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。     

胎儿房室结的组织学和组织化学研究

利用光镜观察了２０例胎儿室房结、房室束和左、右束支的组织结构和组织化学特征。结果如下：１、胎儿房室结位于三尖瓣隔侧瓣上方，中心纤维体右侧。结石侧有普通心肌组成的覆盖层。房室结可分深浅两部。浅部纤维平行排列，垂直下行，止于结的下端。深部可分为上和下部。深部向后延伸与房间隔肌相连，向前延续为房室束。深部向右深入中心纤维体内形成许多细胞岛。２、房室束横断面大多为三角形，外包有疏松结缔组织鞘。房室束的前部     

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.     

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Ⅱ.光镜形态与计算机三维重建

15例人心房室结和房室束的连续切片观察表明:多数成人房室结细胞排列较致密,结内结缔组织较多,有明显的脂肪浸润;另一例房室结仅由纵行细胞组成的松散样结构.婴幼儿房室结细胞有的排列松散,有的排列致密,易形成细胞岛和Mahaim束,结内结缔组织较少,未见脂肪浸润,法四房室结细胞排列致密.同时,在VAX-11/730主机和S-600图象处理系统下,用Fortran-77编制的软件包,对一例正常婴幼儿的房室结和房室束进行了三维重建,在彩色监视器的屏幕上显示了不同角度的房室结和房室束及其毗邻结构,并用透明法处理显示了它们之间的位置关系.     

34例房室通道缺损的手术治疗

目的：探讨提高房室通道缺损手术疗效的方法。方法：2001年9月～2008年6月间，手术治疗房室通道缺损34例，其中部分型28例及过渡型3例采用补片修补缺损及二、三尖瓣成形术矫治，完全型3例采用“双片法”修补室州隔缺损及原发孔房间隔缺损。结果：痊愈32例，死亡2例（占5．88％），手术后存活病人心功能明显改善。结论：房窀通道缺损手术疗效的关键在于防止传导束损伤及恢复房室瓣的结构和功能；而完全型房室通道缺损的手术疗效的关键还在于避免手术所致的心室流出道狭窄。     

房室结后延伸部形态学特征及与折返性心动过速的关系

目的：研究人房室结双径路，尤其是慢径的解剖学基础。方法：(1)取17例尸检心脏包括房室结在内的房室交界区的组织固定、脱水、包埋后切片，HE和Masson染色，光镜规察(2)由冠状窦151向房室结方向在心内膜下注射墨汁0．5ml，24h后光镜观察墨汁走向?结果：17例标本均可发现房室结，房室结前向形成房室束(His束)，发现47％(8例)有明确向后延伸一左后延伸和彳丁后延伸，35％(6例)仅有右后延伸，1例发现仅有左后延伸，2例未发现有向后延伸。向后延伸南房室结自然延伸而成，其有房室结自然延伸而成，左后延伸朝左行向房间隔，有后延伸行向有，与三尖瓣隔瓣近乎平行，纤维可达冠状窦口附近。结论：房室结后延伸部可能为慢径路，作为房室结折返性心动过速(AVNRT)的射频消融慢径的解剖学基础、     

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。     

房室结动脉的应用解剖

目的 :为心脏介入治疗和心血管外科提供房室结动脉的解剖学基础。方法 :对 5 5例成人心脏的房室结动脉进行解剖 ,观察其起源 ,测量其外径、长度和到Koch三角边界相关结构的距离。结果 :房室结动脉以 1支多见 (83 .6%) ,2支少见 (16.4%) ,且多起源于右冠状动脉 (87.5 %) ;房室结动脉外径 (1.0± 0 .2 )mm ,主干长 (18.7± 4.3 )mm ;Koch三角中房室结动脉干到冠状窦口的距离为 (4 .6± 2 .1)mm ,到隔瓣附着处的距离为 (5 .2± 2 .1)mm ,其中发自右冠状动脉分支和左冠状动脉旋支的房室结动脉干到冠状窦口的距离分别为 (4 .6± 2 .0 )mm和 (3 .4± 1.7)mm。结论 :房室结动脉在Koch三角内的行程变异较大 ,在心脏介入治疗或心脏外科手术操作时 ,应密切关注Koch三角区 ,减少对房室结动脉的损伤。     

44例完全性房室通道的外科治疗

目的 总结我院近年来手术治疗完全性房室通道的经验.方法 我院自2003年1月至2008年12月共手术治疗完全性房室通道44例.Rastelli分型:A型43例(其中过渡型17例),B型1例.合并畸形包括:法洛氏四联症2例,动脉导管未闭6例,右室流出道狭窄2例,永存左上腔4例.手术在浅中低温体外循环下进行.采用戊二醛处理的自体心包补片连续缝合修补间隔缺损,单片法6例,双片法21例.17例过渡型采用直接下压共瓣修补室缺,间断缝合二、三尖瓣瓣裂,反复注水测试二尖瓣关闭情况直至满意.冠状静脉窦区采用浅缝合,冠状静脉窦开口留在右房.结果 手术死亡1例,术后死亡2例,术后早期发生Ⅲ0AVB 5例,4例经治疗在术后3周恢复窦性心律,1例安装永久起搏器.存活病例术后随访5个月～6年,症状消失,生长发育良好,心功能均低于Ⅱ级,2例失访.术后Echo检查显示二尖瓣轻度返流8例,中度返流2例,残余室间隔缺损4例,均在半年后自愈. 结论完全性房室通道的患儿在诊断明确后应尽早争取在6个月内行根治性手术,同时尽量完善修复二、三尖瓣裂,会取得良好的效果.     

