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Anatomy Tutorial
Anatomic Position Attitudinally Correct Anatomy Left Anterior Oblique Anterior Posterior Posterior Fresh Cadaver Dissection

Valentine Position

A human heart viewed from the so-called anterior position, demonstrating the valentine heart orientation used by many to incorrectly describe anatomy. The red line surrounding the heart is the characteristic symbol, which was theoretically derived from observing the heart in this orientation.

Anatomy is one of the oldest branches of medicine, dating back as far as the 3rd century B.C. Throughout time, the discipline has been served well by a universal system for describing structures based on the anatomic position. Unfortunately, cardiac anatomy has been an outlier from this long-standing tradition. Cardiac anatomy has often been incorrectly described using confusing and inappropriate nomenclature. This is most likely due to the examination of the heart in the valentine position, in which the heart stands on its apex as opposed to how it is actually oriented in the body. The description of the major coronary arteries, such as the anterior descending and posterior descending, is attitudinally incorrect; as the heart is oriented in the body, the surfaces are actually superior and inferior. (Hill, 2015)

Cardiac anatomy has often been incorrectly described because in early anatomy literature the examined heart was placed in the valentine position: in which the heart stands on its apex as opposed to how it is actually oriented in the body.

Blood volumes: Attitudinally Correct Versus Valentine

Blood volumes: Attitudinally Correct Versus Valentine

The left-hand panel shows casts of the cardiac cavities positioned as the heart usually lies within the thorax. The so-called right chambers have been cast in blue and the alleged left chambers in red. As can be seen, in reality, the right atrium and ventricle are largely positioned in front of their left sided counterparts. All that is seen of the left atrium is the tip of the appendage. So as to see all four cardiac chambers, it is necessary to rotate the casts in both the right to left and posterior to anterior planes.

Long axis of heart vs. body

The left-hand panel (a) shows a typical chest radiograph, illustrating the marked angulation between the long axis of the body (blue arrow) and the long axis of the heart (red arrow). As shown in the right-hand panel (b), the prosector in the autopsy room obtains the same information when observing the heart as it usually lies within the mediastinum

Coronary Arteries

Coronary Arteries

The description of the major coronary arteries, such as the anterior descending and posterior descending, is attitudinally incorrect; as the heart is oriented in the body, the surfaces are actually superior and inferior. (Hill, 2009)


 

The incorrect use of anatomic terminology to describe the heart can be considered to impact a large and diverse group of individuals. Practitioners of medicine, such as interventional cardiologists and electrophysiologists are affected, as are scientists investigating the heart and engineers designing medical devices. It is considered here that describing terms in a more consistent manner, and thus using the appropriate terminology, would greatly increase the efficiency of interactions between these groups.

As the field of cardiac anatomy continues to play an important role in the practice of medicine and the development of medical devices, it benefits all involved to adopt commonly used terminology to describe the heart and its proper location in the body. Furthermore, it may be of great utility to describe the cardiac anatomy of major animal models using the same terminology as that of humans, at least when comparisons are being made between species. Finally, due to advances in 3D and 4D imaging and their growing use in the cardiac arena, a sound foundation of attitudinally correct terms will benefit everyone involved.


Generated Heart Models

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Human Model in Valentine Position

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Human Model in an Attitudinally Correct Position

 

3D Models from Clinical Scans: With Lungs and ribcage, Lungs removed and Heart and Great Vessels only

Download movie: MP4, MOV, WMV

Download movie: MP4, MOV, WMV

Download movie: MP4, MOV, WMV

 

References:

  • Iaizzo PA, Anderson RH, Hill AJ: The importance of human cardiac anatomy for translational research. Journal of Cardiovascular Translational Research, Special Issue on Cardiac Anatomy 6:23139059, 2013. PMID: 23139059
  • Hill AJ: Attitudinally correct cardiac anatomy. In: Handbook of Cardiac Anatomy, Physiology, and Devices, 2nd, 3rd editions. Springer, Chapter 2, pages 15-22 , 2009, 2015.
  • Anderson RH, Hill AJ: The importance of human cardiac anatomy for translational research. Journal of Cardiovascular Translational Research, Special Issue on Cardiac Anatomy 6:23139059, 2013. PMID: 23139059
  • McAlpine WA (1975) Heart and coronary arteries: an anatomical atlas for clinical diagnosis, radiological investigation, and surgical treatment. Springer-Verlag, New York.

 
 
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