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HEART

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Originally appearing in Volume V13, Page 132 of the 1911 Encyclopedia Britannica.
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HEART, in anatomy.—The heart 1 is a four-chambered muscular bag, which lies in the cavity of the thorax between the two lungs. It is surrounded by another bag, the pericardium, for protective and lubricating purposes (see CoELOM AND SEROUS MEMBRANES). Externally the heart is somewhat conical, its base being directed upward, backward and to the right, its apex downward, forward and to the left. In transverse section the cone is flattened, so that there is an anterior and a posterior surface and a superior and inferior border. The superior border, running obliquely downward and to the left, is very thick, and so gains the name of margo oblusus, while the inferior border is horizontal and sharp and is called margo acutus (see fig. I). The divisions between the four chambers of the heart (namely, the two auricles and two ventricles) are indicated on the surface by grooves, and when these are followed it will be seen that the129 posterior part of it open the two venae cavae (see fig. 2), the superior (a) above and the inferior (b) below. In front and to the left of the superior vena cava is the right auricular appendage (e) which overlaps the front of the root of the aorta, while running obliquely from the front of one vena cava to the other is a shallow groove called the sulcus terminalis, which indicates the original separation between the true auricle in front and the sinus venosus behind. When the auricle is opened by turning the front wall to the right as a flap the following structures are exposed: 1. A muscular ridge, called the crista terminalis, corresponding to the sulcus terminalis on the exterior. 2. A series of ridges on the anterior wall and in the appendage, running downward from the last and at right angles to it, like the teeth of a comb; these are known as musculi pectinati. 3. The orifice of the superior vena cava (fig. 2, a) at the upper and back part of the chamber. 4. The orifice of the inferior vena cava (fig. 2, b) at the lower and back part. 5. Attached to the right and lower margins of this opening are the remains of the Eustachian valve (fig. 2, h), which in the foetus directs the blood from the inferior vena cava, through the foramen ovate, into the left auricle. 6. Below and to the left of this is the opening of the coronary sinus (fig. 2, k), which collects most of the veins returning blood from the substance of the heart. 7. Guarding this opening is the coronary valve or valve of Thebesius. 8. On the posterior or septal wall, between the two auricles, is an oval depression, called the fossa ovalis (fig. 2, g), the remains of the original communication between the two auricles. In about a quarter of all normal hearts there is a. small valvular communication between the two auricles in the left margin of this depression (see " 7th Report of the Committee of Collective Investigation," J. Anat. and Phys. vol. xxxii. p. 164). 9. The annulus ovalis is the raised margin surrounding this depression. to. On the left side, opening into the right ventricle, is the right auriculo-ventricular opening. is. On the right wall, between the two caval openings, may occasionally be seen a slight eminence, the tubercle of Lower, which is supposed to separate the two streams of blood fn.,the embryo. 12. Scattered all over the auricular wall are minute depressions, the foramina Thebesii, some of which receive small veins from the substance of the heart. The right ventricle is a triangular cavity (see fig. 2) the base of which is largely formed by the auriculo-ventricular orifice. To the left of this it is continued up into.the root of the pulmonary artery, and this part is known as the infundibulum. Its anterior wall forms part of the anterior surface of the heart, while its posterior wall is chiefly formed by the septum ventriculorum, II right auricle and ventricle lie on the front and right side, while the left auricle and ventricle are behind and on the left. The right auricle is situated at the base of the heart, and its outline is seen on looking at the organ from in front. Into the 1 In O. Eng. heorte; this is a common Teat. word, cf. Out. hart, Ger. Herz, Goth. hairio; related by root are Lat. cor and Gr. Kapbia: the ultimate root is kard-, to quiver, shake. xnl. 5 between it and the left ventricle. Its lower border is the margo acutus already mentioned. In transverse section it is crescentic, since the septal wall bulges into its cavity. In its interior the following structures are seen: r. The tricuspid valve (fig. 2, 1, m, n) guarding against reflux of blood into the right auricle. This consists of a short cylindrical curtain of fibrous tissue, which projects into the ventricle from the margin of the auriculo-ventricular aperture, while from its free edge three triangular flaps hang down, the bases of which touch one another. These cusps are spoken of as septal, marginal and infundibular, from their position. 