This has allowed for a new comprehension of several pathological states, suggests a new explanation of systolic and diastolic function/dysfunction and clarified some negative medical and surgical outcomes otherwise inexplicable. Thanks to the more widespread use of these two techniques, an increasing number of literature dealt with the study of cardiac layers structure and function in normal and diseased heart. Just with the advent of magnetic resonance and 2D echo speckle-tracking and strain, we have been able to re-evaluate this fundamental knowledge of cardiac function. One of the main reasons for that was the technical limitation of not having an instrumental examination that could show it. Although known since the time of Erysistratus and demonstrated by Harvey (1468), the real three-dimensional structure of the heart muscle was not taken into consideration, nor used in clinical practice if not recently. Over the centuries the macroscopic anatomical aspect of the heart has been clarified and its function has been correctly framed, but a sort of erroneous vision has lasted up to the present day: that relating to its three-dimensional, integrated, multidimensional structure. The application of this modern, functional vision of the heart could improve the clinical treatment of heart disease, filling the gaps still present. A new vision based on the whole acquired knowledge must guide an in-depth scientific approach in future papers and guidelines on the topic and a complete, farsighted therapeutic conduct able to ensure the physiological correction of cardiac pathologies. We aim to track key steps of heart development to identify what it “remembers” and maintains in its final form as positively selected. The aim of this review is to identify these key parameters of cardiac structure and function as essential elements of the heart’s proper functioning and bases for its treatment. We can identify the major lines of development of the heart and trace these lines up to the mature organ. Each key step can be recognized in the final features, as the heart maintains a kind of “memory” of these passages. The various ontogenetic passages form the evolutive basis of the final configuration of the heart. The embryological development of the heart is one of the most fascinating phenomena in nature and so is its final structure and function.
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