人心房室结和房室束的光镜观察

本文对13例人心标本房室结和房室束的形态及位置,作了连续切片观察。1.房室结为一扁长形结构,其横切面呈右侧微凸的三角形,有时切面呈梭形或半卵圆形。成人房室结大小为3.5×3.3×1.1 mm~3。有5例房室结表面的右心房心内膜隆起。2.房室结位于二尖瓣与三尖瓣附着缘之间的房室隔内,成人房室结距冠状窦口1.8～5.8 mm,距右心房心内膜0.3～0.7 mm,距三尖瓣隔侧瓣上缘3.3～7.5 mm。结左侧紧贴中心纤维体。3.房室结可分为浅、深两部,浅部纤维纵行止于结的下端。1例深部又分为上、下两部。在结表面右心房心内膜隆起的标本上,结右侧的心房肌覆盖层止于心内膜。结的上缘、右侧面及后缘与房肌相连。4.成人房室束长5.7～7.9 mm,直径1.1～1.5 mm。房室束前部有7例在肌性室间隔顶部;3例在肌性室间隔左侧;2例在肌性室间隔肌肉内部。1例经行特殊,由肌性室间隔顶部至其左侧,最后至肌性室间隔内部偏右侧而终止。     

大鼠房室交界区的组织化学研究

目的：比较大鼠房室交界区各部之间的糖代谢及神经分布的差异。方法：SD大鼠心脏冷冻切片;行糖原,乳酸脱氢酶,琥珀酸脱氢酶,单胺氧化酶和乙酰胆碱酯酶染色。结果：（1）糖原：房室结,中心纤维体＞房间隔,室间隔;乳酸脱氢酶：中心纤维体＞房室结,房间隔,室间隔;琥珀酸脱氢酶,单胺氧化酶：室间隔＞房间隔＞房室结＞中心纤维体;乙酰胆碱酯酶;房室结＞＞房间隔,室间隔,中心纤维体;（2）乙酰胆碱酯酶在房室束未分叉部光密度比其他部位高,其余染色在房室交界区各部无差异。结论：（1）房室交界区与心肌都具备有氧及无氧\代谢的能力,交界区糖原储备丰富;交界区各部间的代谢无差别;（2）副交感神经在房室束未分叉部的分布较其他部位多。     

房室交界区三角的观察和测量

在110例人心(成人70,儿童40)上,观察了由冠状窦口、Todaro腱及三尖瓣隔瓣附着缘围成的房室交界区三角,对上述各边界及室间隔膜部进行了测量。三角的三个角各有不同结构占据,前上角为房室结,顶角有冠状窦和心最小静脉开口,后下角深面为右冠状动脉“U”形袢。就上述特点结合临床进行了讨论。     

房室结区神经结构的组织化学研究

Wistar大白鼠20只,10例用于胆碱酯酶(AchE)组织化学反应.在房间隔内发现AchE阳性神经元,该神经元发出神经纤维延续至房室结及房室束.该结果证实房室结及房室束区副交感神经纤维来源于房间隔内的胆碱能神经元.另外10例行单磷酸硫胺素酶(TMPase)和抗氟酸性磷酸酶(FRAP)组织化学染色,观察到房室结周围区存在(TMPase)阳性神经细胞,室间隔上部近房室结区存在FRAP阳性神经细胞.该二类神经元可能系房室结区局部神经调制结构.     

婴幼儿和法洛氏四联症房室结和房室束的外科解剖及计算机三维重建Ⅰ.位置与毗邻

通过对15例人心(成人5例,婴幼儿5例,法四5例)房室结和房室束的连续切片观察和图像分析,表明:15例房室结均位于Koch三角内.与成人相比,婴幼儿房室结位置相对较高,法四房室结位置偏低,其结前部紧靠三尖瓣隔瓣根部.婴幼儿房室束多位子三尖瓣隔瓣附着缘以上的房室肌隔内或室嵴顶部,而法四房室束起始部紧邻三尖瓣隔瓣根部的深面,其余部份可位:室嵴左侧,室缺的后下缘;房室束可直接位于室缺游离缘的心内膜下,或距室缺游离缘(可为肌性或腱性)1.88-2.14mm处.为临床小儿心外科手术提供了直接的形态学依据.     

