the peripheral extents of these zones of apposition that become the commissures. In terms of philosophy. We agree with Frater11 that. There is a third type of cord that extends from the ventricular wall close to the atrioventricular junction.
Before describing these differences. Tendon of Todaro case with the fourth feature.
Wilcoxs Surgical Anatomy
The alternative name for the mitral valve is the bicuspid valve. The differences in these various features readily permit the morphological differentiation of the valves. Lack of uniform cordal support is Fig. There is little point in characterising the pattern of branching and the generations of these cords further.
The reason that the atrioventricular valves have such a complex tension apparatus is that. Aortic leaflet of mitral valve Uniform cordal support to free edge Figure 3. The different components of the atrioventricular valve making up the overall valve complex Figure 3. Fan-shaped cord Aortic leaflet of mitral valve Post. Mural leaflet of mitral valve Sup. This demands an area of overlap. Not only must the papillary muscles be viable.
The ends of the solitary zone of apposition between them. Carpentier16 has coded these scallops in alphanumeric fashion. Note that the ends of the zone of apposition do not extend to the atrioventricular junction bold red braces.
Also important in the maintenance of competence is the correct action of the papillary muscles and the ventricular myocardium. As discussed previously. As we will see. The tomographic images also clearly show the angle existing between the axis of opening of the valve and the plane of the inlet component of the muscular ventricular septum Figure 3. Morphological observations The original photograph of the mitral valve was kindly sent to us by Dr Van S.
Strictly speaking. As yet. It is trapezoidal. Because of the marked variability that occurs normally in the valve. The advent of computed tomographic imaging. Often these segments are almost completely separate from the central component. Taken together.
In the setting of prolapse. Supplementary heads of both papillary muscles then support other cords running to the free edge. The papillary muscles of the mitral valve are almost always prominent paired Fig. At this point. If the incision is continued superiorly. When the valve is dissected in its natural position within the left ventricle Figure 3. As already emphasised. The atrioventricular node and the penetrating atrioventricular bundle are adjacent to these areas Figures 3.
Although there can be considerable variation in the precise morphology of either muscle The papillary muscles are directly adjacent at their ventricular origins.
Note the position of the atrioventricular AV node red circle relative to the mitral valve. It is this feature that serves to distinguish the tendinous support of the tricuspid valve from that of the mitral valve. Also known as the muscle of Lancisi. More often. They are positioned septally. When the left coronary artery is dominant. This is yet another example of the description of cardiac structures as seen in the autopsy or dissecting room.
There is more variability in the arrangement of its lateral and inferior component. Its medial and superior end is supported by cords from the medial papillary muscle Figure 3. It is less constant than the other two. Anterosuperior leaflet Inferior leaflet Ant. Septal leaflet Post. Right Left Post. Note that the inferior interventricular artery. Base Triangle of Koch Apex Inf. Note the markers produced by the computed tomographic software.
Inferior leaflet ventricular wall. Anterosuperior leaflet Septal leaflet Fig. Their design is simplicity itself. Atrioventricular membranous septum Aortic root Mitral valve Tricuspid valve Sup. The line of closure is some distance from the free edge. Oval fossa defect Inf. When the three semilunar hinges are considered in terms of their overall structure. The patient also has a defect in the oval fossa. Not infrequently.
In terms of histological structure. Tricuspid valvar orifice Fig. Artery to atrioventricular node Sup. There are two true rings within the extent of the arterial root.
Perhaps the most obvious is the sinutubular junction. The stars mark the commissures. In light of these arrangements. It shows how the overall arrangement is crown-like. Valvar hinge Ventricular myocardium Sup.
Crown-like configuration Right Left Inf. Note that the valvar hinge is well below the anatomical ventriculoarterial junction. It is a virtual anatomical ring. There is a marked discrepancy between this ring-like anatomical junction and the haemodynamic junction. Part of the ventricle at the base of each sinus is. The blue ring shows the ventriculoarterial junction.
Note that the widest part of the root is at the midsinusal level green double-headed arrow. The superiorly located green ring is the sinutubular junction.
By virtue of this arrangement. The sinuses themselves are arranged in clover-like fashion. The anatomical rings in the arterial roots are formed by the sinutubular junction red double-headed arrow. In almost all instances.
In reality. The origins of the coronary arteries permit two sinuses to be named as right and left coronary aortic sinuses. Left ventricle Left coronary artery Pulmonary valve Right coronary aortic sinus Left coronary aortic sinus Fig.
In those circumstances. Right Left Non-adjacent sinus Right coronary artery Inf. This plane. The third sinus is nonadjacent relative to the pulmonary trunk. The two sinuses giving rise to the coronary arteries have septal musculature at their bases inner red arrows.
Their more distal adjacent parts take origin from the free aortic wall. Appreciation of the anatomy of the valvar hinges brings into focus the important surgical danger areas related to the aortic valve.
These individual variations do not distort the basic anatomical relationships as described earlier. In a small percentage of normal hearts. Half of it. The extensive posterior extension. Beyond this area. In this way. This is the basis of the right ventricular approach for relief of subaortic obstruction. The base of the triangle is made up of the membranous septum dashed white oval. Beyond this point.
Incisions through the right Fig. Because of its oblique position. Transverse sinus Apex of interleaflet triangle Non-coronary leaflet Left ventricle Sup. It is in relationship externally with the free pericardial space. The white triangle is between the non-adjacent and left coronary aortic sinuses. The black dotted line shows the apex of the triangle. Our preference. It is better to describe them according to their relationship to the aortic valve Figure 3.
Viewed in surgical orientation. When looked at from the stance of the observer positioned within the nonadjacent sinus. The two stars show how the wall has been folded open. Pulmonary valve Muscular infundibulum Left Sup. Right musculature Figure 3.
