Anatomical Science International

, Volume 86, Issue 1, pp 30–49 | Cite as

Anatomy of the cardiac nervous system with clinical and comparative morphological implications

Review Article


Unlike autonomic nervous preservation in other surgeries for improving patient quality of life, autonomic cardiac nervous system (ACNS) preservation has been neglected in cardiovascular surgery because of technical difficulties and other unsolved issues. Because such ACNS preservation in cardiovascular surgery is anticipated in the future, detailed anatomical investigation of the human ACNS is required. Therefore, we have conducted morphological studies of the ACNS from macroscopic, clinical, and evolutionary anatomical viewpoints. In this study, I review detailed anatomical studies of the human ACNS together with their clinical implications. In addition, the evolutionary comparative anatomical significance of primate ACNS is also summarized to help understand and translate the findings of functional experiments to humans. These integrated findings will be the subject of a future study unifying molecular embryological and anatomical findings to clarify cardiac functions based on functional animal experiments, clinical applications such as improving surgery techniques and individual order-made surgery in cardiac surgery, and for future evaluation in regenerative medicine.


Autonomic cardiac nervous system Clinical anatomy Comparative anatomy Evolution Primate Human heart Cardiac nerve Cardiac branch 



Ascending aorta


Superior interventricular artery (anterior interventricular/descending branch of the coronary artery)


Accessory middle cervical ganglion




Azygos vein


Anterior cardiac vein


Brachiocephalic trunk


Brachial plexus


Bronchial artery


Circumflex branch of the coronary artery


Common carotid artery


Cervicothoracic (stellate) ganglion


First to eighth cervical nerves




Great cardiac vein


Inferior (vagal) cardiac branch


Inferior cervical ganglion


Inferior cervical cardiac nerve


Inferior caval vein


Nerve branches to the lung


Left atrium


Left common carotid artery


Left coronary artery


Left subclavian artery


Left superior vena cava


Left ventricle


Middle cervical ganglion


Middle cardiac nerve


Vagus nerve


Oblique vein of the left atrium


Pectoral nerve


Pulmonary artery




Phrenic nerve


Pulmonary trunk


Pulmonary vein


Inferior pulmonary vein


Superior pulmonary vein


Right atrium


Right common carotid artery


Right coronary artery


Retroesophageal right subclavian artery


Recurrent laryngeal nerve of the vagus nerve


Right subclavian artery


Right superior vena cava


Right ventricle


Sinuatrial nodal branch of the coronary artery


Superior (vagal) cardiac branch


Nerve to the subclavian muscle


Superior cervical ganglion


Superior cardiac nerve


Superior caval vein


Thoracic (vagal) cardiac branch


Thoracic cardiac nerve


First to sixth thoracic nerves


Vertebral artery


Vertebral ganglion


Vertebral nerve


Vagus nerve


Accessory nerve


Hypogastric nerve


Second to sixth thoracic ganglia


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Copyright information

© Japanese Association of Anatomists 2010

Authors and Affiliations

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

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