人心室间隔的动脉及其吻合

本文采用冠状动脉X线造影法、解剖法和腐蚀法研究了14例成人心脏室间隔的动脉及其吻合。供应室间隔的动脉有前中隔动脉,后中隔动脉,房室结动脉,后上中隔动脉和降隔动脉。左、右冠状动脉在室间隔的供应范围分别占40～98％和2～40％。室间隔动脉不仅在室间隔形成丰富的冠状动脉内吻合和冠状动脉间吻合,它们还可与其它动脉吻合于房间隔,心房后壁,动脉圆锥部,心尖部和后室间沟。本文还观察了正常人和心脏病患者室间隔动脉吻合支的形态特点和直径。     

人体心脏房室结、房室环及主动脉后结的巨微解剖

目的解剖分离人体心脏房室结和房室环的结构,阐述它们的形态特征及相互关系。方法通过体视显微镜解剖12例人体心脏的房室结、主动脉后结及房室环,再进行组织学观察,并绘图演示它们的结构关系。结果在二尖瓣环和三尖瓣环靠近冠状窦前缘处分别暴露了左、右房室环(12/12),直径分别为(0.69±0.12)mm、(0.78±0.13)mm。此处的左、右房室环穿行在房室隔内的心房肌与心室肌之间的间隙中,向房室结方向延伸。主动脉后结在主动脉根后方的房间隔中被探查到(7/9),它的后上方的房间隔间隙中有肌纤维与其相连,它的前下方分出左、右房室环,并且此处的左环比右环粗。在中心纤维体后方的心内膜下的深部,主动脉后结与房室结之间有直接的心肌组织连接通路,这条通路有别于另两条通路(左、右房室环)。结论主动脉后结和房室环可通过体视显微镜解剖暴露,主动脉后结与房室结之间有3条通路。     

心脏介入治疗与解剖(续)

2 心律失常介入与解剖。2．1 阵发性室上性心动过速的介入治疗。2．1．1 房室结折返性心动过速。正常情况下，房室结是心房、心室之间的唯一电学通道，位于房间隔近三尖瓣环处的前方，Koch三角的前上角。所谓Koch三角是指右房内由Todaro腱、冠状静脉窦口和三尖瓣隔瓣围成的三角形区域。房室结在其中穿过中心纤维体延续为希氏束。房室交界区由三部分组成，即位于房间隔前上区域的前上部分，冠状窦口处延伸而来的后下部分和真房室结。房一结连接区有三个独特的房结束，即上束、中束和侧束。后两融合成近端房结束，并与真房室结相连。上房结束是快径的一部分，中、侧束是慢径的一部分。     

带血供半腱肌肌腱转位重建膝交叉韧带的应用解剖

目的：为带血供半腱肌肌腱转位重建膝交叉韧带术提供解剖学基础。方法：在４０侧成人下肢标本上观测半腱肌肌腱形态,血供来源,分支及分布特点：２侧新鲜下肢标本进行模拟术式。结果：半腱肌肌腱长１５．１ｃｍ、宽０．５ｃｍ、、厚０．４ｃｍ,ａ其血供来源于动半腱肌支,膝下内侧动的腱支、腱外周组织血管网动脉和胫前返动脉。结论：半腱肌肌腱与交叉韧带形态相似,有足够的游离长度。血供丰富,为多源性。以半腱肌肌腱转移重起初     

人心传导系统的变异

目的　探讨划分心传导系统 (CCS)形态变异与发育异常 (畸形 )的界线。　方法　用我们建立的CCS检查法 ,即窦房结和房室结沿其长轴切 1～ 2块 ,房室束沿长轴垂直切 2～ 4块 ,连续切片 ,间断取片 ,每例共取 30片。对 886例 (非心源性死亡 737例 ,心源性猝死 149例 )人CCS进行组织学观察 ,并对两组进行CCS形态、死因分析比较。　结果　 1 人CCS具有大小、位置及形态的先天性变异 ;2 也有增龄性变化的后天性变异 ;3 死因不明的心源性猝死者中CCS见到有成年人胎儿型房室结、房室结全部移位至房室束穿部、房室束穿部完全分成 3束以上、房室束分叉部房室结化及移位至三尖瓣根部等 ,这些改变不应认为是正常变异 ,因为它们都可能有病理学意义。　结论　房室束分叉部向室间隔膜部内移位、偏位于室间隔左侧、向室间隔左下侧移位 ,以及不足 1 2房室结移位至中心纤维体内 (房室束穿部 ) ,心肌束移位于房室束或左束支内等应属CCS变异 ,不是畸形。     

