Morphology of the atrioventricular node, bundle and proximal bundle branches: a study employing computerized reconstruction.

The morphology of the human atrioventricular node, atrioventricular bundle and bundle branches is described. A block of tissue bounded by the ostium of the coronary sinus, the pars membranacea, the septal leaflet of the tricuspid valve and the atrial and ventricular septa is removed. The block is then sectioned serially from the right endocardial surface in the frontal plane of the heart. Sectioning in this way produces fewer sections than from techniques previously described. Outlines of the atrioventricular node, atrioventricular bundle and proximal bundle branches are digitally registered and stored in a computer. Three dimensional reconstructions of the structures are then generated by computer and displayed on an oscilloscope so that the entire three dimensional image can be rotated in any plane. Stereoscopic image pairs are produced to assist perception of the shape of the atrioventricular node, bundle and branching patterns of the bundles. This technique is unique in that it describes a method from which a relatively small number of histologic sections are generated permitting not only a complete histologic examination, but also a study of the morphology of the area.     

Morphology of the atrioventricular node,bundle and proximal bundle branches: A study employing computerized reconstruction

The morphology of the human atrioventricular node, atrioventricular bundle and bundle branches is described. A block of tissue bounded by the ostium of the coronary sinus, the pars membranacea, the septal leaflet of the tricuspid valve and the atrial and ventricular septa is removed. This block is then sectioned serially from the right endocardial surface in the frontal plane of the heart. Sectioning in this way produces fewer sections than from techniques previously described. Outlines of the atrioventricular node, atrioventricular bundle and proximal bundle branches are digitally registered and stored in a computer. Three dimensional reconstructions of the structures are then generated by computer and displayed on an oscilloscope so that the entire three dimensional image can be rotated in any plane. Stereoscopic image pairs are produced to assist perception of the shape of the atrioventricular node, bundle and branching patterns of the bundles. This technique is unique in that it describes a method from which a relatively small number of histologic sectionsare generated permitting not only a complete histologic examination, but also a study of the morphology of the area.     

Spatial distribution of "tissue-specific" antigens in the developing human heart and skeletal muscle. III. An immunohistochemical analysis of the distribution of the neural tissue antigen G1N2 in the embryonic heart; implications for the development of the atrioventricular conduction system.

A monoclonal antibody raised against an extract from the Ganglion Nodosum of the chick and designated G1N2 proves to bind specifically to a subpopulation of cardiomyocytes in the embryonic human heart. In the youngest stage examined (Carnegie stage 14, i.e., 4 1/2 weeks of development) these G1N2-expressing cells are localized in the myocardium that surrounds the foramen between the embryonic left and right ventricle. In the lesser curvature of the cardiac loop this "primary" ring occupies the lower part of the wall of the atrioventricular canal. During subsequent development, G1N2-expressing cells continue to identify the entrance to the right ventricle, but the shape of the ring changes as a result of the tissue remodelling that underlies cardiac septation. During the initial phases of this process the staining remains recognizable as a continuous band of cells in the myocardium that surrounds the developing right portion of the atrioventricular canal, subendocardially in the developing interventricular septum and around the junction of the embryonic left ventricle with the subaortic portion of the outflow tract. During the later stages of cardiac septation, the latter part of the ring discontinues to express G1N2, while upon the completion of septation, no G1N2-expressing cardiomyocytes can be detected anymore. The topographic distribution pattern of G1N suggests that the definitive ventricular conduction system derives from a ring of cells that initially surrounds the "primary" interventricular foramen. The results indicate that the atrioventricular bundle and bundle branches develop from G1N2-expressing myocytes in the interventricular septum, while the "compact" atrioventricular node develops at the junction of the band of G1N2-positive cells in the right atrioventricular junction (the right atrioventricular ring bundle) and the ("penetrating") atrioventricular bundle. A "dead-end tract" represents remnants of conductive tissue in the anterior part of the top of the interventricular septum. The location of the various components of the avian conduction system is topographically homologous with that of the G1N2-ring in the human embryonic heart, indicating a phylogenetically conserved origin of the conduction system in vertebrates.     

