Interactive Interactive Learning Learning

There is more to the dissection of a pigs heart

Yeung Chung Lee Hong Kong Institute of Education

The dissection of the mammalian heart in secondary biology classes need not be restricted to revealing the internal structure of the heart and its function. It could also be used to demonstrate other important aspects of blood circulation, including the blood supply to the heart itself as well as the causes and effects of coronary heart disease. The activities described in this paper serve to enrich this kind of classical dissection and extend its objectives to address new curricular emphases on Science-Technology-Society themes. Key words: Heart; Circulatory system; Dissection; Coronary heart disease

Introduction
The dissection of a pigs heart is a common activity performed in biology classes in Hong Kong and elsewhere. The aim is often to enhance students understanding of the structure of the heart including its four chambers, the valves and the major blood vessels associated with it. The emphasis is on relating the structure to its function, which is to drive blood through a double circulatory system. However, there is more that students could learn from the dissection of a mammalian heart. First, the heart is an ideal organ to demonstrate how blood is supplied to a body organ by means of the arterial-capillary-venous system. This is due to the proximity of the coronary arteries to the base of the aorta, the location of the major coronary arteries and veins on the surface of the myocardium, and also to the relatively small size of the heart which nevertheless has an efficient arterial and venous network. The proximity of its arteries to the base of the aorta means that they are available for study in an intact form even after the heart has been removed from the dead animal. The superficial location of the major blood vessels in the myocardium allows them to be easily observed from the outside. The relatively small size of the heart and its efficient network of blood vessels allow easy demonstration of blood circulation from the arteries to the veins. This advantage will become apparent in the practical activities to be described in the next section. Second, by studying the blood flow through the coronary artery into the heart muscles, students can explore the causes of coronary heart disease and its effects on the blood supply to the heart. This disease is commonly induced by atherosclerosis, that is, the formation of plaques made of fatty substances in the coronary arteries, blocking the flow of blood to the myocardium. This condition can be simulated using the pig heart. Coronary heart disease is a topic in secondary biology curricula of Hong Kong, which focus increasingly on connecting classical biology topics to Science-Technology-Society themes (Curriculum
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Development Council, 2002; Curriculum Development Council/Hong Kong Examinations Authority, 2002).

Methodology
Before leading students through the activities described in the following paragraphs, it is useful to provide them with a preliminary understanding of the structure of the coronary circulation, although they need not memorise the names of individual blood vessels. The coronary arteries and veins are conspicuously located on the surface of the heart, their branches being quite easily discernible. There are two coronary arteries: the left and right coronary arteries running from the base of the aorta to the anterior and posterior side of the heart respectively. Both arteries are divided into branches to supply blood to the atria and ventricles. One branch of the two arteries runs in a circular manner, meeting each other at the posterior side of the heart, giving the coronary arteries the shape of a crown. Two major branches, the anterior interventricular branch from the left coronary artery and posterior interventricular branch from the right, run more or less vertically downwards to the apex of the heart, their tributaries fusing with each other. Both coronary arteries carry oxygenated blood to the myocardium. Deoxygenated blood is collected and carried away by cardiac veins. The veins run more or less parallel to the arteries but are more visible on the surface of the heart, hence they are easily mistaken as arteries. Figures 1a and 1b show the main branches of the left and right coronary arteries and the cardiac veins as they appear on the surface of the pig heart. The cardiac veins eventually reach the coronary sinus, a large vein-like tube draining blood into the right atrium (Figure 2). Method The following two activities were tried out successfully with a class of senior secondary students of age 16. In these two activities, the pig hearts used should be as intact as possible and students
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Dissection of a pigs heart

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Figure 1a Anterior view of the pig heart