2. The chordae tendineae are fine fibrous cords which fasten the cusps to the musculi papillares and ventricular wall, and prevent the valve being turned inside out when the ventricle contracts. 3. The columnae carneae are fleshy columns, and are of three kinds. The first are attached to the wall of the ventricle in their whole length and are merely sculptured in relief, as it were; the second are attached by both ends and are free in the middle; while the third are known as the musculi papillares and are attached by one end to the ventricular wall, the other end giving attachment to the chordae tendineae. These musculi papillares are grouped into three bundles (fig. 2, o). 4. The moderator band is really one of the second kind of columnae carneae which stretches from the septal to the anterior wall of the ventricle. 5. The pulmonary valve (fig. 2, p) at the opening of the pulmonary artery has three crescentic, pocket-like cusps, which, when the ventricle is filling, completely close the aperture, but during the contraction of the ventricle fit into three small niches known as the sinuses of Valsalva, and so are quite out of the way of the escaping blood. In the middle of the free margin of each is a small knob called the corpus Arantii (fig. 2, q), and on each side of this a thin crescent-shaped flap, the lunula (fig. 2,r) , which is only made of two layers of endocardium, whereas in the rest of the cusp there is a fibrous backing between these two layers. The left auricle is situated at the back of the base of the heart, behind and to the left of the right auricle. Running down behind it are the oesophagus and the thoracic aorta. When it is opened it is seen to have a much lighter colour than the other cavities, owing to the greater thickness of its endocardium obscuring the red muscle beneath. There are no musculi pectinati except in the auricular appendage. The openings of the four pulmonary veins are placed two on each side of the posterior wall, but sometimes there may be three on the right side, and only one on the left. On the septal wall is a small depression like the mark of a finger-nail, which corresponds to the anterior part of the fossa ovalis and often forms a valvular communication with the right auricle. The auriculo-ventricular orifice is large and oval, and is directed downward and to the left. Foramina Thebesii and venae minimae cordis are found in this auricle, as in the right, although the chamber is one for arterial or oxidized blood. At the lower part of the posterior surface of the unopened auricle, lying in the left auriculo-ventricular furrow, is the coronary sinus, which receives most of the veins returning the blood from the heart substance; these are the right and left coronary veins at each extremity and the posterior and left cardiac veins from below. One small vein, called the oblique vein of Marshall, runs down into it across the posterior surface of the auricle, from below the left lower pulmonary vein, and is of morphological interest. The left ventricle is conical, the base being above, behind and to the right, while the apex corresponds to the apex of the heart and lies opposite the fifth intercostal space, 3i in. from the mid line. The following structures are seen inside it: r. The mitral valve guarding the auriculo-ventricular opening has the same arrangement as the tricuspid, already described, save that there are only two cusps, named marginal and aortic, the latter of which is the larger. 2. The chordae tendineae and columnae carneae resemble those of the right ventricle, though there are only two bundlesof musculi papillares instead of three. These are very large. A moderator band has been found as an abnormality (see J. Anat. and Phys. vol. xxx. p. 568). 3. The aortic valve has the same structure as the pulmonary, though the cusps are more massive. From the anterior and left posterior sinuses of Valsalva the coronary arteries arise. That part of the ventricle just below the aortic valve, corresponding to the infundibulum on the right, is known as the aortic vest ibtile. The walls of the left ventricle are three times as thick as those of the right, except at the apex, where they are thinner. The septum ventriculorum is concave towards the left ventricle, so that a transverse section of that cavity is nearly circular. The greater part of it has nearly the same thickness as the rest of the left ventricular wall and is muscular, but a small portion of the upper part is membranous and thin, and is called the pars membranacea septi; it lies between the aortic and pulmonary orifices. Structure of the Heart.