The local expression of adult chicken heart myosins during development

Summary Immunofluorescence studies were performed on serial sections of three days embryonic chicken hearts using antibodies specific for adult atrial and ventricular myosin heavy chains respectively.The anti-ventricular myosin serum reacted with the entire myocardium showing a decreasing intensity going from the truncus arteriosus to the atrial part; however, the antiatrial myosin serum reacted weakly with the myocardium of the atrial part.Two other interesting observations were made, i) the anti-atrial myosin serum reacted with non-myocardial cells the cardiac jelly, ii) both antisera reacted with a thin myocardial layer, extending from the ventral wall of the atrial part via the medio-dorsal wall of the atrio-ventricular canal to the dorsal wall of the ventricular part     

A method of study of the pathology of the conduction system for electrocardiographic and his bundle electrogram correlations

There have been advances in electrophysiology which have necessitated a more thorough semi-quantitative analysis of the entire conduction system to yield data useful for correlation purposes. Thus an attempt is made to modify and expand our previous method of studying the conduction system pathologically. This method thus includes the study of the sinoatrial (SA) node and its approaches, the atrial preferential pathways, the approaches to the atrioventricular (AV) node, the AV node, the penetrating and branching portions of the AV bundle, the bundle branches, the peripheral Purkinje nets, and the remainder of the atrial and ventricular myocardium. The SA node and its approaches are studied in a longitudinal manner. This gives a better insight into the pathologic changes than does a study in the transverse direction. The approaches to the AV node, bundle and bundle branches are studied in an oblique manner, rather than horizontally apicalward, or from the posterior to the anterior septal region. The horizontal manner does not give sufficient sampling of the AV node and bundle unless complete serial sections are made. Sectioning from the posterior to the anterior septal wall makes difficult an evaluation of the right bundle branch. In conduction system correlation with Wolff-Parkinson-White and Lown-Ganong-Levine syndromes complete serial sectioning of both AV rims is advisable. Where complete serial sectioning is impossible in large adult hearts, retaining every fifth section may be permissable. In the study of congenitally abnormal hearts, it is advisable to embed the entire heart as a unit. If that is impossible because of the size of the heart, then very careful judicious planning of the fashioning of the blocks is necessary, so that displaced SA nodes, and anterior AV nodes and bundles are not overlooked.     

Myosin light chain 2a and 2v identifies the embryonic outflow tract myocardium in the developing rodent heart

The embryonic heart consists of five segments comprising the fast‐conducting atrial and ventricular segments flanked by slow‐conducting segments, i.e. inflow tract, atrioventricular canal and outflow tract. Although the incorporation of the flanking segments into the definitive atrial and ventricular chambers with development is generally accepted now, the contribution of the outflow tract myocardium to the definitive ventricles remained controversial mainly due to the lack of appropriate markers. For that reason we performed a detailed study of the pattern of expression of myosin light chain (MLC) 2a and 2v by in situ hybridization and immunohistochemistry during rat and mouse heart development. Expression of MLC2a mRNA displays a postero‐anterior gradient in the tubular heart. In the embryonic heart it is down‐regulated in the ventricular compartment and remains high in the outflow tract, atrioventricular canal, atria and inflow tract myocardium. MLC2v is strongly expressed in the ventricular myocardium and distinctly lower in the outflow tract and atrioventricular canal. The co‐expression of MLC2a and MLC2v in the outflow tract and atrioventricular canal, together with the single expression in the atrial (MLC2a) and ventricular (MLC2v) myocardium, permits the delineation of their boundaries. With development, myocardial cells are observed in the lower endocardial ridges that share MLC2a and MLC2v expression with the myocardial cells of the outflow tract. In neonates, MLC2a continues to be expressed around both right and left semilunar valves, the outlet septum and the non‐trabeculated right ventricular outlet. These findings demonstrate the contribution of the outflow tract to the definitive ventricles and demonstrate that the outlet septum is derived from outflow tract myocardium. Anat Rec 254:135–146, 1999. © 1999 Wiley‐Liss, Inc.     

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.     

Pathogenesis of cardiac conduction disorders in children genetic and histopathologic aspects

