Autopsy as a Source of Discovery in Cardiovascular Medicine
Authors: Gaetano Thiene, Jeffrey E. Saffitz
Journal: Circulation (2018)

his may come as a surprise to many cardiologists, but much of what we know about the normal structure and function of the heart and circulatory system and their disorders was first learned through careful postmortem dissections.Today, of course, we are drowning in information emanating from multiple sources of variable reliability-advances, big and small, are being reported almost daily.But the bedrock information, the foundation from which all new insights derived, came from seeing for one's self (autopsy is from the Greek, autos or self, and optos or seen) through actual observation of the human heart and circulation.Here, we undertake a brief historical survey of the autopsy as a source of discovery in cardiovascular medicine and look to its future role in the era of precision medicine.In the mid-16th century, human postmortem dissection was first used to define the anatomy and, by inference, the physiology of the cardiovascular system.In 1543 (annus mirabilis or admirable year), De Revolutionibus Orbium Coelestium (On Movements of Planets and Stars) by Nicolaus Copernicus and De Humani Corporis Fabrica (On the Building of the Human Body) by Andreas Vesalius were published.Both authors were educated at the University of Padua, where, in 1597, students sent a letter to the university president (rector) saying, "Few or none of us have come here only for the sake of lecturers and all of us have come to learn practice.We do not lack for lecturers in our own country or elsewhere, and we also have books at home which we can just as well read there as here.It is the study of practice [ie, anatomy] that has led us to cross so many mountains and at such great expenses."Copernicus advanced the heliocentric theory that the sun, not the earth, is at the center of the macrocosm (the universe), whereas Vesalius, by examining cadavers, put the heart at the center of the microcosm (human body).Later, William Harvey said that the heart is the sun of the body (cor microcosmi sol).The anatomic drawings prepared by Vesalius were truly beautiful and so precise that they remain a valuable teaching tool today.Vesalius corrected many inaccuracies in Galen's anatomy.For example, he refuted the existence of pores in the interventricular septum as a pathway for blood from the right heart to the left ventricle.In 1559, his pupil, Matteo Realdo Colombo, in the book De Re Anatomica, discovered the pulmonary blood circulation by in vivo dissection of dogs, demonstrating that the pulmonary veins contained not air but bright red blood.He thus established that blood reached the left ventricle from the lungs.The Englishman William Harvey, who graduated from the School of Medicine at the University of Padua on April 25, 1602, observed valves within the veins of the limbs and, by performing dissections, recognized that blood was pumped by forceful contraction of the left ventricle into the arteries, passing then to the veins and draining into the right heart and back again to the left heart via the lungs.By incising the aorta in beating hearts of fallow deer in the forests surrounding Windsor Castle, he calculated stroke volume and cardiac output,