Operative Anatomy of the Heart PDF
113.84 MB PDF
Books and articles on techniques in cardiac surgery date back to 1952, when the first successful closure of an atrial septal defect was performed. In all surgical disciplines, but particularly in cardiac surgery, success is greatly dependent upon the use of appropriate operative techniques. In one of the first textbooks on operative surgery, Kirschner remarked that a good operative technique requires a detailed knowledge of the underlying morphology. This rule has gained further importance since the introduction of minimally invasive techniques, which have highlighted the necessity of a perfect knowledge of the underlying cardiac and thoracic morphology.
A precise knowledge of the anatomy of not only the valvular structures, but also the coronary vessels and the conducting system has become essential for procedures involving the mitral or tricuspid valves. Similarly, new reconstructive procedures relating to the aortic and pulmonary root require not only detailed knowledge of the macroscopic anatomy, but also a thorough understanding of the spatial relationships between these complex physiological and morphological units.
The first chapter of this book describes the detailed topographical anatomy of the human thorax. The morphological regions are illustrated using preserved human specimens, which were dissected from skin level to the bony skeleton of the thorax. The most important regions are presented from the ventral and dorsal aspects. The second chapter discusses the approaches used in standard cardiac surgery, including a detailed step-by-step presentation of the standard sternotomy and right anterolateral thoracotomy. Special attention is devoted to minimally invasive approaches to the heart, such as limited sternotomies and thoracotomies, as well as the transdiaphragmatic approach to the inferior aspect of the heart. Furthermore, other approaches to the thoracic aorta, such as posterolateral thoracotomy and thoracoabdominal incision, are visualized.
The chapter on coronary surgery (Chap. 3) emphasizes the arterial coronary conduits.Normal coronarymorphology and their anatomical variants, as well as surgical approaches are described. This chapter is divided into two major parts, the first dealing with the general anatomy of the coronary vasculature, from descriptions of their orifices to an analysis of arterial dominance. The second part is devoted to a description of the venous drainage of the heart and to the surgical exposure of target coronary vessels.
Chapter 4 describes the heart valves. As in previous chapters, the general morphology and their variations are detailed together with the topography and histology, and a description of related structures. This is followed by the surgical section, wherein the valves are exposed and shown from the view point of the surgeon. The remaining chapters deal with themorphology of the interventricular septum, with special attention paid to the variations in its blood supply, the heart conduction system, and exposure of the thoracic and abdominal aorta.
We have chosen photographs that depict the structures as they appear to the surgeon in the operating theater. In order to clarify surgical procedures and anatomical structures, some photographs have been supplemented with drawings to provide better orientation.
We trust this new book will be of interest not only to the cardiac surgeon, but also to the cardiologist, surgical pathologist, and anesthesiologist, all of whom should profit from the detailed descriptions of the cardiac structures provided in this work.
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