Common usage of cardiologic anatomical terminology: critical analysis and a trilingual discussion proposal

Background: Terminology and Lexicography have been especially addressed to the Allied Health Sciences regarding discussion of case reports or concerning publication of scientific articles. The knowledge of Human Anatomy enables the understanding of medical terms and the refinement of Medical Terminology makes possible a better anatomicomedical communication in a highly technical level. Most of the scientific publications in both Anatomy and Medicine are found only in English and most of dictionaries or search resources available do not have specificity enough to explain anatomicomedical, terminological, or lexicographical occurrences. Objective: To design and produce a multilingual terminological dictionary (Latim-English-Portuguese-Spanish) containing a list of English anatomicomedical terms in common usage in cardiology subspecialties addressed to medical students and professionals, to other allied health sciences professionals, and to translators working in this specific field. Methods: Terms, semantical and grammatical components were selected to compose an anatomicocardiological corpus. The adequacy to the thematic terminological research requests and the translation reliability level will be settled from the terminology specificity in contrast to the semantics, as well as from a peer survey of the main terms used by national and international experts in specialized journals, Internet sites, and from text-books on Anatomy and

generally used when physicians discuss case reports and when medical papers are published.Terminology establishes with Translation extremely close relationships, once performing their professional activities, translators of technical-scientific texts need to consult the lexical material resulting from the terminological practice, either being mono-, bi-, or, even multilingual.These lexical materials are the glossaries, terminological dictionaries, and terminological database, among others relevant materials [4].
It seems rather unnecessary to say that Anatomy has an international vocabulary that is the foundation of medical terminology, thus, it is highly important that all health professionals throughout the world use the same terms [5,6].The technical-scientific vocabulary is, along with other lexicographic compositions, one of the vital instruments to clipping scientific "events" in order to store and retrieval of these data to accomplish a more intensive and efficient communication among specialists within and among scientific areas.Moreover, it is highlighted as an important instrument of research and support of the theoretical framework of the science itself [7].
Unfortunately, the terminology commonly used in hospitals, textbook, atlases or articles may differ from the official terminology.Because this discrepancy may be source of confusion, misunderstanding, misinterpretation [7], we decided to draw attention to the differences between both official and nonofficial terminology to enlighten the practitioners, health science students, translation students, and to a large extent dispel the confusion exiting up to the present moment.

INTRODUCTION
It is important for medical students to have a sound knowledge and understanding of the basic anatomical terms [1] taking into account that Anatomy forms the basis for the practice of medicine.Anatomical terminology leads the physician towards an understanding of a patient's disease, whether he or she is carrying out a physical examination or using the most advanced imaging techniques [2].It is important not only the understanding of medical anatomical terms, but to place the terms within their proper context, that is, to give an appreciation of how the human body functions in both health and disease [3].
The accurate use of anatomical terms by medical and allied health sciences personnel enables them to communicate with their colleagues both nationally and internationally.Without anatomical terms, one cannot discuss or record accurately the abnormal functions of joints, the actions of muscles, the alteration of position of organs, or the exact location of swellings or tumors [1].Anatomical terms are also important for dentists, chiropractors, physical therapists, and others involve in any aspect of patient treatment that begins with an analysis of clinical signs.The ability to interpret a clinical observation correctly is therefore, the endpoint of a sound anatomical terminology understanding.Thus, an understanding of anatomical terms requires an understanding of the context in which the terminology can be remembered [2].
The aim of the present study is to promote a critical analysis and a brief discussion among official and alternative official terms, nonofficial technical terms, and common usage terms in English, Portuguese, and Spanish commonly used in cardiologic subspecialties.

METHODS
Considering the Terminology specific orientation, the selection of the terms which composes the lexical universe -the vocable (terms), the standard units of techno-scientific vocabulary, and the word-occurrence sets -was not conducted in the same way as that of developing a general language dictionary.The type of bibliographic source varied according to the aims of the study.At first sight, one of the sources to be privileged was the text to which we had access to both the original manuscript and its translation.The consultation to the specialists of specific subject fields, calling forth their precious expertise, as well as their nation-and worldwide representativity, eliminates or mitigates the effect of the terminological dialects [4].
Another criterion, innately and purely quantitative, which could guide the task of selecting the terminological units to be analyzed, is the "reliability index" (the level of acceptability, advisability, and reliability).The main reliability codes usually employed by the terminologists are: normalized term, privileged term, admitted term, and rejected term.The codes can also include the following: term to be avoided, correct term, official term, nonofficial technical term, etc. Examples: internal mammary artery is a term to be avoided; the correct and official anatomical term is: internal thoracic artery; circumflex artery is an unofficial term; circumflex branch of the left coronary artery is the official anatomical term.Another example of the abovementioned is: arteriovenular anastomosis; although arteriovenous anastomosis is widely used, for the sake of correctness arteriovenular anastomosis is the preferred term, since the structure in question does not link an artery and a vein, but an arteriole and a venule [6,8].
Based on the identified critical issues and concepts aforementioned, we came to identify relevant Medical Subject Headings (MeSH) terms, Health Sciences Descriptors (DeCS) terms, and terms in English language, peer-reviewed scientific literature, such as The Annals of Thoracic Surgery (the Official Journal of the Society of Thoracic Surgeons and the Southern Thoracic Surgical Association), the Journal of Thoracic and Cardiovascular Surgery (the Official Publication of the American Association of the Thoracic surgery and the Western Thoracic Surgical Association), and the Brazilian Journal of Cardiovascular Surgery (Official Journal of the Brazilian Society of Cardiovascular Surgery).In order to give more credibility to our research, the Terminologia Anatomica (English and Latin), the Terminologia Anatômica (Portuguese), and the Terminología Anatómica (Spanish) were also used to compile the Official Anatomical Terms and give more reliability to the present research.Only the Latin list of terms should be used as the basis for creating lists of equivalents terms in other languages.English, Portuguese, and Spanish equivalents are given in this list as they are spoken in their respective countries.
Table 1 with a sample of the 30 main used official Cardiologic Terms in Latin, English, Portuguese and Spanish, and Table 2 with 30 English, Portuguese, and Spanish main cardiologic terms in common usage peerreviewed journals of cardiology and (pediatric and adult) thoracic surgery are provided.