—The arrangement of the muscular fibres of the heart is very complicated and only imperfectly known. For details one of the larger manuals, such as Cunning-ham's Anatomy (London, 191o), or Gray's Anatomy (London, 1909), should be consulted. The general scheme is that there are superficial fibres common to the two auricles and two ventricles and deeper fibres for each cavity. Until recently no fibres had been traced from the auricles to the ventricles, though Gaskell predicted that these would be found, and the credit for first demonstrating them is due to Stanley Kent, their details having subsequently been worked out by W. His, Junr., and S. Tawara. The fibres of this auriculo-ventricular bundle begin, in the right auricle, below the opening of the coronary sinus, and run forward on the right side of the auricular septum, below the fossa ovalis, and close to the auriculo-ventricular septum. Above the septal flap of the tricuspid valve they thicken and divide into two main branches, one on either side of the ventricular septum, which run down to the bases of the anterior and posterior papillary muscles, and so reach the walls of the ventricle, where their secondary branches form the fibres of Purkinje. The bundle is best seen in the hearts of young Ruminants, and it is presumably through it that the wave of contraction passes from the auricles to the ventricles (see article by A. Keith and M. Flack, Lancet, rrth of August 1906, p. 359). The central fibrous body is a triangular mass of fibro-cartilage, situated between the two auriculo-ventricular and the aortic orifices. The upper part of the septum ventriculorum blends with it. The endocardium is a delicate layer of endothelial cells backed by a very thin layer of fibro-elastic tissue; it is continuous with the endothelium of the great vessels and lines the whole of the cavities of the heart. The heart is roughly about the size of the closed fist and weighs from 8 to 12 oz.; it continues to increase in size up to about fifty years of age, but the increase is more marked in the male than in the female. Each ventricle holds about 4 f. oz. of blood, and each auricle rather less. The nerves of the heart are derived from the vagus, spinal accessory and sympathetic, through the superficial and deep cardiac plexuses. Embryology. In the article on the arteries (q.v.) the formation and coalescence of the two primitive ventral aortae to form the heart are noticed, so that we may here start with a straight median tube lying ventral to the pharynx and being prolonged cephalad into the ventral aortae and caudad into the vitelline veins. Thls. soon shows four dilatations, which, from the tail towards the head end, are called the sinus venosus, the auricle, the ventricle and the truncus 1 arteriosus. As the tubular heart grows more rapidly than the pericardium which contains it, it becomes bent into the form of an S laid on its side (Cl)), the ventral convexity being the ventricle and the dorsal the auricle. The passage from the auricle to the ventricle is known as the auricular canal, and in the dorsal and ventral parts of this appear two thickenings r This is often called bulbus arteriosus, but it will be seen that the term is used rather differently in comparative anatomy. ovalis, so that, in the later months of foetal life, the foramen ovale is a valvular opening, the floor of which is formed by, the septum primum and the margins by the septum secundum. The closure of the foramen. is brought about by adhesion of the two septa. The pulmonary veins of the two sides at first join one another, dorsal to the left auricle, and open into that cavity by a single median trunk, but, as the auricle grows, this trunk and part of the right and left veins are absorbed into. its cavity. The mitral and tricuspid valves are formed by the shortening of the auricular canal which becomes telescoped into the ventricle, and the cusps are the remnants of this telescoping process. The columnae carneae and chordae tendineae are the remains of a spongy network which originally filled the cavity of the primary ventricle. The aortic and pulmonary valves are laid down in the ventral aorta, before it is divided into aorta and pulmonary artery, as four endocardial cushions; anterior, posterior and two lateral. The septum aorticum cuts the latter two into two, so that each artery has the rudiments of three cusps. Abnormalities of the heart are very numerous, and can usually be explained by a knowledge of its development. They often cause grave clinical symptoms. A clear and well-illustrated review of