Advertisement

Anatomy and Embryology

, Volume 209, Issue 6, pp 425–438 | Cite as

The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution

  • Tomokazu KawashimaEmail author
Original Article
First Online:

Abstract

A submacroscopic anatomical investigation of the entire autonomic cardiac nervous system, from origin to peripheral distribution, was performed by examining 36 sides of 18 adult human cadavers under a stereomicroscope. The following new results and points of discussion were obtained: (1) The superior cervical, the middle cervical, the vertebral, and the cervicothoracic (stellate) ganglia, composed of the inferior cervical and 1st thoracic ganglia, were mostly consistent among the specimens. (2) The superior, middle, and inferior cardiac nerves innervated the heart by simply following the descent of the great arteries. In contrast, the thoracic cardiac nerve in the posterior mediastinum followed a complex course because of the long distance to the middle mediastinum. (3) The actual course of the right thoracic cardiac nerve differed from that of the previous descriptions in that it ascended obliquely or ran transversely to the vertebrae, regardless of the intercostal vessels. Regarding the right thoracic cardiac nerve, two descending courses were observed: the descent of the right thoracic cardiac nerve via the azygos vein and right venous porta, and the descent of the recurrent right thoracic cardiac nerve via the aorta. (4) The cranial cardiac nerve and branch tended to distribute into the heart medially, and the caudal cardiac nerve and branch tended to distribute into the heart laterally. (5) The mixing positions (cardiac plexus) of the sympathetic cardiac nerve and the vagal cardiac branch, as well as the definitive morphology of brachial arteries with the recurrent laryngeal nerves, tended to differ on both sides. These new and detailed anatomical descriptions of the human autonomic cardiac nervous system may provide important clues regarding the morphogenesis of autonomic cardiac nerves in addition to contributing to the improvement of cardiac surgery.

Keywords

Sympathetic cardiac nerves Vagal cardiac branches Cardiac plexus Human Gross anatomy 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

This study was supported by grants from the Japan Foundation of Cardiovascular Research (2003) and Scientific Research from the Ministry of Education, Culture, Sports Science and Technology (No. 16790804). The author wishes to thank Prof. Hiroshi Sasaki of Tokyo Women’s Medical University and Prof. Kenji Sato of Tokyo Medical and Dental University for their valuable criticism and advice.

