Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Self-portrait, Henry Vandyke Carter, MD (Public Domain)
Self-portrait, Henry Vandyke Carter, MD (Public Domain)

Henry Vandyke Carter, MD
(1831 – 1897)

English physician, surgeon, medical artist, and a pioneer in leprosy and mycetoma studies.  HV Carter was born in Yorkshire in 1831. He was the son of Henry Barlow Carter, a well-known artist and it is possible that he honed his natural talents with his father. His mother picked his middle name after a famous painter, Anthony Van Dyck. This is probably why his name is sometimes shown as Henry Van Dyke Carter, although the most common presentation of his middle name is Vandyke.

Having problems to finance his medical studies, HV Carter trained as an apothecary and later as an anatomical demonstrator at St. George’s Hospital in London, where he met Henry Gray (1872-1861), who was at the time the anatomical lecturer. Having seen the quality of HV Carter’s drawings, Henry Gray teamed with him to produce one of the most popular and longer-lived anatomy books in history: “Gray’s Anatomy”, which was first published in late 1857.  The book itself, about which many papers have been written, was immediately accepted and praised because of the clarity of the text as well as the incredible drawings of Henry Vandyke Carter.

While working on the book’s drawings, HV Carter continued his studies and received his MD in 1856.

In spite of initially being offered a co-authorship of the book, Dr. Carter was relegated to the position of illustrator by Henry Gray and never saw the royalties that the book could have generated for him. For all his work and dedication, Dr. Carter only received a one-time payment of 150 pounds. Dr.  Carter never worked again with Gray, who died of smallpox only a few years later.

Frustrated, Dr. Carter took the exams for the India Medical Service.  In 1858 he joined as an Assistant Surgeon and later became a professor of anatomy and physiology. Even later he served as a Civil Surgeon. During his tenure with the India Medical Service he attained the ranks of Surgeon, Surgeon-Major, Surgeon-Lieutenant-Colonel, and Brigade-Surgeon.

Dr. Carter dedicated the rest of his life to the study of leprosy, and other ailments typical of India at that time. He held several important offices, including that of Dean of the Medical School of the University of Bombay. In 1890, after his retirement, he was appointed Honorary Physician to the Queen.

Dr. Henry Vandyke Carter died of tuberculosis in 1897.

Personal note: Had history been different, this famous book would have been called “Gray and Carter’s Anatomy” and Dr. Carter never gone to India. His legacy is still seen in the images of the thousands of copies of “Gray’s Anatomy” throughout the world and the many reproductions of his work available on the Internet. We are proud to use some of his images in this blog. The image accompanying this article is a self-portrait of Dr. Carter. Click on the image for a larger depiction. Dr. Miranda

1. “Obituary: Henry Vandyke Carter” Br Med J (1897);1:1256-7
2. “The Anatomist: A True Story of ‘Gray’s Anatomy” Hayes W. (2007) USA: Ballantine
3. “A Glimpse of Our Past: Henry Gray’s Anatomy” Pearce, JMS. J Clin Anat (2009) 22:291–295
4. “Henry Gray and Henry Vandyke Carter: Creators of a famous textbook” Roberts S. J Med Biogr (2000) 8:206–212.
5. “Henry Vandyke Carter and his meritorious works in India” Tappa, DM et al. Indian J Dermatol Venereol Leprol (2011) 77:101-3

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The aortic root and the aortic valve (1)

The term “aortic valve” refers to the three leaflets (or cusps) components that allow passage of blood from the left ventricle to the ascending aorta during ventricular systole, while at the same time preventing regurgitation or reflux of blood back into the ventricle during ventricular diastole. In reality, the “valve” is only a component of a larger structure called the “aortic root”. This article will describe the components of the aortic root and the aortic valve.

The ascending aorta presents with two distinct segments. The proximal segment is a dilated portion called the aortic root. The distal portion is known as the tubular portion of the ascending aorta. The boundary between these two portions is the [sinotubular junction (STJ). Some authors will recognize as the ascending aorta only the tubular portion.

The aortic root is that portion of the ventricular outflow tract and proximal aorta that supports the leaflets of the aortic valve. It is a functioning unit with relations both to the to the aorta and to the left ventricle, and it is here where in most cases we find the ostia of the right and left coronary arteries.

Aortic root and aortic valve
Aortic root and aortic valve.
Click on the image for a larger version.
The aortic root is composed of the three dilated sinuses of Valsalva, two of which give origin to the coronary arteries (right and left), three leaflets (or cusps), and the interleaflet triangles. While the distal boundary of the aortic root is clearly defined (the STJ), the proximal boundary is not as clear and is difficult to define. The STJ is defined by the apices of the three aortic leaflets as well as a clear line that appears as the aorta passes from the dilations of the sinuses of Valsalva to the well-defined tubular portion of the ascending aorta.

This proximal boundary is defined clinically by two circular regions: the ventriculoaortic ring distally and the virtual basal ring proximally.

The ventriculoaortic ring is a circular region formed by the left ventriculoaortic junction (the point where the aorta anchors on the left ventricle), and fibrous tissue of both the “cardiac skeleton” and the membranous interventricular septum. It is also called the “surgical anulus”. This is the area where a surgeon will anchor an aortic replacement valve.

Continued here: The Aortic Root and the Aortic Valve (2)

Note: The image depicts only one complete aortic leaflet. The other one has been transected to show the sinus of Valsalva and the third has been removed to show the attachment or "hinge" of the leaflet. For an anatomical image of the aortic valve click here.

1. The Anatomy of the Aortic Root: Loukas, M et al. Clinical Anatomy 27:748–756 (2014)
2. “Extracardiac aneurysm of the interleaflet triangle above the aortic-mitral curtain due to infective endocarditis of the bicuspid aortic valve.” Hori D, et al. Gen Thorac Cardiovasc Surg. 2008 Aug;56(8):424-6
3. “Anatomy of the aortic root: implications for valve-sparing surgery” Efstratios I. Charitos, HS. Ann Cardiothorac Surg 2013;2(1):53-56
4. “The Forgotten Interleaflet Triangles: A Review of the Surgical Anatomy of the Aortic Valve” Sutton JP, et al Ann Thorac Surg 1995;59:419-27

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