Cardiovascular Physio-Pathology by Leonardo Da Vinci (1452–1519)
2019; Lippincott Williams & Wilkins; Volume: 124; Issue: 4 Linguagem: Inglês
10.1161/circresaha.118.314390
ISSN1524-4571
Autores Tópico(s)Medical History and Innovations
ResumoHomeCirculation ResearchVol. 124, No. 4Cardiovascular Physio-Pathology by Leonardo Da Vinci (1452–1519) Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBCardiovascular Physio-Pathology by Leonardo Da Vinci (1452–1519) Antonio V. Sterpetti Antonio V. SterpettiAntonio V. Sterpetti Correspondence to Antonio V. Sterpetti, MD, Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico, Rome 00167, Italy. Email E-mail Address: [email protected] From the Policlinico Umberto I, University of Rome Sapienza, Italy. Originally published14 Feb 2019https://doi.org/10.1161/CIRCRESAHA.118.314390Circulation Research. 2019;124:472–474Leonardo was able to translate the results of his research in the cardiovascular field, described in the previous article1 to the clinical field. He possessed an intuition that overcame the established theory that considered diseases an unbalance of the humors. It was not easy for Leonardo to express these ideas freely in the tumultuous environment of the Italian Renaissance.The Italian Renaissance was driven by the wish of the local princes to obtain authority and prestige, following a rapid economic growth in all major cities based on the florid trades all over Europe and Asia, and considerable incomes from the thousands of pilgrims coming to Rome to obtain indulgences for their sins. It was a form of intellectual revolution, in an unstable environment, where criticisms to the old theories represented not only an offense to tradition, but also a threat to the power of the establishment.2,3Leonardo's interest in medicine started when he performed his first anatomic dissections. In those days, painters were one of the few people allowed to do post mortem dissections to better define the anatomy of the personages of their paintings. Having developed in the meantime a special interest also in hydraulics, engineering, and physics, Leonardo was fascinated by the complexity of the human body, which he considered a perfect machine.4–8Diseases were considered in those days as a punishment from God by the general public, and an unbalance of humors by scientists, who followed closely the theories of Galen. The most common remedy for the majority of the diseases, independent of their nature, was continuous venous bloodlettings, with great satisfaction of everybody watching the removal of dark venous blood, full of impurities.Leonardo theorized that diseases derived from some imperfection in the structure of the human body. These theories remained almost unknown until 250 years later (1761), when Giovanni Battista Morgagni, Professor in Padua, published the opera, De sedibus et causis morborum per anatomen indagatis which represents one of the basis of modern medicine. Similarly to Leonardo, he put in evidence that for each disease there was a correlated anatomic change, overcoming the old theories of the diseases as unbalance of the humor of the body.AtherosclerosisIn ≈1505, Leonardo met a man in Santa Maria Nuova in Florence, who was more than 100 years old. Leonardo wrote, "… this man was wise, happy despite his advanced age … when he died, I performed an autopsy to understand the reason for his happy elderly.""I made an autopsy to understand the causes of this peaceful death, and I found that it was caused by weakness though the failure of the blood and of artery that feeds the heart and the other lower members …."In another annotation, he made clear the concept of atherosclerosis, and its correlation with aging "… when the vessels become old they lose the straightness of their branching and become more folded or tortuous and rigid …" and "… one [can] ask why the vessels in the old acquire great length and those which were formerly straight become tortuous and their coat gets thicker so much as to occlude and prevent the movement of the blood …". Leonardo also performed an autopsy on a 2-year-old child in whom he found "… all the arteries are soft and straight … differently from an old man …".Leonardo made several assumptions about the cause of atherosclerosis,9–11 based on his previous hydrodynamic studies on the water flow in the rivers, talking about "… the continuous stress on the wall of the arteries" and about "… the lack of nourishment in the medial wall of the artery, distant from the blood which nourish it …".Pathology of Cardiac ValvesLeonardo's interest and experience in hydraulic and engineering was the impulse to analyze in detail the mechanics of the movement of the cardiac valves. Using sophisticated methods, unusual for those