An Attitudinal Review of the Heart—An Introduction to Spatial Clinical Investigations

Abstract

Ultrasonography brings a new perspective in the study of physiology of the normal heart and affords greater comprehension of disease and its mechanisms. It has unfolded the epidemiology and pathophysiology of asymmetric septal hypertrophy and provides a safe and often superior technique for the determination of the type and degree of functional impairment of the heart. This technique, along with cardiac imaging with radiopharmaceutical agents, is now added to cineradiographic and radiographic techniques, utilizing contrast agents, in the spatial study of cardiac structure and its abnormalities. This chapter is intended to provide an anatomic basis for this spatial examination. The four chambers will be examined in the four traditional radiographic planes; in some instances, the desirability of other examinations in either the horizontal or an elevated plane will also be indicated. Features, some of a nonradiographic nature, will be placed in summation. Before we commence this study, we will examine two separate features: (1) The two atria have been examined separately in Chapters 5 and 7. We will now examine transections to demonstrate the spatial disposition of each and the septum between the two. (2) The mitral valve is a vital feature of left heart contrast studies; additive to the brief spatial examination on page 53, it will be seen here in two planes. Few structures can equal the anterior leaflet of the mitral valve in clinical interest and importance. The mode of its apposition to the posterior leaflet, and the line of flexion within the leaflet are important pathogenetic considerations. To the radiologist, the knowledge of the geometry of its planes is a prerequisite for his task. To the surgeon, the precise knowledge of the attachment of both leaflets brings sophistication and greater safety to the operation of valve replacement.