References

  1. Axford MB (1927–1928) Some observations on the cervical sympathetic in man. J Anat 62:301–318Google Scholar
  2. Becker RF, Grunt JA (1957) The cervical sympathetic ganglia. Anat Rec 127:1–14CrossRefPubMedGoogle Scholar
  3. Bourgery IM (1844) Traité complet de l’anatomie de l’homme. C.-A. Delaunay, Paris (cited in Braeucker 1927)Google Scholar
  4. Braeucker W (1927) Der Brustteil des vegetativen Nervensystems. Beiträge zur Klinik der Tuberkulose 66:1–65Google Scholar
  5. Broek AJP (1908) Untersuchungen über den Bau des sympathischen Nervensystem der Säugetiere. 1 Der Halssympathicus. Morphol Jahrb 37:202–288Google Scholar
  6. Cruveilhier J (1852) Traité d’anatomie descriptive, vol 4. Labé, Paris (cited in Braeucker 1927)Google Scholar
  7. Ellison JP, Williams TH (1962) Sympathetic nerve pathways to the human heart, and their variations. Am J Anat 124:149–162CrossRefGoogle Scholar
  8. Fernoholm M (1971) On the development of the sympathetic chain and the adrenal medulla in the mouse. Z Anat Entwickl 133:305–317CrossRefGoogle Scholar
  9. Fukuyama U (1982) Gross anatomy of the extrinsic cardiac nerve branches of human beings. Acta Anat Nippon 57:357–380 [in Japanese]PubMedGoogle Scholar
  10. Gomez H (1958) The development of the innervation of the heart in the rat embryo. Anat Rec 130:53–71CrossRefPubMedGoogle Scholar
  11. Guerrier Y (1944) Le sympathique cervical. Imprem de la Charité, Montpellier, p 245 (cited in Wrete 1959)Google Scholar
  12. Harman NB (1900) The anterior limit of the cervico-thoracic visceral efferent nerves in man. J Anat Physiol 34:359–391Google Scholar
  13. Hausmann E (1956) Über die Anatomie der Herznerven. Z Anat Entwickl 119:263–279CrossRefGoogle Scholar
  14. Hirakow R (1987) A basic pattern of the cardiac nerves in vertebrates. Brain Nerve 39:417–423 [in Japanese]PubMedGoogle Scholar
  15. Hirschfeld L (1866) Traité et iconographie du systéme nerveux. Masson, Paris (cited in Braeucker 1927)Google Scholar
  16. His Jr (1897) Über die Entwickelung des Bauchsympathicus beim Hühnchen und Menschen. Arch Anat Physiol Suppl:137–170Google Scholar
  17. Hoffmann HH (1957) An analysis of the sympathetic trunk and rami in the cervicula and upper thoracic regions in man. Ann Surg 145:94–107PubMedGoogle Scholar
  18. Jamieson RW, Smith DB, Anson BJ (1952) The cervical sympathetic ganglia—an anatomical study of 100 cervico-thoracic dissections. Quart Bull Northwestern Univ Med Sch 26:219–227Google Scholar
  19. Janes RD, Brandys JC, Hopkins DA, Johnstone DE, Murphy DA, Armour JA (1986) Anatomy of human extrinsic cardiac nerve and ganglia. Am J Cardiol 57:299–309CrossRefPubMedGoogle Scholar
  20. Kawashima T, Sasaki H (2003b) The morphological significance of the human sinuatrial nodal branch. Heart Vessels 18:213–219CrossRefPubMedGoogle Scholar
  21. Kawashima T, Sasaki H (2004) Anatomical comparison of a defect in the hepatic segment of the inferior vena cava with the normal azygos system. Eur J Anat 8:71–79Google Scholar
  22. Kawashima T, Sasaki H (2005) A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg Radiol Anat February 19 [Epub ahead of print]Google Scholar
  23. Kawashima T, Sato K (2000) Morphological analysis of sympathetic cardiac nerves in the Japanese monkey and man. Autonomic Nerv Sys 37:521–531 [in Japanese with English abstract]Google Scholar
  24. Kawashima T, Sato K, Sasaki H (2001) An anomalous case of the thoracic cardiac nerve in the Japanese monkey. Acta Anat Nippon 76:399–406 [in Japanese with English abstract]PubMedGoogle Scholar
  25. Kawashima T, Sato K, Sato F, Sasaki H (2003a) An anatomical study of the human cardiac veins with special reference to the drainage of the great cardiac vein. Ann Anat 185:535–542PubMedGoogle Scholar
  26. Kuntz A, Morehouse A (1930) Thoracic cardiac nerves in man. Arch Surg 20:607–613Google Scholar
  27. Kuntz A (1946) The autonomic nervous system, 3rd edn. Baillière, Tindall & Cox, LondonGoogle Scholar
  28. Kuratani SC, Miyagawa-Tomita S, Kirby M (1991) Development of cranial nerves in the chick embryo with special reference to the alterations of cardiac branches after ablation of the cardiac neural crest. Anat Embryol 183:501–514CrossRefPubMedGoogle Scholar
  29. Lazorthes G, Cassan L (1939) Essai de schématisation des ganglions étoilé et intermédiaire (ganglion cervico-thoracique) d’après 80 dissections chez l’adulte et chez le foetus. Bull Ass Anat 49:193–210Google Scholar