Figure 2 Coronary sinus running in the atrio-ventricular groove to the right atrium

need to wear gloves for maximum protection. Activity 1: To demonstrate blood flow from coronary arteries to veins The specific outcomes to be achieved by students in this activity are as follows: to study the system of the blood vessels supplying blood to the myocardium and to distinguish between coronary arteries and cardiac veins to consolidate the understanding that blood enters the myocardium (and other organs as well) through the arteries and leaves through the veins to understand that the relentless beating of the heart is made possible by an efficient blood supply through the coronary circulation. To demonstrate how blood flows through the arterial-venous system within the myocardium, the first step is to locate the entrance of the right and left coronary arteries in the aorta. This can be done by slitting the posterior side of the aorta down to its base with a pair of scissors. The openings of the two coronary arteries are discernible as two holes located just above the semilunar valves (Figure 3). Care has to be taken not to cut through the holes. After this, a seeker can be inserted into the two openings to locate the position of the two arteries outside the aorta. The position of the coronary arteries and its major branches on the surface of the heart can be traced further by sliding an extra fine tube (about 1 mm in diameter) carefully downwards from the entrance. The left coronary artery is easier to work with since it is more prominent. It branches off shortly after leaving the aorta into the circumflex branch and the anterior interventricular branch. The circumflex branch runs circularly in the atrioventricular groove to the posterior side of the heart. This is not very visible as it is covered by fatty tissues. The anterior interventricular branch is much more conspicuous, running all the way down from the upper part of the heart to the apex. The extra fine tube can be slid into either of these two branches until it reaches the farthest point. Figures 4a and b shows how this is done for the anterior interventricular branch. In this way, the

Figure 1b Posterior view of the pig heart Journal of Biological Education (2004) 38(4)

Figure 3 Entrances of the left and right coronary arteries in the aorta 173

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Extra fine tubing

Aorta

Left coronary artery

Circumflex branch

Anterior interventricular branch

Figure 4a (above) & b (below): The anterior interventricular branch with an extra fine tubing inserted into it

main branches of the left coronary artery can be revealed, making them easily distinguishable from the veins that run parallel to the artery. After this, the extra fine tube is taken out and a shorter but wider tube (about 3 mm in diameter) is inserted into the entrance to the anterior interventricular branch. The tubing should fit tightly to the entrance of this blood vessel, with about 0.5 cm inserted into it. A thin piece of muscle is sliced from the anterior end of the apex of the heart to open up some of the blood capillaries in the muscles. Using a 10 ml or 50 ml syringe, blue dye is injected slowly and carefully through the tubing into the anterior interventricular artery. (Methyl blue is preferred to blue ink since it is more soluble in water and can be washed away easily in the case of accidental spillage). As the blue dye infuses into the artery, this turns blue, followed by its tributaries. When the dye reaches the capillaries, it begins to percolate through the damaged capillaries (Figure 5). If the heart is squeezed repeatedly from its apical end towards the upper part while the blue dye is continuously injected, the blue

Figure 5: Dye percolating the damaged capillaries in the exposed heart muscles

dye will enter the venous system (Figure 6). As this happens, blue colouration will spread slowly through the network of cardiac veins, eventually reaching the coronary sinus. For better observation, another tube could be fitted through the right atrium to the entrance of the coronary sinus. If the heart is squeezed hard

Figure 4b: see caption for Figure 4a 174

Figure 6: Blue dye accentuates the appearance of the venous system of the myocardium Journal of Biological Education (2004) 38(4)

Dissection of a pigs heart

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Left coronary artery

Anterior interventricular branch

Short piece of extra fine tubing with plasticine at one end

Figure 7: Squeezing the heart makes dye flow through the venous system and out from a tubing connected to the coronary sinus

