家猪心脏三尖瓣复合体的形态学观测

目的　观测家猪心脏三尖瓣复合体 ,为家猪心脏研究和心脏移植积累资料。方法　甲醛固定的家猪心脏 35例 ,大体解剖并观测三尖瓣复合体。结果　家猪心脏三尖瓣复合体由瓣环、瓣膜、腱索和乳头肌构成 ,瓣环周长为 70 75± 8 4 5mm ,前瓣、后瓣、隔侧瓣、前隔连合、前后连合、后隔连合的高度分别为 14 5 8±2 6 4、14 16± 2 5 0、12 84± 2 37、6 2 9± 1 97、6 86± 1 0 1、6 5 1± 1 36mm。前隔连合、前后连合、后隔连合的宽度分别为 6 4 0± 1 5 4、6 78± 1 2 3、6 4 3± 1 4 6 ;前乳头肌起始 ,腱索附着于前瓣、后瓣和前后连合的条数分别为 3 0 0± 0 97、3 0 9± 1 0 9、2 4 4± 1 16 ;后乳肌起始 ,腱索附着于后瓣、隔侧瓣和后隔连合的条数分别为 2 6 0± 0 6 9、3 0 9± 1 6 3、1 14± 0 4 3。隔侧乳头肌起始 ,附着于前瓣、隔侧瓣、前隔连合的腱索条数分别为1 71± 0 6 7、2 37± 1 2 6、0 94± 0 4 2。结论　家猪心脏三尖瓣复合体中各结构与人类相似 ,但大小有一定差异。     

家猪心脏二尖瓣复合体的形态学观测

目的　观测家猪心脏二尖瓣复合体 ,为家猪心脏研究和心脏移植积累资料。方法　甲醛固定的家猪心脏 3 5例 ,解剖并观测二尖瓣复合体。结果　家猪心脏二尖瓣复合体由瓣环、瓣膜、腱索和乳突肌构成 ,瓣环周长为 73 0 0± 9 71mm ;前瓣、后瓣、前外侧连合、后外侧连合的高度分别为 17 45± 1 99mm、16 3 3±2 2 2mm、5 68± 1 3 7mm、5 3 5± 1 11mm ,前外侧连合、后内侧连合的宽度分别为 4 3 1± 0 80mm、4 40±0 63mm ,前乳头肌起始 ,腱索附着于前瓣、后瓣和后内侧连合的条数为 4 0 0± 1 3 0、5 2 1± 1 84、2 44±1 16,后乳头肌起始 ,腱索附着于前瓣、后瓣和前外侧连合的条数为 3 76± 1 78、5 3 8± 2 2 0、2 12± 0 91。结论　家猪心脏二尖瓣复合体中各结构与人类相似 ,但大小有一定差异     

山羊心脏二尖瓣复合体的应用解剖学研究

目的观测山羊心脏二尖瓣复合体的解剖结构,为比较解剖学积累资料。方法利用大体解剖方法观测山羊二尖瓣复合体的形态结构。结果山羊心脏二尖瓣复合体由二尖瓣瓣环、瓣膜、腱索和乳头肌构成,二尖瓣瓣环周长为47.00±7.39mm,前瓣的高度为7.93±2.03mm,宽度为21.58±4.17mm,后瓣的高度为9.89±1.90mm;宽度分别为20.61±4.22mm;前乳头肌起始点至前瓣、后瓣和后内侧连合的腱索条数分别为5.06±1.71,3.19±1.11,1.25±0.48;后乳头肌起始点附着于前瓣、后瓣和前外侧连合的腱索条数分别为4.50±1.88,4.16±1.84,1.32±0.54。结论山羊心脏二尖瓣复合体的结构与人类相似,但形态有特异性。     

心脏室上嵴形态观察

观察了102例中国人心脏室上嵴,室上嵴由漏斗隔、隔带和壁带组成.漏斗隔长3.09±0.51cm;隔带呈Y形.其主干长2.14±0.58cm,宽1.38±0.33cm.主动脉右窦最高点位于肺动脉右瓣下方,主动脉右窦下缘,在漏斗隔的上方.锥状乳头肌有1～3个,隔缘肉柱可终止于前乳头肌根部、右室前壁或两者.     