days, he studied in vivo and in vitro models of the closure and opening of the cardiac valves in relation to the contraction of the atria and of the ventricles. He described the heart as "… a muscle animated by spontaneous rhythmic contraction which stops only with death … the valves open and close following the contractions of the heart … if they do not close completely there is blood flow reversal …". He made several drawings and annotations describing the characteristics of the blood flowing through the valves and the turbulences determined by incomplete opening of the valves. Those turbulences could determine stress to the heart (Figure 1).Download figureDownload PowerPointFigure 1. Intuition of blood oxygenation. Heart and pulmonary circulation. Leonardo describes exactly the anatomy of the coronary arteries and their blood supply to the different regions. He adds that the heart functions on a spontaneous contraction which ends with life. He seems to rise the suspicion that life can bring back making the heart contract again. (Drawing and Annotations by Leonardo—1510 circa—Collection Windsor Castle, United Kingdom. Permission by Her Majesty Queen Elisabeth II 2018.)Coronary ArteriesHe recognized that the heart feeds itself through the coronary arteries, and these arteries can occlude with aging, determining a malfunction of the heart (Figure 2A and 2B).Download figureDownload PowerPointFigure 2. Cardiac valves. A, Cardiac valves. Leonardo was much interested in the function of the cardiac valves. He performed numerous in vivo and in vitro experiments, defining the mechanisms leading to valve opening and closure. He determined the possible problems related to inadequate closure or opening of the valves. (Drawing and Annotations by Leonardo—1510 circa—Collection Windsor Castle, United Kingdom. Permission by Her Majesty Queen Elisabeth II 2018.) B, Dynamics of blood flowing through the cardiac valves. Leonardo was much interested in flow dynamics. He performed numerous experiments analyzing the blood flow through the valves in glass models, made from wax molds of bull heart. He made continuous comparisons between the blood flow patterns in these glass models and the water flow in rivers, which were visualized with different colors. (Drawing and Annotations by Leonardo—1510 circa—Collection Windsor Castle, United Kingdom. Permission by Her Majesty Queen Elisabeth II 2018.)Cirrhosis and Portal HypertensionHe described accurately a case of portal hypertension with liver cirrosis, possibly in the same autopsy in which he described precisely arteriosclerosis, "… the artery and the vein which go from the spleen to the liver become so large that they block the blood coming from the mesenteric vein; the latter vein dilates so much and become so tortuous like a snake, that the liver dries and become like frozen bran, either in colour or consistency…". Leonardo thought that the changes in the liver were secondary to the dilatation of the veins and not the cause. However, in another occasion, he writes "… the liver is nourished by the blood coming from the porta …". The importance of the factors coming from the porta to the liver has been recognized only around 1980, when patients who had portocaval shunts suffered from liver failure and hepatic encephalopathy.12Pulmonary Circulation and Chronic Obstructive Pulmonary DiseaseWhen Leonardo was painting a fresco in the Church Santa Maria Novella, a middle-aged man was preparing the colours for his frescos. The man, breathing the vapours from the colours, developed a severe form of chronic pulmonary obstructive disease, with severe restrictive disease, and consequent dyspnea at rest.11 Leonardo asked the man to be the model for Saint Jerome in the Wilderness. The painting shows Saint Jerome, who lived the life of hermit in the desert, in severe sufferance. The muscle of the neck, chest and face are shown in spasmodic contraction.When the man died, Leonardo performed the autopsy, to understand the reasons for such suffering. He found emphysema of the lungs, and annotated the possibility to correct this alterations. From his knowledge in engineering, he hypothesized that the lungs were dilated because the air could not be expelled properly.Mechanics of the Lower Limb Venous CirculationLeonardo was interested in the venous circulation of the lower limbs. Varicose veins have been described since antiquity, but Leonardo had the intuition to understand the importance of the contraction of the muscle in favouring the return of the venous blood. He described the presence of collaterals between the superficial and deep venous system in the lower limb. In Italian Anatomy, the group of perforating veins around and just below the knee are connected by the so-called, Vein