Figure 9: Anterior interventricular branch blocked by a short piece of tubing

enough, draining of the blue dye from the tube can be observed (Figure 7).When injecting dye into the blood vessels, it is important not to push either too hard or too rapidly otherwise the dye may flow out from the aorta and stain the surface of the heart, obscuring changes inside the blood vessels as a result. Activity 2: Blockage of the coronary arteries in coronary artery disease The specific outcomes to be achieved by students in this activity are as follows: to understand the major cause of coronary heart disease to understand how the occurrence of fatty plaques and thrombus in the coronary arteries affects the blood supply to the myocardium to identify the most common vessels in the heart where fatty plaques and thrombus may occur to realise that blockage of the coronary circulation may result in myocardial infarction, which when occurring extensively, will lead to cardiac failure. In coronary heart disease, the common cause is the occurrence of atherosclerosis and thrombosis in the anterior or posterior interventricular branches (Rogers, 1992). Fatty plaques, or atheroma, start to deposit on the inner wall of those blood vessels, restricting blood flow into the myocardium. These plaques may eventually damage the endothelial lining of the arteries, leading to the formation of blood clots or thrombus. These blood clots may block the

blood flow entirely. When this occurs, blood supply to the corresponding part of the myocardium will be severely hampered, resulting in myocardial infarction, i.e. the death of cardiac muscles. To demonstrate the occurrence of plaques or thrombus in coronary heart disease, another pigs heart is used. A small piece of extra fine tube (about 1 cm in length and 1 mm in diameter) is taken with one end blocked with plasticine. As illustrated in Figures 8 and 9, a seeker is used to introduce this piece of tube into the anterior interventricular branch about half-way down to the apex of the heart. This small piece of tube is used to simulate the plaque and thrombus formed in a patient suffering from

Figure 8: A seeker holding a short piece of extra fine tubing with one end blocked by plasticine Journal of Biological Education (2004) 38(4)

Figure 10a: Coronary heart disease model (front view) 175

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Figure 11: Simulation of the effect of atherosclerosis on coronary circulation

Figure 10b: Coronary heart disease model (back view)

coronary heart disease. Blue dye is then injected into the left coronary artery by the same method described in Activity 1. As the passage of the dye is blocked by the thrombus, blue colouration will not appear in the lower apex receiving blood supply from the blocked vessel. To further enhance students understanding of the effect of coronary heart disease, a simple model of the heart can be made. Figures 10a and 10b show the front and back view of the model. To construct this model, a heart shape is cut out from a piece of foam rubber or cardboard paper to represent the heart. A short wide transparent tube (about 1.5 cm in diameter) is used to represent the aorta. The lower end of the aorta is stoppered by a rubber bung. The tubing is attached to the back of the heart with its open end protruding from the upper part. A piece of iron wire or adhesive tape could be used to fix its position. A small hole is bored through the aorta near its upper end to which a short fine transparent tube (about 4 mm in diameter) is fitted to represent the coronary artery. The junction between the two tubings is made air-tight by applying adhesive glue or silicone to it. The coronary artery is then joined by means of a Y-shaped adapter to two other transparent tubes which represent its branches.To simulate atherosclerosis, one of the two branches is pre-fitted with a small piece of plasticine which partially blocked the tubing. The free ends of the two branches are fitted into a vial through its cover. Another hole is bored through the vial cover to equalise the pressure inside and outside of the vial. Using this model, the effect of coronary heart disease could be simulated by injecting coloured liquid into the opening of the coronary artery with a syringe. Students should observe that the solution flows through the unblocked branch much more
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easily than through the blocked branch, depending on the degree of the blockage (Figure 11). Coloured liquid will be collected in the vial and also the aorta due to spilling at the time of injection. The liquid can be drained after the activity. As a follow-up to this activity, the teacher can discuss with students the possible consequences of this problematic condition, like myocardial infarction and cardiac failure. This model is preferably used in conjunction with another heart model (Lee 2001, p 44) which could be used to simulate congestive heart failure due to severe weakening of either side of the heart. The two simulation activities together would lead students to appreciate the importance of an unhampered blood supply to the myocardium in maintaining the continuous beating of the heart and hence an effective blood circulation in the body.