桡侧腕屈与腕长伸肌腱部分转位修复手部关节脱位应用解剖

目的 :为桡侧腕屈与腕长伸肌腱部分转位修复桡尺远侧及第 1腕掌关节脱位提供解剖学基础。方法 :3 0侧成人上肢标本 ,分别对桡侧腕屈肌腱、桡侧腕长伸肌腱进行形态学测量。结果 :桡侧腕长伸肌腱性部长 ( 17.8± 2 .6)cm ,肌腱的上、中、下段宽分别为 ( 13 .7± 3 .1)、( 5 .6± 1.1)和 ( 4 .6± 0 .5 7)mm肌腱的上、中、下段厚分别为 ( 1.5± 0 .5 )、( 2 .0± 0 .3 )和 ( 2 .4± 0 .3 )mm。桡侧腕屈肌腱性部长 ( 14 .3± 1.1)cm ,肌腱的上、中、下段宽分别为 ( 9.11.4)、( 5 .5± 0 .9)和 ( 4 .0± 0 .4) ,肌腱的上、中、下段厚分别为 ( 2 .4± 0 .6)、( 2 .2± 0 .4)和 ( 2 .6± 0 .5 )mm。结论 :采用桡侧腕屈肌腱和桡侧腕长伸肌腱部分转位 ,有足够的长度和强度 ,适用于桡尺远侧关节或第 1腕掌关节脱位的修复 ,临床应用获得良好效果     

山羊心脏房间隔、室间隔的观测及解剖学特征

目的　观测山羊心脏房间隔、室间隔的形态及其位置关系,为心脏研究提供比较解剖学资料。方 法　用大体解剖法观测山羊房间隔的卵圆窝、室间隔膜部和肌部。结果　卵圆窝纵轴长9.63±2.18mm,横 轴长6.85±1.54mm,卵圆窝中心点距冠状窦口中心点9.09±2.10mm,距三尖瓣隔侧瓣中点12.81±2.34 mm,距二尖瓣前瓣中点8.94±2.65mm。卵圆窝上缘厚1.26±0.50mm,下缘厚1.80±0.40mm,前缘厚2.39 ±1.78mm,后缘厚2.29±0.89mm。室间隔膜前部宽2.94±1.13mm,中部宽4.66±1.15mm,后部长6.13 ±1.41mm,后部宽9.62±1.83mm,下缘长15.06±2.63mm。室间隔肌部上缘长37.63±4.48mm,前缘长 52.84±6.22mm,后缘长33.77±2.96mm,厚度9.34±1.69mm。结论　山羊心脏房间隔和室间隔与成人相 似,是心外科房间隔、室间隔修复的良好材料。     

家猪心脏纤维支架的大体解剖

目的　观察猪心纤维支架 ,为猪心的研究和比较解剖学积累资料。方法　取甲醛固定后的猪心2 7例 ,液态塑料浸渍的塑化猪心 5例 ,解剖显示纤维支架后用游标卡尺进行观测。结果　猪心左纤维三角的三边分别平均为 17 4 1± 1 99mm、18.96± 3.2 6mm和 17.6 4± 2 .4 4mm ;右纤维三角三边分别为 15 .83± 2 .11mm、16 .19± 1.94mm和 2 0 .96± 2 .6 2mm ;二尖瓣环、三尖瓣环的周长平均为 73.0 0± 9.71mm ,6 8.89±7.2 4mm ;主动脉瓣环和肺动脉瓣环直径分别为 18.4 4± 2 .89mm和 16 .0 3± 2 .6 3mm ;猪Todaro腱呈扁带状 ,走行部位较深 ,且分支较人心多 ,长度为 2 0 98± 4 2 0mm。结论　猪心纤维支架与人类形态结构相似 ,但瓣环周长和Todaro腱形态有一定差别。     

成人房室隔的研究

利用56例成人心脏标本和4例心脏切片对人心房室隔进行了观察和测量.认为房室隔位于右房与左室之间,上界为二尖瓣前瓣环和主动脉后瓣环与右瓣环,下界为三尖瓣隔侧瓣附着缘.前界为室上嵴后缘,后界为冠状窦口.房室隔分为前部与后部,分别与左室流出道和流入道相对应.测量了房室隔的下缘下、前部长和后部长,分别为2.95±0.08,1.62±0.07和1.33±0.07cm;测量后缘宽、中部宽和前部宽,分别为1.61±0.05,1.04±0.04和0.49±0.04cm.描述了各部的组织结构.对房室隔的命名、机能和临床意义进行了讨论.     

带膝降动脉大收肌腱骨皮瓣修复小腿创伤的应用解剖

目的 :为带膝降动脉大收肌腱骨皮瓣修复小腿及跟骨的创伤提供应用解剖学基础。方法 :在70侧成人下肢标本上解剖观测了膝降动脉的起始、分支、分布及大收肌腱的形态特点和血管分布。结果 :①膝降动脉的主干长 1.2± 0 .5cm ,起点外径为 2 .6± 0 .6mm ,主要分支有股内侧肌支、关节支、隐支。②关节支的主干长 6.6± 1.2cm ;起点外径为 1.9± 0 .5 ,分支营养大收肌腱和股骨内侧髁骨质骨膜 ,并参与吻合形成膝关节动脉网。③隐动脉长 10 .9± 3 .3cm ,起点外径 1.8± 0 .6mm。分支营养缝匠肌下部、膝内侧上部皮肤 ,并参与吻合形成膝关节动脉网。④胫后动脉、腓动脉在内踝上方 11cm处的直径分别是 2 .5± 0 .6mm和 2 .0± 0 .4mm。⑤大收肌肌腱部长 6.8± 1.2cm ,宽 9.6± 2 .0mm ,厚 2 .2± 0 .6mm。结论 :带膝降动脉大收肌腱骨瓣、皮瓣血供丰富 ,供区形态可塑性大 ,可作为修复跟腱、跟骨及皮肤缺损的供体。     