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。     

A new anatomic approach of the ventricular septal defect in the interruption of the aortic arch

The aim of this study was to analyse the anatomy of the ventricular septal defect (VSD) in heart specimens with interruption of the aortic arch (IAA) in order to explore the hypothesis of different embryologic mechanisms for the different anatomic types of IAA. We examined 42 human heart specimens, 25 with IAA as the main disease with concordant atrioventricular and ventriculo‐arterial connections and two distinct great arteries, and 17 hearts with IAA associated with other malformations [six common arterial trunk (CAT), five double‐outlet right ventricle (DORV), three transposition of the great arteries (TGA), three atrioventricular septal defect (AVSD)]. The interruption was classified according to Celoria and Patton. We focused on the anatomy of the VSD viewed from the right ventricular side. There were 15 IAA type A, 27 type B, no type C. The VSD in IAA type B was always an outlet VSD, located between the two limbs of the septal band, with posterior malalignment of the outlet septum in hearts with concordant ventriculo‐arterial connections, without any fibrous tricuspid‐aortic continuity. In addition, the aortic arch was always completely absent. Conversely, the VSD in IAA type A could be of any type (outlet in six, muscular in four, central perimembranous in two, inlet in three) and the aortic arch was either atretic or absent. In addition, IAA type B, when found in the setting of another anomaly, was always associated with neural crest‐related anomalies (CAT and DORV), whereas IAA type A was found in association with anomalies not related to the neural crest (TGA and AVSD). These results reinforce the hypothesis that different pathogenic mechanisms are responsible for the two types of IAA, and the inclusion of IAA type B in the group of neural crest defects. Conversely, IAA type A could be due to overlapping mechanisms: flow‐related defect (coarctation‐like) and neural crest contribution.     

Cardiac conduction system in the chicken: Gross anatomy plus light and electron microscopy

Twenty-three chicken hearts were used to study the cardiac conduction system by light and electron microscopy. In addition to a sinus node, atrioventricular node (AVN), His bundle, left and right bundle branches (LBB, RBB), the chicken also has an AV Purkinje ring and a special middle bundle branch (MBB). The sinus node lies near the base of the lower portion of the right sinoatrial valve. The AV node is just above the tricuspid valve and anterior to the coronary sinus. The His bundle descends from the anterior and inferior margin of the AV node into the interventricular septum, then dividing into right, left and middle branches some distance below the septal crest. The middle bundle branch turns posteriorly toward the root of the aorta. The AV Purkinje ring originates from the proximal AV node and then encircles the right AV orifice, joining the MBB to form a figure-of-eight loop. The chicken conduction system contains four types of myocytes: (1) The P cell is small and rounded, with a relatively large nucleus and sparse myofibrils. (2) The transitional cell is slender and full of myofibrils. (3) The Purkinje-like cell resembles the typical Purkinje cell, but is smaller and darker. (4) The Purkinje cell is found in the His bundle, its branches, and the periarterial and subendocardial Purkinje network. © 1993 Wiley-Liss, Inc.     

经导管植入钳夹装置治疗三尖瓣膜关闭不全的应用解剖

目的　为经导管植入钳夹装置治疗三尖瓣膜关闭不全提供三尖瓣区相关的应用解剖。 方法　解剖28例(男18,女10)外形大小正常的成年人心脏标本,观察三尖瓣膜的形态及与周围组织的解剖关系,测量与三尖瓣膜相关的数据。 结果　三尖瓣环周长为(109.4±14.2) mm,长径为（43.5±6.5）mm,短径为（29.3±5.4）mm。前瓣游离缘到附着缘最大距离为（22.3±4.1）mm,后瓣游离缘到附着缘最大距离为（20.5±3.8）mm。 结论　钳夹装置的大小和形状的设计应根据三尖瓣区解剖特点及与周边结构的关系来决定,钳夹三尖瓣的前后瓣叶可行。     

Morphological characteristics of heart conduction system in diphtheria

Heart conductive system (HCS) including the sinoatrial node (SAN), atrioventricular node (AVN), AV bundle (AVB) and its left and right parts was studied histologically. It is shown that different portions of HCS are damaged in diphtheria with different frequency and intensity, the frequency depending on the depth of their location. Left part of AVB is affected most frequently, followed by the right part of AVB, AVB, AVN and the least frequently SAN.     

迷走神经切断后大鼠心房室结区神经肽变化的研究

切断大鼠颈部一侧迷走神经后，用组织化学方法结合图像分析定量观察了心房室结区乙酰胆碱酯酶，神经肽Ｙ（ＮＰＹ）、血管活性肠肽（ＶＩＰ）和降钙素基因相关肽（ＣＧＲＰ）的变化，同时用生物深化法测定了ＡＶＮ区ＡＣＨＥ、去甲肾上腺素（ＮＡ）的含量。并用逐步回归分析了各递质间的相互关第。本实验发现：ＡＶＮ区有ＮＰＹ、ＶＩＰ、ＣＧＲＰ免疫反应神经纤维和神经细胞。图像分析表明，左侧或右侧迷走神经切断５ｄ后ＡＶＮ区Ｎ