Discussion
Before introducing students to coronary circulation and guiding them through the two activities, I found it worthwhile to pose this question to them, How does our heart obtain the energy for continuous beating that lasts a lifetime? This question is of particular relevance to these activities with students. From my experience, it seems striking that although many students knew the heart obtains energy from the food we absorb or the oxygen we breathe, very few were able to explain further that the blood supply to the heart muscles is essential for the continuous replenishment of food and oxygen for sustaining the heart beat. Nevertheless, after the activities many students acknowledged that the activities reinforced their understanding of the circulatory system, in particular the role of arteries and veins, and the function of coronary circulation. These activities can also help to dispel students intuitive conception that the heart obtains its supply of essential materials from the blood flowing through its four chambers by diffusion. It should be made clear to students that diffusion is a shortrange activity, taking place only within a thickness of about 20 layers of muscle cells, which is too short a distance to meet the needs of the myocardium (Rogers 1992). Hence, an independent blood supply is crucial for the continuous supply of oxygen and nutrients to the heart muscle cells.
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Dissection of a pigs heart

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Despite the fact that the blood supply system in the heart shares the same characteristics as other body organs, students should note that it is unique in at least two aspects. The first is that the venous blood from the heart is not drained via the vena cavae but directly into the right atrium through the coronary sinus. In fact, a small proportion of the venous blood can pass directly into the heart chambers through small venous channels (Wilson 1990). The second concerns the mechanism by which arterial blood is supplied to the myocardium. Unlike other internal organs where the arteries supply blood as a result of an increase in arterial blood pressure during ventricular systole, ventricular systole actually shut the arteries and capillaries within the heart due to the powerful contraction of the heart muscles. These blood vessels can refill only in the diastole phase, as the ventricular muscles relaxes again (Rogers 1992). Another reason for the restriction of blood supply during ventricular systole is that the entrance to the coronary artery is partially blocked by the flap of the aortic semi-lunar valve as the left ventricle contracts (Marieb 1992). Hence, blood is sucked into the coronary arteries and capillaries during ventricular diastole and forced out through the veins during ventricular systole. In Activity 1, the flow of blue dye into cardiac veins and the coronary sinus by squeezing the heart actually simulates this mechanism. As far as teaching is concerned, it is interesting to note that through these activities value is added to a classical dissection by linking to S-T-S. These activities should begin to draw students attention to the importance of maintaining a healthy heart, and preventing themselves from suffering from myocardial infarction or cardiac failure when they get older. Hence these activities could contribute to health education against coronary heart disease, which claims thousands of lives in Hong Kong every year second only to cancer. As a further step to enhance students understanding of this disease, they could be engaged in project work to inquire into, first, the rate of occurrence of coronary heart disease and its relationship with various demographic variables such as age, body weight, gender, etc; second, the factors underlying its occurrence, e.g. smoking, overweight and sedentary lifestyles; and, third, the methods of treatment and prevention of this disease.

References
Curriculum Development Council (2002). Biology Curriculum Guide (Secondary 4-5). Hong Kong. CDC. Curriculum Development Council/ Hong Kong Examinations Authority (2002). Biology Curriculum and Assessment Guide (Advanced Level). Hong Kong. CDC/HKEA. Lee Y C (2001). Construction of heart models using simple air pumps. Journal of Biological Education, 36(1), 42-44. Marieb E (1992). Human anatomy and physiology. California, USA. Benjamin/Cummings. Rogers A W (1992). Textbook of anatomy. Edinburgh, UK. Churchill Livingstone. Wilson K (1990). Anatomy and physiology. Edinburgh, UK. Churchill Livingstone.

Yeung Chung Lee is a lecturer in the Department of Science, Hong Kong Institute of Education, The Peoples Republic of China. Address: D3-1/F-41, Department of Science, Hong Kong Institute of Education, 10 Lo Ping Road, Taipo, Hong Kong. Telephone No: + (852) 2948 7658. Fax No: + (852) 2948 7676 (Please quote address in the fax). Email: yclee@ied.edu.hk

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