三尖瓣装置的应用解剖研究Ⅰ.瓣膜、腱索和乳头肌的生化成分

选用脑死亡2～4小时后成年男性(20～40岁)新鲜心脏的三尖瓣瓣叶、腱索和乳头肌标本各20例,用生物化学方法测定了瓣叶、腱索、乳头肌尖部和乳头肌基部内羟脯氨酸(hydroxyprolin,HX)和氨基已糖(aminohexose,AH)的含量(μg/100mg组织),结果依次为1435.00±138.46和1670.33±358.39.2156.26±309.38和2156.26±309.38和1324.16±428.37、543.25±115.94和1267.50±105.23、347.50±80.48和1238.00±202.71.上述各部内HP的含量比值依次为1:1.50:0.39:0.24;AH为1:0.79:0.76:0.74.HP在腱索内含量最高,瓣叶内次之,乳头肌内最低.AH在瓣叶内含量最高.结果提示腱索和瓣叶是富含HP和AH的组织,这与形态学上观察到的腱索和瓣叶内胶原纤维密集的结果相符.此结果为进一步研究瓣膜装置的生化成分和对心瓣膜疾病的诊断、治疗提供参考资料.     

Quantitative morphology of the normal human tricuspid valve: Autopsy study of 24 cases

Objective: To describe thoroughly and quantitatively the morphologic features of the human tricuspid valve, to define and classify classify certain prominent normal variations, and to offer a clear and concise terminology for describing its morphology. Background. In recent years there has been growing interest in the tricuspid valve. Noninvasive imaging is now commonplace and remarkably detailed. Surgical interventions involving the tricuspid valve have become increasingly common. These factors underscore the need variations. Methods. Quantitative and anatomic features of the tricuspid valve were studied in 24 normal hearts at autopsy from subject evenly distributed by age and sex. Leaflet length, surface area, chordal number, and leaflet morphology were recorded. Results. Valves demonstrated some degree of leaflet subdivision in 92% of cases. Mean tricuspid valve length was 11.3 ± 0.1 cm and the surface area was 21.0 ± 1.1 cm². Mean lengths and surface areas were similar for the anterior, posterior, and septal leaflets (38–42 mm and 5.9–7.8 cm², respectively). However, for a given valve, the longest leaflet could be twice the length and three times the area of the smallest. Calculated valvular diameter was 2.13 ± 0.03 cm/m². The tricuspid valve was served by and average of 170 ± 36 chordae tendineae, 49% inserted on the free edge of the valve, 44% on the undersurface, and 7% on the basal regions. Chordal density (number of chordae/cm²) was greater in women than men (9.9 ± 0.5 vs. 7.3 ± 0.7 chordae/cm², P < 0.02). The septal leaflet had the greatest chordal density and the anterior leaflet the lowest (12.7 ± 0.9 vs. 5.9 ± chordae/cm²). Conclusions. The concept of chordal density for the tricuspid valve has not been previously described and may be clinically relevant in the pathogensis of valvular prolapse. Modifications of existing tricuspid valve nomenclature are suggested. © 1993 Wiley-Liss, Inc.     

Papillary muscles and tendinous cords of the right ventricle of the human heart morphological characteristics

A series of 79 normal human hearts was studied focusing on the morphological characteristics of the papillary muscles of the right ventricle and their tendinous cords (chordae tendineae). The number, incidence, length and shape of the anterior, septal and posterior papillary muscles were observed. The tendinous cords attached to each papillary muscle were counted at their origin. The papillary muscles and the tendinous cords were measured in situ and after the removal of the right atrioventricular valve (tricuspid valve). The anterior and posterior papillary muscles (apm, ppm) were present in 100% of the cases. The septal papillary muscle (spm) was absent in 21.5% of the hearts. The apm presented 1 head in 81% and 2 heads in 19% it was 19.16 mm in length. The spm was one-headed in 41.7% and presented two heads in 16.5% the presence of a 3 and 4 heads appeared in 12.7% and 7.6% respectively the spm was 5.59 mm in length. The ppm had 1 head in 25.4%, 2 heads in 46.8%, 3 heads in 21.5% and 4 heads in 6.3% of the cases it was 11.53 mm in length. Tendinous cords (TC) varied as follows from 1 to 11 TC originated in the apm (mean 4.74) from 1 to 8 TC originated in the ppm (mean 2.67) and from 1 to 5 TC originated in the spm (mean 1.77).     