of Leonardo.Influence of Psychological Conditions on Heart DiseaseLeonardo was a man in a continuous psychological turmoil trying to understand the world around him, and above all trying to understand himself. His desire to understand human nature is confirmed by the efforts he made to correlate the psychological conditions with alterations in human body and vice versa. He analyzed the condition of the heart in many dissections, trying to correlate the psychology of the person and the overall body conditions. Leonardo understood the influence of evident and hidden psychological factors on heart disease. Sigmund Freud, the father of psychoanalysis was the first to understand this aspect of Leonardo and he tried to define Leonardo's personality. Freud found himself lost in a jungle of sensations in his efforts.13–15 Leonardo seems so simple, yet impossible to define. Scientists, consciously or not, remain attracted to his message that science and art can work together.DisclosuresNone.FootnotesCorrespondence to Antonio V. Sterpetti, MD, Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico, Rome 00167, Italy. Email antonio.[email protected]itReferences1. Sterpetti AV. Cardiovascular research by Leonardo da Vinci (1452–1519).Circ Res. 2019; 124:189–191. doi: 10.1161/CIRCRESAHA.118.314253LinkGoogle Scholar2. Burckhardt J. The Civilization of Renaissance in Italy. Middlemore, New Zealand: Trans S.G.C; 1878.Google Scholar3. Kehoe TJ, Damerow H E, Duvall JM. Exploring Western Civilization to 1648. Dubuque, IA: Kendall/Hunt Publishing Company; 1997:411–436.Google Scholar4. Burke P. The Italian Renaissance: Culture and Society in Italy. Princeton, NJ: PrincetonUniversity Press; 1999.Google Scholar5. Clayton M. Leonardo's medicine years.Nature. 2012; 484:314–316.CrossrefGoogle Scholar6. O'Malley CD, Sounders CM. Leonardo on the human body: The Anatomical, Physiological and Embryological Drawings of Leonardo da Vinci. New York, NY: Henry Schuman; 1952.Google Scholar7. Bortolon L. The Life and Times of Leonardo. London, United Kingdom: Paul Hamlin; 1967.Google Scholar8. Vasari G. Tormentino L, ed. In: Vita dei più eccellenti pittori, scultori ed architetti italiani, da Cimabue insino i giorni nostri. Florence, Europe; 1550Google Scholar9. Sterpetti AV. Anatomy and physiology by Leonardo: the hidden revolution?Surgery. 2016; 159:675–687. doi: 10.1016/j.surg.2015.10.001CrossrefMedlineGoogle Scholar10. Sterpetti AV. The influence of the stroke suffered by Leonardo on his last paintings. A pioneer of psychoanalysis?Eur J Intern Med. 2016; 33:e7–e8. doi: 10.1016/j.ejim.2016.03.024CrossrefMedlineGoogle Scholar11. Keele KD. Leonardo da Vinci's views on arteriosclerosis.Med Hist. 1973; 17:304–308.CrossrefMedlineGoogle Scholar12. Keele KD. Leonardo da Vinci on Movement of Heart and Blood. London, United Kingdom: Lippincott; 1952.Google Scholar13. Sterpetti AV. The revolutionary studies by Leonardo on blood circulation were too advanced for his times to be published.J Vasc Surg. 2015; 62:259–263. doi: 10.1016/j.jvs.2015.03.036CrossrefMedlineGoogle Scholar14. Balducci G, Sterpetti AV, Ventura M. A short history of portal hypertension and of its management.J Gastroenterol Hepatol. 2016; 31:541–545. doi: 10.1111/jgh.13200CrossrefMedlineGoogle Scholar15. Freud S. Deuticke F ed. In: Einekindheitserinnerung des Leonardo da Vinci. Lei pzig und Wien; 1910.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Vahid F, Chiriboga D, Bohn T and Hébert J (2022) Diet, inflammation, and cardiovascular disease Diet, Inflammation, and Health, 10.1016/B978-0-12-822130-3.00015-6, (367-472), . Armentano R (2020) Leonardo Da Vinci, the Great Innovator in Cardiovascular Biomechanics VIII Latin American Conference on Biomedical Engineering and XLII National Conference on Biomedical Engineering, 10.1007/978-3-030-30648-9_127, (975-981), . Picardi E, Macchi V, Porzionato A, Boscolo‐Berto R, Loukas M, Tubbs R and De Caro R (2019) Marco antonio della torre and leonardo da vinci, Clinical Anatomy, 10.1002/ca.23393, 32:6, (744-748), Online publication date: 1-Sep-2019. Fughelli P, Stella A and Sterpetti A (2019) Antonio Maria Valsalva (1666–1723), Circulation Research, 124:12, (1704-1706), Online publication date: 7-Jun-2019. Monsuez J (2019) Léonard de Vinci : une anatomie cardiovasculaire dynamique, Archives des Maladies du Coeur et des Vaisseaux - Pratique, 10.1016/j.amcp.2019.04.005, 2019:279, (22-24), Online publication date: 1-Jun-2019. February 15, 2019Vol 124, Issue 4 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCRESAHA.118.314390PMID: 30763213 Originally publishedFebruary 14, 2019 Keywordsblood circulationheartenvironmentgrowthmedicinePDF download Advertisement
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