  30. Meckel JF (1817) Handbuch der menschlichen Anatomie. Halle, Berlin (cited in Braeucker 1927)Google Scholar
  31. Mitchell GAG (1953) Anatomy of the autonomic nervous system. ES Livingstone, LondonGoogle Scholar
  32. Mizeres NJ (1963) The cardiac plexus in man. Am J Anat 112:141–152CrossRefGoogle Scholar
  33. Müller LR (1924) Die Lebensnerven, 2nd edn. Springer, Heidelberg Berlin New York, pp 141–168Google Scholar
  34. Ogawa T (1952) On the cardiac nerve of some cetacea, with special reference to those of Berardius bairdii Stejneger. Whales Research Inst 12:1–22Google Scholar
  35. Pauza DH, Skripka V, Pauziene N, Stropus R (2000) Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart. Anat Rec 259:353–382CrossRefPubMedGoogle Scholar
  36. Perman E (1924) Anatomische Untersuchung über die Herznerven bei den hoheren Säugetieren und bei Menschen. Z Anat Entwickl 71:382–457Google Scholar
  37. Pick J (1970) The autonomic nervous system. Morphological, comparative, clinical and surgical aspects. Lippincott, PhiladelphiaGoogle Scholar
  38. Pick J, Sheehan D (1946) Sympathetic rami in man. J Anat 80:12–20Google Scholar
  39. Plank VJ, Rychlo A (1952) Eine schnellentkalkungsmethode. Zbl Pathol 89:252–254Google Scholar
  40. Roberts LA (1991) Morphological innervation pattern of the developing rabbit heart. Am J Anat 190:370–384CrossRefPubMedGoogle Scholar
  41. Saccomanno G (1943) The components of the upper thoracic sympathetic nerves. J Comp Neurol 79:355–378CrossRefGoogle Scholar
  42. Sappy PC (1889) Traité d’anatomie descriptive. V.-A. Delahaye & Cie, Paris (cited in Braeucker 1927)Google Scholar
  43. Schumacher SV (1902) Die Herznerven der Säugetiere und des Menschen. Sitz Ber Kaiserl Akad Wiss 111:3Google Scholar
  44. Sharner RF (1930) On the development of the nerves to the mammalian heart. Anat Rec 46:23–39CrossRefGoogle Scholar
  45. Shinozaki S (1929–1930) Human cardiac nerves. Acta Anat Nippon 2:399–425 [in Japanese]Google Scholar
  46. Souza RR, Gama EF, Carvalho CAF, Liberti EA (1996) Quantitative study and architecture of nerves and ganglia of the rat heart. Acta Anat 156:53–60PubMedGoogle Scholar
  47. Swan J (1834) A demonstration of the nerves of the human body. Longman, Rees, Orme, Brown, London (cited in Braeucker 1927)Google Scholar
  48. Tanaka S, Nakatani T, Mizukami S, Yasui K, Uemura M, Lee HY, Chung IH (1998) Branches of the vagus nerve destined for the heart and the adjoining great vessels in the house shrew, Suncus murinus, with reference to the terminology of the vagal cardiac branches. Acta Anat Nippon 73:141–156PubMedGoogle Scholar
  49. Valentin G (1843) Hirn- und Nervenlehre. Leopold Voss, Leipzig (cited in Braeucker 1927)Google Scholar
  50. Verberne ME, Gittenberger-de Groot AC, Poelmann RE (1998) Lineage and development of the parasympathetic nervous system of the embryonic chick heart. Anat Embryol 198:171–184CrossRefPubMedGoogle Scholar
  51. Verberne ME, Gittenberger-de Groot AC, Iperen LV, Poelmann RE (1999) Contribution of the cervical sympathetic ganglia to the innervation of the pharyngeal arch arteries and the heart in the chick embryo. Anat Rec 255:407–419CrossRefPubMedGoogle Scholar
  52. Verberne ME, Gittenberger-de Groot AC, Iperen LV, Poelmann RE (2000a) Distribution of antigen epitopes shared by nerves and the myocardium of the embryonic chick heart using different neuronal markers. Anat Rec 260:335–350CrossRefPubMedGoogle Scholar
  53. Verberne ME, Gittenberger-de Groot AC, Iperen LV, Poelmann RE (2000b) Distribution of different regions of cardiac neural crest in the extrinsic and intrinsic cardiac nervous system. Dev Dyn 217:191–204CrossRefPubMedGoogle Scholar
  54. White JC, Smithwick RH (1952) The autonomic nervous system, 2nd edn. Macmillan, New YorkGoogle Scholar
  55. Woollard HH (1925–1926) The innervation of the heart. J Anat 60:345–373Google Scholar
  56. Woollard HH, Norrish RE (1933) The anatomy of the peripheral sympathetic nervous system. Br J Surg 21:83–103Google Scholar
  57. Wrete M (1959) The anatomy of the sympathetic trunk in man. J Anat 93:448–459PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of Anatomy, School of MedicineTokyo Women’s Medical UniversityTokyoJapan

Personalised recommendations

Cite article

Buy options