RESULTS
The terms are laid out in four columns, with each Latin term accompanied by a term in current usage in English-, Portuguese-, and Spanish-speaking countries.These are the Official Standard Anatomical Terms according to each Terminologia Anatomica of each country.Only Latin list of terms should be used as the basis for creating lists of equivalent terms in other languages.English equivalents are given in this list as English is spoken in many countries.

DISCUSSION
The aims of the terminological research determine the terminological set units that a Nomenclature of a speciality vocabulary should be composed of.The accuracy in identifying the addressed subdomains and a counterbalanced research are the only guarantee of establishing a homogeneous terminological set, thus presenting several advantages such as: to the reader, it allows to clearly know what kind of term, he/she will find in the book; to the terminologist, it allows to make choices concerning the nomenclature boundaries, to identify the derangements and the lack of homogeneity in the usage of the subdomains allowing the professional to correct occasional distortions in the further nomenclature of the vocabulary [8].
Anatomy -the study of the structure and function of the human body -first studied formally in Egypt, approximately 500 BC, is one of the oldest basic medical sciences.The earliest descriptions of Anatomy were written on papyruses between 3000 and 2500 BC.Hyppocrates, who is regarded as the Father of Medicine and a founder of the science of Clinical Anatomy, wrote several books on Anatomy.In one he stated: "The nature of the body is the beginning of medical science" [9].Vesalius' masterpiece De Humani Corporis Fabrica, published in 1543, marked a new era in the history of medicine.The study of Anatomy Concerning the specialized dictionaries (n=3) examined, we have found the following situation: the Stedman's Medical Dictionary [19,20] registers the nonofficial anatomical terms, however, the synonymous used is the official anatomical term and its translation to Portuguese the Nomina Anatomica (Terminologia Anatômica, Tradução CTA-SBA [21], is used, that is, the official terminology.For example: Anterior interventricular artery (EM) -Ramo interventricular anterior da a. coronária esquerda PTBr); synonym: anterior interventricular branch of left coronary artery.Regarding the Dorland's Illustrated Medical Dictionary [22,23], all the terms are registered using the nonofficial terminology; it registers the referent in Latin and the translation to Portuguese is completely wrong with regard to the official Nomina Anatomica (Terminologia Anatômica, Tradução CTA-SBA, 2001).The "Glossário de Termos Médicos" [24] (Medical Terms Glossary, free translation) -English-Portuguese, registers the non official terminology, the official terminology, and the official anatomical translation.For example, anterior interventricular artery (see anterior interventricular branch) is translated as Ramo interventricular anterior da A. coronária esquerda.
Another example of the distance between official and nonofficial terminologies relies on well-established terms known world-wide such as Mitral Valve and Tricuspid Valve.The English official terminology has established as the official term, Mitral Valve, and as an alternative official term, Left Atrioventricular Valve.The Brazilian Terminology Committee has established the term Valva atrioventricular esquerda, as the official terminology.Likewise, the same happens to another official anatomical term, Tricuspid Valve.The alternative official term is Right Atrioventricular Valve; while in Portuguese the official anatomical term is Valva atrioventricular direita only.
In the Terminología Anatómica [25], in Spanish, as we can observe in the appendage A, the official anatomical term is Válvula atrioventricular derecha; the alternative official term is Válvula tricúspide; the same is true for Válvula atrioventricular izquierda, the official anatomical, while the alternative official term is Válvula mitral.
It is difficult to generalize, but it can be said that, on the whole, as abovementioned, our health science practitioners are not aware of the new terminology, once it is worth remembering here that the Nomina Anatomica [26]

CONCLUDING REMARKS
There is no consensus regarding the use of official anatomical terms.Usual or nonofficial technical terms which lead to terminology or translation misunderstanding is often a source of confusion to practitioners and translators worldwide.Because anatomical terminology is the foundation of medical terminology and language, it is important that physicians and scientists, as well as all the Allied Health Sciences practitioners throughout the world use the same name for each structure.Physicians must be aware of the new Terminologia Anatomica, which is the joint creation of the Federative Committee on Anatomical Terminology (FCAT).They all must learn the correct nomenclature that enables precise communication among practitioners worldwide, as well as among scholars in basic and applied health sciences.
, 5 th ed., approved by the 11 th International Congress of Anatomists, Mexico, 1980, and published in Brasil in 1984, had already the terms written in Portuguese, such as Valva atrioventricular direita (Right Atrioventricular Valve) and Valva atrioventricular esquerda (Left Atrioventricular Valve).

Table 1 .
Main used official Cardiological Terms in Latin, English, Portuguese and Spanish.

Table 2 .
English, Portuguese, and Spanish main cardiological terms in common usage.