This muscular mass is the supraventricular crest of the right ventricle. The particular part separating the hinges of the atrioventricular and arterial valves is the ventriculoinfundibular fold. When considered as a whole. Anterior interventricular artery Aortic valve Left Post.
Left Right Non-adjacent component Left coronary component Inf. Preservation of this artery is one of the features that underscores the success of the Ross procedure The components retain their relationships.
The other sinus is non-adjacent. It is mandatory to avoid damage to these structures during surgery. Right Infundibular sleeve Figure 3. First septal perforator Fig. Care must be taken when placing sutures in this area. It courses back across the septum as a thin. The axis takes its origin from the atrioventricular node and its atrial zones of transitional cells.
When considered from the right side. It then runs. The right bundle branch takes origin from the axis beyond the takeoff of the left bundle branches. These atrial components of the conduction axis are contained completely from the heart shown in Figure 3.
When seen from the left ventricle. Although we have mentioned these landmarks when discussing the individual valves. As the axis penetrates the septum. It is. The atrioventricular conduction axis penetrates this septum to reach the crest of the muscular ventricular septum.
The great walls of the right atrium and ventricle having been removed. In its course in an adult. Tricuspid valvar orifice Medial papillary muscle Ant. The right bundle branch re-emerges on the right side beneath the medial papillary muscle. Aorta Fig. Excised membranous septum Right Left Aorta Inf.
Apex Left atrium Left ventricle Fig. The vein does not become the coronary sinus until it receives the oblique vein of the left atrium. The great cardiac vein becomes the coronary sinus at the point where it receives the oblique vein of the left atrium. The coronary arteries are intimately related to both the mitral and tricuspid valves. The normal anatomy may well have been distorted by the earlier operation.
Coronary sinus Left Base Apex Right Middle cardiac vein placed sutures in this area during replacement of the mitral valve may lead to damage to the coronary sinus. This can cause extremely troublesome bleeding. When the right coronary artery is dominant.
Right Dominant right coronary artery Mitral valvar orifice Ant.
Wilcox’s Surgical Anatomy of the Heart 4th Ed [PDF][tahir99] VRG.pdf
The cannula is in the inferior caval vein. Circumflex a. L Post. This important artery could be damaged by extensive dissection in this area. The anterior interventricular artery moves away from the valves. Eur J Cardiothorac Surg Anatomy of the muscular subpulmonary infundibulum with regard to the Ross procedure. McAllister HA. It can be damaged by deeply placed sutures in this area Sweeny LJ. Editorial Am J Cardiol Clark EB. Circulation Edward Arnold. Kumar N. Congenital malformations of the mitral valve in children.
Is the morphologically right atrioventricular valve tricuspid? The tricuspid valve is bicuspid. The 2 most common congenital heart diseases. Chordae tendineae: Mitral valve apparatus. A spectrum of normality relevant to mitral valve prolapse. Whether arising from a dominant left or right coronary artery. Frater R. Yacoub MH. Duran CM. Branchini B.
Anatomy and physiology of the normal mitral valve. Pathology and surgical treatment. The Mitral Valve. Ranganathan N.
Hemmer G. Vogel M. J Am Coll Cardiol Merrick AF. Functional anatomy of mitral regurgitation. J Thorac Cardiovasc Surg A Pluridisciplinary Approach. Van der Bel-Kahn J. Ho Sy. The right coronary artery always runs a circumferential course around the mural attachments of the tricuspid valve. Victor S.
Cour JC. Just prior to its descent. Duren DR. Lam JHC. Mavroudis C. Yacoub M. Beyersdorf F. Demolishing the Tower of Babel. Morphology of the human mitral valve. Perloff JK.
Culpepper WS 3rd. Anatomy of the mitral valve chordae and cusps. The everyday used nomenclature of the aortic root components: Kumar M. Backer CL. Discussion In: Kalmanson D ed. Nayak VM. Roberts WC. Angelini A. Sievers HH.
Kalmason D ed. Silver MD. The mitral apparatus. Congenital heart surgery nomenclature and database project: Carpentier A. Isolated mitral valve prolapse: Dodge-Khatami A. The normal spectrum of mitral and aortic valve discontinuity.
Wigle ED. The initial course of the artery is through the right atrioventricular groove Figure 3. In the normal heart. There are three sinuses within the aortic root. In this chapter. When described in this fashion.
Because the lymphatics. The sinuses can be named. The third edition also contained still more new illustrations, retaining the approach of orientating these illustrations, where appropriate, as seen by the surgeon working in the operating room, but reverting to anatomical orientation for most of the pictures of specimens. All accounts were 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.
A major change was forced upon us as we prepared this fourth edition, as our original surgical author, Benson Wilcox, died in May of It is very difficult to replace such a pioneer and champion of surgical education, but we are gratified that Carl Backer has assumed the role of surgical editor.
She has contributed enormously by providing many new and better illustrations of the anatomy as seen in the autopsied heart. These advances are complimented by the contributions of our other new editor, Tony Hlavacek.
Tony has provided quite remarkable images obtained using computed tomography and magnetic resonance imaging, which show that the heart can be imaged with just as much accuracy during life as when we hold the specimens in our hands on the autopsy bench.
As with the previous editions, it is our hope that the new edition will continue to be of interest not only to the surgeon, but also to the cardiologist, anaesthesiologist, and surgical pathologist.Hemmer G. In those circumstances. Anterocaval course Origin from right coronary artery Origin from circumflex artery Fig. Pulmonary valve Right coronary artery Fig. Note the haemorrhagic pericardial effusion.
If the incision is continued superiorly. Wigle ED. Knowledge of the surgical anatomy of the valves themselves. Left ventricle Left coronary artery Pulmonary valve Right coronary aortic sinus Left coronary aortic sinus Fig.
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