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Left Atrial Appendage Anatomy

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Amina Johnston July 13, 2020 Anatomy

Like most scientific disciplines, anatomy has areas of specialization. Gross anatomy is the study of the larger structures of the body, those visible without the aid of magnification (Figure 1a). Macro- means “large,” thus, gross anatomy is also referred to as macroscopic anatomy.

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This ancient discipline reached its culmination between 1500 and 1850, by which time its subject matter was firmly established. None of the world’s oldest civilizations dissected a human body, which most people regarded with superstitious awe and associated with the spirit of the departed soul. Beliefs in life after death and a disquieting uncertainty concerning the possibility of bodily resurrection further inhibited systematic study. Nevertheless, knowledge of the body was acquired by treating wounds, aiding in childbirth, and setting broken limbs. The field remained speculative rather than descriptive, though, until the achievements of the Alexandrian medical school and its foremost figure, Herophilus (flourished 300 bce), who dissected human cadavers and thus gave anatomy a considerable factual basis for the first time. Herophilus made many important discoveries and was followed by his younger contemporary Erasistratus, who is sometimes regarded as the founder of physiology.

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Furthermore, most movement involves muscles that work as a pair. For example, when we bend our arm, muscles in that region contract, become shorter and stiffer and pull the bones to the direction of movement. For relaxation (stretching), muscles in the opposite direction have to pull the bones towards it.

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The need for thinner, more transparent tissue specimens for study under the light microscope stimulated the development of improved methods of dissection, notably machines called microtomes that can slice specimens into extremely thin sections. In order to better distinguish the detail in these sections, synthetic dyes were used to stain tissues with different colours.

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In contrast, micro- means “small,” and microscopic anatomy is the study of structures that can be observed only with the use of a microscope or other magnification devices (Figure 1b). Microscopic anatomy includes cytology, the study of cells and histology, the study of tissues. As the technology of microscopes has advanced, anatomists have been able to observe smaller and smaller structures of the body, from slices of large structures like the heart, to the three-dimensional structures of large molecules in the body.

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Owing to church prohibitions against dissection, European medicine in the Middle Ages relied upon Galen’s mixture of fact and fancy rather than on direct observation for its anatomical knowledge, though some dissections were authorized for teaching purposes. In the early 16th century, the artist Leonardo da Vinci undertook his own dissections, and his beautiful and accurate anatomical drawings cleared the way for Flemish physician Andreas Vesalius to “restore” the science of anatomy with his monumental De humani corporis fabrica libri septem (1543; “The Seven Books on the Structure of the Human Body”), which was the first comprehensive and illustrated textbook of anatomy. As a professor at the University of Padua, Vesalius encouraged younger scientists to accept traditional anatomy only after verifying it themselves, and this more critical and questioning attitude broke Galen’s authority and placed anatomy on a firm foundation of observed fact and demonstration.

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