Three-dimensional visualization of the bovine cardiac conduction system and surrounding structures compared to the arrangements in the human heart

In the human heart, the atrioventricular node is located toward the apex of the triangle of Koch, which is also at the apex of the inferior pyramidal space. It is adjacent to the atrioventricular portion of the membranous septum, through which it penetrates to become the atrioventricular bundle. Subsequent to its penetration, the conduction axis is located on the crest of the ventricular septum, sandwiched between the muscular septum and ventricular component of the membranous septum, where it gives rise to the ramifications of the left bundle branch. In contrast, the bovine conduction axis has a long non-branching component, which penetrates into a thick muscular atrioventricular septum having skirted the main cardiac bone and the rightward half of the non-coronary sinus of the aortic root. It commonly gives rise to both right and left bundle branches within the muscular ventricular septum. Unlike the situation in man, the left bundle branch is long and thin before it branches into its fascicles. These differences from the human heart, however, have yet to be shown in three-dimensions relative to the surrounding structures. We have now achieved this goal by injecting contrast material into the insulating sheaths that surround the conduction network, evaluating the results by subsequent computed tomography. The fibrous atrioventricular membranous septum of the human heart is replaced in the ox by the main cardiac bone and the muscular atrioventricular septum. The apex of the inferior pyramidal space, which in the bovine, as in the human, is related to the atrioventricular node, is placed inferiorly relative to the left ventricular outflow tract. The bovine atrioventricular conduction axis, therefore, originates from a node itself located inferiorly compared to the human arrangement. The axis must then skirt the non-coronary sinus of the aortic root prior to penetrating the thicker muscular ventricular septum, thus accounting for its long non-branching course. We envisage that our findings will further enhance comparative anatomical research.     

Anatomy of the human atrioventricular junctions revisited

There have been suggestions made recently that our understanding of the atrioventricular junctions of the heart is less than adequate, with claims for several new findings concerning the arrangement of the ordinary working myocardium and the specialised pathways for atrioventricular conduction. In reality, these claims are grossly exaggerated. The structure and architecture of the pathways for conduction between the atrial and ventricular myocardium are exactly as described by Tawara nearly 100 years ago. The recent claims stem from a failure to assess histological findings in the light of criterions established by Monckeberg and Aschoff following a similar controversy in 1910. The atrioventricular junctions are the areas where the atrial myocardium inserts into, and is separated from, the base of the ventricular mass, apart from at the site of penetration of the specialised axis for atrioventricular conduction. There are two such junctions in the normal heart, surrounding the orifices of the mitral and tricuspid valves. The true septal area between the junctions is of very limited extent, being formed by the membranous septum. Posterior and inferior to this septal area, the atrial myocardium overlies the crest of the ventricular septum, with the atrial component being demarcated by the landmarks of the triangle of Koch. The adjacent structures, and in particular the so-called inferior pyramidal space, were accurately described by McAlpine (Heart and Coronary Arteries, 1975). Thus, again there is no need for revision of our understanding. The key to unravelling much of the alleged controversy is the recognition that, as indicated by Tawara, the atrioventricular node becomes the atrioventricular bundle at the point where the overall axis for conduction penetrates into the central fibrous body. There are also marked differences in arrangement, also described by Tawara, between the disposition of the conduction axis in man as compared to the dog.     

Anatomical and neurohistological observation of the heart of the jungle bush quail, Perdicula asiatica (Latham.).

Anatomy, histology and innervation of the heart of the jungle bush quail, Perdicula asiatica have been described. The cardiac conducting system is well developed except the atrioventricular node. The sinuatrial node is located at the cephalic end of the interatrial septum and comprised of a large number of specialised muscle fibres enclosing a few small nodal arteries. A few syncytial cells could also be observed. The atrioventricular node is small, rounded and compact mass present at the ventrocaudal end of the interatrial septum. The node is not enclosed by any connective tissue sheath. Atrioventricular bundle is quite conspicuous and a special left bundle branch descends from it and extending to the left ventricle. The presence of special left bundle branch probably helps in pumping the pure blood of left ventricle with a great force. The heart of the jungle bush quail is richly innervated. Large number of nerve fibres and ganglion cells are present at the sulcus terminalis and atrioventricular sulcus. Fine nerve fibres are also present in the mass of sinuatrial node, atrioventricular node, atrioventricular bundle and its branches. Nerve cells are found to be absent in the conducting system. A nervous connection exists between the sinuatrial node and atrioventricular node. Nerve fibres are also seen in the ventricular myocardium and at the sites of aortic arches.     