Fetal dysrhythmias are usually transient. Abnormal fetal rates and rhythms during labor are "functional." Fetal dysrhythmias may be associated with congenital heart disease and fetal hydrops. Bradycardia is usually related to fetal distress; supraventricular tachycardia, atrial flutter, and atrial fibrillation may be associated with severe congestive heart failure. Ventricular fibrillation is rare in the fetus and infant and is usually associated with myocardial necrosis with perimembranous septal defect; the nonbranching atrioventricular (AV) bundle may have an aberrant position and result in cardiac arrhythmia. Wolff-Parkinson-White syndrome with conduction abnormalities and left ventricular hypertrophy (LVH) is due to an accessory pathway that bypasses the AV sulcus and results in faster conduction. Carnitine deficiency may be primary or secondary and may result in cardiac arrhythmia. Histiocytoid cardiomyopathy is characterized by cardiomegaly, incessant ventricular tachycardia, and frequently sudden death. Arrhythmogenic right ventricular dysplasia (ARVD) results in ventricular tachycardia and left bundle branch block. Noncompaction of the left ventricle predisposes to potentially fatal arrhythmias. Long Q-T syndromes (LQTS) are a heterogeneous group of disorders with many genetic mutations. Brugada syndrome is an autosomal dominant trait with right bundle branch block and ST elevation. Barth syndrome is an X-linked disorder with dilated cardiomyopathy, cyclic neutropenia and skeletal myopathy. Hypertrophic cardiomyopathy in infancy may be related to metabolic diseases, particularly glycogen storage diseases; the familial form predisposes to sudden death. Arrhythmias following cardiac surgery may occur after closure of a ventricular septal defect (VSD) or damage to the conduction system.     

The structure of the atrioventricular conducting system in the avian heart

The atrioventricular conduction system in three avian species has been studied by light and electron microscopy. A morphologically definable atrioventricular node was not found in any of these. The atrioventricular bundle is a well-defined structure, the proximal portion of which is in direct continuity with the atrioventricular ring, located in the arterial sheet of the muscular valve of the right atrioventricular opening. In the zone of transition between atrioventricular ring and bundle the compactness of the bundle is loosened, but the fibers do not establish continuity with the atrial fibers. The ring consists of Purkinje-like fibers, 10–15 μm in diameter, and (peripherally) small 3–5-μm-diameter junctional fibers which are in continuity with the common atrial fibers. In the muscular atrioventricular valve the fibers of the ring are insulated from the ventricular myocardium by a connective tissue sheet of the annulus fibrosus. It is suggested that in the avian heart the atrioventricular ring may fulfill a role similar to that of the atrioventricular node of mammals.     

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.     

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.     

The arterial blood supply of the conducting system in normal human hearts

The distributing artery of the conducting system of the heart is occasionally injured in cardiac surgery. The aim of this study was to define the anatomic characteristics of the principal arterial source of the sinu-atrial node and atrioventricular node. Furthermore, the morphology of the tendon of Todaro was clarified. Thirty hearts were studied by gross anatomic methods, and the exact area of the conducting system was supported by histologic observations of four hearts. The sinu-atrial node was supplied by the right coronary artery more frequently (73% of cases) than by the left (3%), and in 23% of cases this node was supplied by both coronary arteries. The atrioventricular node was supplied by the right coronary artery (80% of cases) more than by the left (10%), and in 10% of the cases this node was supplied by both coronary arteries. The atrioventricular bundle branch arose from the right coronary artery in 10% of cases, the left coronary artery in 73%, and both coronary arteries in 17%. Most of the blood to the right bundle (the moderator band) was supplied by the interventricular septal branches of the anterior interventricular branch from the left coronary artery. Finally, all the arteries of the right bundle and left bundle were defined to be derived from left coronary arteries.     

Atrioventricular node and input pathways: a correlated gross anatomical and histological study of the canine atrioventricular junctional region

To determine the architecture of the atrioventricular (AV) junctional region, structures in atrial preparations were correlated to those in serial sections made either parallel or perpendicular to the long axis of the AV node (AVN)/AV bundle complex. The results demonstrated the following for the first time: 1) A right medial atrial wall (MAW) extends anteriorly from the interatrial septum, superior to the interventricular septum (IVS). 2) An atrial interventricular septum (A-IVS) groove is located between the base of the MAW and the crest of the IVS. 3) Three atrionodal bundles converge to form a proximal AV bundle (PAVB), which in turn is contiguous with the AVN. The atrionodal bundles are associated with the MAW or the superomedial and inferolateral margins of the coronory sinus. Terminal portions of the atrionodal bundles and the PAVB reside within the A-IVS groove. The AV bundle was termed distal (DAVB) to avoid confusion. 4) The location of the AVN/DAVB complex topographically is deep to the apex of the septal cusp of the tricuspid valve subjacent to the MAW. Intracardially, the AVN/DAVB complex is within the central fibrous body. Significantly, this study resulted in the first unequivocal demonstration of discrete bundles of myocardial fibers associated with the atrial end of the AV node. Moreover, it appears likely that the atrionodal AV bundles are continuous with the sinoatrial nodal extensions, thereby forming internodal tracts.     