the most important of them will be found in the chapter on congenital disease of the heart in Clinical Applied Anatomy, by C. R. Box and W. McAdam Eccles, London, Igo6. known as endocardial cushions, which approach one another and leave a transverse slit between them (fig. 3, E.C.). Eventually these two cushions fuse in the middle line, obliterating the central part of the slit, while the lateral parts remain as the two auriculo-ventricular orifices; this fusion is known as the septum intermedium. From the bottom (ventral convexity) of the ventricle an antero-posterior median septum grows up, which is the septum inferius or septum ventriculorum (fig. 3, V). Posteriorly (caudally) this septum fuses with the septum intermedium, but anteriorly it is free at the lower part of the truncus arteriosus. On referring to the development of the arteries (see ARTERIES) it will be seen that another septum starts between the last two pairs of aortic arches and grows downward (caudad) until it reaches and joins with the septum inferius just mentioned. This septum aorticum (formed by two ingrowths from the wall of the vessel which fuse later) becomes twisted in such a way that the right ventricle is continuous with the last pair of aortic arches (pulmonary artery), while the left ventricle communicates with the other arches (the permanent ventral aorta and its branches); it joins the septum ventriculorum in the upper part of the ventricular cavity and so forms the pars membranacea septi (fig. 3, T. Ar). The fate of the sinus venosus and auricle must now be followed. Into the former, at first, only the two vitelline veins open, but later, as they develop, the ducts of Cuvier and the umbilical veins join in (see VEINS). As the ducts of Cuvier come from each side the sinus spreads out to meet them and becomes transversely elongated. The slight constriction, which at first is the only separation between the sinus and the auricle, becomes more marked, and later the opening is into the right part of the auricle, and is guarded by two valvular folds of endocardium (the venous valves) which project into that cavity, and are continuous above with a temporary downgrowth from the roof, known as the septum spurium. Later the right side of the sinus enlarges, and so does the right part of the aperture, until the back part of the right side of the auricle and the right part of the sinus venosus are thrown into one, and the only remnants of the partition are the crista terminalis and the Eustachian and Thebesian valves. The left part of the sinus venosus, which does not enlarge at the same rate as the right part, remains as the coronary sinus. It will now be seen why, in the adult heart, all the veins which open into the right auricle open into its posterior part, behind the crista terminalis. The septum spurium has been referred to as a temporary structure; the real division between the two auricles occurs at a later date than that between the ventricles and to the left of the septum spurium. It is formed by two partitions, the first of which, called the septum primum, grows down from the auricular roof. At first it does not quite reach the endocardial cushions in the auricular canal, already mentioned, but leaves a gap, called the ostium primum, between. This has nothing to do with the foramen ovale, which occurs as an independent perforation higher up, and at first is known as the ostium secundum. When it is established the septum primum grows down and meets the endocardial cushions, and so the ostium primum is obliterated. The septum secundum grows down on the right of the septum primum and is never complete; it grows round and largely overlaps the foramen ovale and its edges form the annulus Au. Auricle. E.C. Endocardial cushions forming septum intermedium. V. Septum ventriculorum. T. Ar. Septum aorticum intruncus teriosus. V.A. Ventral aorta. ar- For further details of the embryology of the heart see Oscar Hertwig's Entwickelungslehre der Wirbeltiere (Jena, 1902) ; G. Born, " Entwicklung des Saugctierherzens," Archie f. mile. Anat. Bd. 33 (1889); W. His, Anatornie menschlicher Embryonen (Leipzig, 1881—1885); Quain's Anatomy, vol. i. (1908); C. S. Minot, Human Embryology (New York, 1892); and A. Keith, Human Embryology and Morphology (London, 1905). , Comparative Anatomy. In the Acrania (e.g. lancelet) there is no heart, though the vessels are specially contractile in the ventral part of the pharynx. In the Cyclostomata (lamprey and hag), and Fishes, the heart has the same arrangement which has been noticed in the human embryo. There is a smooth, thin-walled sinus venosus, a thin reticulate-walled auricle, produced laterally into two appendages, a thick-walled ventricle, and a conus arteriosus containing valves. In addition to these