A thorough understanding of the fundamental anatomy of the heart and great vessels is essential to grasp the pathological conditions of patients undergoing surgery. With this knowledge, the intended surgical procedure can be understood more clearly. The team in the cardiac surgery operating room should correlate surgical anatomy with the planned surgical procedures. The principal components of the heart, over and above its chambers and great vessels of entry and exit, are its conducting system, autonomic innervation, and the coronary arterial and venous circulations. In this chapter, we review the position of the heart in the thorax, its pericardial covering, chambers and the valves between them, vascular supply, the location of the so-called conduction system, and the anatomy of the great veins and intrapericardial arterial trunks.