Ultrastructure of the atrioventricular junctional area in the heart of Molossus molossus Pallas 1766 (Chiroptera: Molossidae)

The atrioventricular junctional area (AVJA) consists of a group of structures that connects the atrial and ventricular myocardium. Five hearts of an insect-eating bat were studied in light and transmission electron microscopy. In M. molossus, the AVJA consists in a mass of muscle fibers intermingled with variable amount of connective tissue and blood vessels surrounded by the adjacent myocardium and the attachment of the right atrioventricular and aortic valves in the fibrous skeleton. In light microscopy, conducting cells of the AV node and bundle can be distinguished from working cells: smaller size, paler staining reaction and the presence of e sheath of connective tissue surrounding each cell (largely composition by type I collagen fibers). Three cell types are observed in the AVJA. Nodal cells are irregular with few cytoplasmic organelles and several slender sarcolemmal modifications. Myofibrils are sparse and not clearly observable. Transitional cells are spindle-shaped and grouped together into bundles. The cytoplasm, poor in glycogen, has scarce electron-density and myofibrils organized into sarcomeres. Caveolae is observed randomly distributed at the periphery of the cell. The AV bundle cells are elongated with clusters of myofibrils organized in the periphery and a glycogen free area around the nucleus. Ventricular cells are bigger than the atrial ones and show well-developed myofibrils in alternated rows with mitochondria. Lipid droplets are seen near mitochondria and glycogen granules. Intercalated discs and T-tubules are found in working cells but not in conducting ones. The fibrous skeleton has collagen fibers intercalated with fibroblasts.     

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。     

The distribution of atrial natriuretic polypeptide (ANP)-containing cells in the adult rat heart

Summary The present study was performed to clarify the distribution of ANP-containing cells in the adult rat heart by immunostaining for ANP using antiserum against -human ANP. ANP-immunoreactive cells were generally present in the atrial walls except for the sinoatrial node. In the ventricular walls, they were distributed in the impulse conducting system, particularly the left bundle branch, Purkinje fibers on the left side of the interventricular septum, and those in the false tendons in the left ventricle, while they were sporadically seen in the atrioventricular node and bundle of His. The immunoreactive cells contained specific granules that were positive for ANP. These findings demonstrate that ANP-containing cells are present in the atrial and ventricular walls.     

Developmental transitions in electrical activation patterns in chick embryonic heart

The specialized conduction tissue network mediates coordinated propagation of electrical activity through the adult vertebrate heart. Following activation of the atria, the activation wave is slowed down in the atrioventricular canal or node, then spreads rapidly into the left and right ventricles via the His-Purkinje system (HPS). This results in the ventricle being activated from the apex toward the base and is thought to represent HPS function. The development of mature HPS function in embryogenesis follows significant phases of cardiac morphogenesis. Initially, cardiac impulse propagates in a slow, linear, and isotropic fashion from the sinus venosus at the most caudal portion of the tubular heart. Although the speed of impulse propagation gradually increases, ventricular activation in the looped heart still follows the direction of blood flow. Eventually, the immature base-to-apex sequence of ventricular activation undergoes an apparent reversal, maturing to apex-to-base pattern. The embryonic chick heart has been studied intensively by both electrophysiological and morphological techniques, and the morphology of its conduction system (which is similar to mammals) is well characterized. One interesting but seldom studied feature is the anterior septal branch (ASB), which came sharply to focus (together with the rest of the ventricular conduction system) in our birthdating studies. Using an optical mapping approach, we show that ASB serves to activate ventricular surface between stages 16 and 25, predating the functionality of the His bundle/bundle branches. Heart morphogenesis and conduction system formation are thus linked, and studying the abnormal activation patterns could further our understanding of pathogenesis of congenital heart disease.     