the beginning of the ventral aorta is often thickened and expanded to form a bulbus arteriosus, which is non-contractile, and, strictly speaking, should rather be described with the arteries than with the heart. In relation to human embryology the smooth sinus venosus and reticulated auricle are interesting. Between the auricle and ventricle is the auriculo-ventricular valve, which primarily consists of two cusps, comparable to the two endocardial cushions of the human embryo, though in some forms they may be sub-divided. In the interior of the ventricle is a network of muscular trabeculae. The conus arteriosus in the Elasmobranchs (sharks and rays) and Ganoids (sturgeon) is large and provided with several rows of semilunar valves, but in the Cyclostomes (lamprey) and Teleosts (bony fishes) the conus is reduced and only the anterior (cephalic) row of valves retained. With the reduction of the conus the bulbus arteriosus is enlarged. So far the heart is a single tubular organ expanded into various cavities and having the characteristic CO-shaped form seen in the human embryo; it contains only venous blood which is forced through the gills to be oxidized on its way to the tissues. In the Dipnoi (mud fish), in which rudimentary lungs, as well as gills, are developed, the auricle is divided into two, and the sinus venosus opens into the right auricle. The conus arteriosus too begins to be divided into two chambers, and in Protopterus this division is complete. This division of the heart is one instance in which mammalian ontogeny does not repeat the processes of phylogeny, because, in the human embryo, it has been shown that the ventricular septum appears before the auricular. This want of harmony is sometimes spoken of as the " falsification of the embryological record." In the Amphibia there are also two auricles and one ventricle, though in the Urodela (tailed amphibians) the auricular septum is often fenestrated. The sinus venosus is still a separate chamber, and the conus arteriosus, which may contain many or few valves, is usually divided into two by a spiral fold. Structurally the amphibian heart closely resembles the dipnoan, though the increased size of the left auricle is an advance. In the Anura (frogs and toads) the whole ventricle is filled with a spongy network which prevents the arterial and venous blood from the two auricles mixing to any great extent. (For the anatomy and physiology of the frog's heart, see The Frog, by Milnes Marshall.) In the Reptiles the ventricular septum begins to appear;' this in the lizards is quite incomplete, but in the crocodiles, which are usually regarded as the highest order of living reptiles, the partition has nearly reached the top of the ventricle, and the condition resembles that of the human embryo before the pars membranacea septi is formed. The conus arteriosus becomes included in the ventricular cavity, but the sinus venosus still remains distinct, and its opening into the right ventricle is guarded by two valves which closely resemble the two venous valves in the auricle of the human embryo already referred to. In the Birds the auricular and ventricular septa are complete; the right ventricle is thin_walled and Crescentic in section, as in Man, and the musculi papillares are developed. The left auriculoventricular valve has three membranous cusps with chordae tendineae attached to them, but the right auriculo-ventricular valve has a large fleshy cusp without chordae tendineae. The sinus venosus is largely included in the right auricle, but remains of the two venous valves are seen on each side of the orifice of the inferior vena cava. In the Mammals the structure of the heart corresponds closely with the description of that of Man already given. In the Ornithorynchus, among the Monotremes, the right auriculoventricular valve has two fleshy and two membranous cusps, thus snowing a resemblance to that of the bird. In the Echidna, the other member of the order, however, both auriculo-ventricular valves are membranous. In the Edentates the remains of the venous valves at the opening of the inferior vena cava are better marked than in other orders. In the Ungulates the moderator band in the right ventricle is especially well developed, and the central fibrous body at the base of the heart is often ossified, forming the os cordis so well known in the heart of the ox. The position of the heart in the lower mammals is not so oblique as it is in Man. For further details, see C. Rose, Beitr. z. vergl. Anat. des Herzens der Wirbelthiere Morph. Jahrb., Bd. xvi. (1890); R. Wiedersheim, Vergleichende Anatomie der Wirbelthiere (Jena, 1902) (for literature) ; also Parker and Haswell's Zoology (London, 1897). (F. G. P.)
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