成人右房室瓣瓣叶分区与形态的解剖观测

目的为心脏右房室瓣病变的临床诊治提供解剖学资料。方法对171个成人心脏右房室瓣瓣叶分区进行形态学测量。结果右房室瓣瓣叶分为粗糙区、透明区、基底区。瓣膜形状有三角形、半椭圆形、半圆形、长方形和梯形。双前瓣瓣叶高度最高,内瓣瓣叶高度最低。前瓣透明区和基底区室面腱索最少,因而前瓣活动性最大。内瓣和后内瓣室面附着的腱索多而短小,使瓣叶活动性最小。结论心脏外科手术中应密切注意瓣叶的解剖学特点。     

Sequential segmental analysis of the crocodilian heart

Differences between hearts of crocodilians and those of mammals and birds are only partly understood because there is no standardised approach and terminology for describing cardiac structure. Whereas most reptiles have an undivided ventricle, crocodilians have a fully septated ventricle. Their hearts, therefore, are more readily comparable with the hearts of mammals and birds. Here, we describe the heart of a crocodile (Crocodylus noliticus). We use the versatile sequential segmental approach to analysis, juxtaposing several key views of the crocodilian heart to the comparable views of human hearts. In crocodiles, the atrial and ventricular septums are complete but, unlike in placental mammals, the atrial septum is without an oval fossa. The myocardial component of the crocodilian ventricular septum dominates, but the membranous septum likely makes up a greater proportion than in any mammal. In the crocodile, the aortic trunk takes its origin from the left ventricle and is not wedged between the atrioventricular junctions. Consequently, there is a common atrioventricular junction, albeit with separate right and left atrioventricular valvar orifices. As in mammals, nonetheless, the crocodilian left atrioventricular valvar orifice is cranial to the right atrioventricular valvar orifice. By applying a method of analysis and terminology usually restricted to the human heart, we build from the considerable existing literature to show neglected and overlooked shared features, such as the offset between the left and right atrioventricular valvar orifices. Such commonalities are surprising given the substantial evolutionary divergence of the archosaur and synapsid lineages, and likely reflect evolutionarily shared morphogenetic programmes.     

The rotational position of the aortic root related to its underlying ventricular support

We aimed to assess the relationship of the rotational position of the aortic root to its underlying ventricular support, and to the position of the inferior margin of the membranous septum, which serves as a surrogate of the atrioventricular conduction axis. We analyzed 40 normal heart specimens (19 children, 21 adults). The inferior margin of the membranous septum was measured relative to the virtual basal ring. The rotational position of the aortic root was determined by assessing the relationship of the aortic leaflet of the mitral valve to the interleaflet triangle between the non‐ and left coronary leaflets. The extent of supporting fibrous versus myocardial tissues was measured. We also performed a similar investigation of 30 adult computed tomographic data sets. The median age was 0.25 years (44% male) for children, and 64 years (33% male) for adults. The aortic root was positioned centrally in 22 specimens (55%), rotated counterclockwise in 6 (15%), and clockwise in 12 (30%). In the setting of counterclockwise rotation, 53.4% (median) of the supporting circumference was myocardial, as opposed to 41.4% (median) in those with centrally positioned roots, and 31.9% (median) in those with clockwise rotation (P < 0.0001). The position of the inferior margin of the membranous septum was not associated with the rotational position. Analysis of the 30 adult computed tomographic data sets (median age 66.5 years, 57% male) confirmed the positive relationship between clockwise rotation of the aortic root and an increase in the extent of fibrous as opposed to myocardial support. The rotational position of the aortic root correlates with variation in the extent of its fibrous as opposed to myocardial ventricular support, but not with the position of the inferior margin of the membranous septum relative to the virtual basal ring. Clin. Anat. 32:1107–1117, 2019. © 2019 Wiley Periodicals, Inc.