Developmental pattern of ANF gene expression reveals a strict localization of cardiac chamber formation in chicken

In mouse, atrial natriuretic factor (ANF) gene expression was shown to be a marker for chamber formation within the embryonic heart. To gain insight into the process of chamber formation in the chicken embryonic heart, we analyzed the expression pattern of cANF during development. We found cANF to be specifically expressed in the myocardium of the morphologically distinguishable atrial and ventricular chambers, similar to ANF in mouse. cANF expression was never detected in the myocardium of the atrioventricular canal (AVC), inner curvature, and outflow tract (OFT), which is lined by endocardial cushions. Expression was strictly excluded from the interventricular myocardium and most proximal part of the bundle branches, as identified by the expression of Msx‐2, whereas the rest of the bundle branches, trabeculae, and surrounding working myocardium did express cANF. The myocardium that forms de novo within the cushions after looping did not express cANF. At HH9 cANF expression was first observed in a subset of cardiomyocytes, which was localized ventrally in the fused heart tube and laterally in the unfused cardiac sheets. Together, these results show that cANF expression can be used to distinguish differentiated chamber (working) myocardium, including the peripheral ventricular conduction system, from embryonic myocardium. We conclude that differentiation of chamber myocardium takes place already at HH9 at the ventral side of the linear heart tube, possibly preceded by latero‐medial signals in the unfused cardiac sheets. Anat Rec 266:93–102, 2002. © 2002 Wiley‐Liss, Inc.     

The heart after surgery for congenital heart disease

The pathology of the heart following surgical correction for congenital cardiac defects has not been fully explored. This study is based on valvar aortic stenosis, atrioventricular septal defect, complete transposition of the great arteries, and Fallot's tetralogy. Emphasis has been put on preexistent gross pathology, with histological verification, and postoperative complications. Among patients with aortic valve stenosis preexistent anomalies dominated (left ventricular hypoplasia, mitral valve abnormalities, left ventricular endocardial fibroelastosis). The findings suggest that the cases represent an extreme within a spectrum and could explain the late postoperative dismal results in patients suffering from congenital left heart obstruction. In patients with atrioventricular septal defects the important pathology related predominantly to the operative procedure (injury to the atrioventricular bundle, patch dehiscence at the site of the atrioventricular node, inadequate repair of the left atrioventricular valve leaflets) and to pulmonary obstructive vascular disease. In complete transposition of the great arteries, with or without ventricular septal defects, technical problems dominated. Obstruction of the systemic and pulmonic venous pathways, atrial dysrhythmia, and tricuspid valve injury were the most serious complications following Mustard's procedure. The Rastelli-type procedure was complicated by degeneration and calcification of the porcine valve and crowding of the left ventricle. The arterial switch was complicated by abnormal origin and course of the left circumflex artery, which led to kinking and myocardial infarction. In Fallot's tetralogy surgical complications (injury to the atrioventricular bundle and the tricuspid valve) were the most important. The study discloses that the heart after surgery for congenital heart disease cannot be considered without taking preexistent pathology into account. Careful preoperative investigations are mandatory, since most anomalies could have been detected and, hence, might have changed the operative result.     

核纤层蛋白A、转录因子TBX3、缝隙连接蛋白43表达与小鼠胚胎心发育

目的 探讨小鼠胚胎心脏工作心肌和传导系心肌在形态发生和分化过程中核纤层蛋白A（lamin A）、转录因子TBX3、缝隙连接蛋白43（Cx43）的表达特点。
方法 用抗α-平滑肌肌动蛋白（α-SMA）、抗心肌肌球蛋白重链（MHC）、抗α-横纹肌肌动蛋白（α-SCA）、抗胰岛因子1（ISL-1）、抗Cx43、抗lamin A和抗转录因子TBX3,对46只胚龄8～15d小鼠胚胎心脏连续石蜡切片进行免疫组织化学及免疫荧光染色。 结果 胚龄9d,TBX3在原始心管的表达集中在房室管壁。10d始,TBX3阳性的表达逐渐从房室管壁沿着静脉瓣延续至窦房结、右心房背侧壁和房间隔。胚龄12～13d,TBX3阳性表达结构构成了中枢传导系雏形,包括窦房结、左右静脉瓣、房间隔、房室管、房室结和房室束。Cx43首先在胚龄9d的左心室腹侧壁和部分小梁心肌出现弱阳性表达,随着发育,Cx43逐渐在TBX3阴性的心房、心室工作心肌表达。Lamin A首先出现在10d房室管心内膜垫间充质细胞和左心室部分小梁心肌,随后在右心室小梁心肌出现,至胚龄15d,心室和心房小梁心肌及房室瓣均可见lamin A阳性表达,但致密心肌和中枢传导系心肌持续呈阴性表达。 结论 中枢传导系统雏形在小鼠胚龄13d形成,呈TBX3阳性,Cx43阴性的互补性表达。致密心肌和中枢传导系心肌在15d仍为lamin A表达阴性,说明此部分心肌分化成熟较晚。