Right ventricular false tendons, a cadaveric approach

Left ventricular false tendons (LFTs) have been extensively described and recognized by gross anatomic studies. However, there is very little information available regarding right ventricular false tendons (RFTs). The aim of our study, therefore, was to explore and delineate the morphology, topography and morphometry of the RFTs, and provide a comprehensive picture of their anatomy across a broad range of specimens. We identified 35/100 heart specimens containing right ventricular RFTs and classified them into five types. In Type I (21, 47.7%) the RFTs, was located between the ventricular septum and the anterior papillary muscle; in Type II (11, 22.9%) between ventricular septum and the posterior papillary muscle; in Type III (7, 14.5%) between the anterior leaflet of the tricuspid valve and the right ventricular free wall; in Type IV (5, 10.4%) between the posterior papillary muscle and the ventricular free wall; and lastly, in Type V (4, 8.3%) between the anterior papillary muscle and ventricular free wall. The mean length of the RFTs was 18 ± 7 mm with a mean diameter of 1.4 ± 05 mm. Histologic examination with Masson trichrome and PAS revealed that 20 (41.6%) of the 48 RFTs carried conduction tissue fibers. The presence of conduction tissue fibers within the RFTs was limited to Types I, III, and IV. In Types II and V the RFTs resembled fibrous structures in contrast with Type I, II and IV, which were composed more of muscular fibers, including conduction tissue fibers. RFTs containing conduction tissue fibers were identified, which may implicate them in the appearance of arrhythmias.     

An endoscopic and anatomical approach to the septal papillary muscle of the conus

Many authors have questioned the gross anatomy of the septal papillary muscle of the conus known as the papillary muscle complex (PMC) during the past century. An anatomical investigation was conducted to identify the morphology and the topography of the PMC. Our study involved 200 formalin fixed adult human hearts. The PMC was present in 82% of the hearts, while in the remaining 18% of specimens, it was replaced by tendinous chords. The PMC was connected with the septal (59.7%), anterior (20.7%), or both septal and anterior leaflets (19.5%) with single (29.8%) or multiple chordae tendinae (70.1%). The PMC was also found to be present as a single papilla (51.8%), double papilla (32.9%) or triple papilla (15.2%). In addition to the PMC, we observed accessory single septal papillary muscles 42 specimens, double septal papillary muscles 32 specimens and triple septal papillary muscles 26 specimens. In the right ventricular inflow tract, the location of the PMC was consistently found to be in a position below the junction of the anterior and septal leaflets of the tricuspid valve. In the right ventricular outflow tract, we were able to identify 73 specimens in which the PMC was located at the junction formed superiorly by the inferior border of the subpulmonary infundibulum and inferiorly by the superior-lateral border of the septal band, extending into the region of the subpulmonary infundibulum. In the remaining 27%, the PMC was located primarily at the area occupied by the superiolateral border of the septal band without extending to the subpulmonary infundibulum. The present study describes the topography of the PMC according to its surrounding anatomical structures such as the tricuspid valve, subpulmonary infundibulum and septal band of the right ventricle. This anatomical data could have important clinical significance for cardiac surgeons operating in this area.     

Two unusual congenital anomalies of the tricuspid valve

We describe two unusual congenital anomalies of the tricuspid valve discovered incidentally at autopsy. One is an abnormal attachment of the tricuspid septal leaflet to one of two posterior papillary muscles with a concomitant fusion of the right ventricular septal and anterior papillary muscles in a patient with ectodermal dysplasia. The other involves a fenestration defect of the septal leaflet of the tricuspid valve in a patient with aortic stenosis, coronary artery atherosclerosis, and cardiac amyloidosis.     

Anatomic study of the tricuspid valve in children

We performed an anatomic study of the right atrioventricular valve in children under one year of age using a conservative method of dissection of the heart valve. The main aspects studied were the number of cusps and their morphometric characteristics, such as the width of the base and the depth of the cusps. Other parameters studied were the number of papillary muscles, number of tendinous cords, and diameter of the fibrous ring and the last one were divided in three regions, anterior, posterior and septal for localization of cusps. Our results showed that the number of cusps varied from two to four. Three cusps was the commonest finding and the fourth cusp, if present, was classified as anterolateral in location. The anterior and septal cusps had bases bigger than those of the posterior and anterolateral cusps; the septal cusp was deeper than the others; and the number of tendinous cords was greater for the anterior and septal cusps than for the posterior and anterolateral cusps. In addition, the posterior region showed great variability: in 35.7% it was occupied by undeveloped valve tissue and the posterior valve in these cases was located anteriorly.