Versican proteolysis mediates myocardial regression during outflow tract development.

An important phase of cardiac outflow tract (OFT) formation is the remodeling of the distal region of the common outlet in which the myocardial sleeve is replaced by with smooth muscle. Here we demonstrate that expression of the proteoglycan versican is reduced before the loss of myocardium from the distal cardiac outlet concomitant with an increase in production of the N-terminal cleavage fragment of versican. To test whether versican proteolysis plays a role in OFT remodeling, we determined the effects of adenoviral-mediated expression of a versican isoform devoid of known matrix metalloproteinase cleavage sites (V3) and an N-terminal fragment of versican (G1). V3 expression promoted an increase in thickness of the proximal OFT myocardial layer independent of proliferation. In contrast, the G1 domain caused thinning and interruptions of the OFT myocardium. These in vivo findings were consistent with findings using cultured primary cardiomyocytes showing that the V3 promoted myocardial cell-cell association while the G1 domain caused a loss of myocardial cell-cell association. Taken together, we conclude that intact versican and G1-containing versican cleavage products have opposing effects on myocardial cells and that versican proteolysis may facilitate the loss of distal myocardium during OFT remodeling.     

Visualization of outflow tract development in the absence of Tbx1 using an FgF10 enhancer trap transgene.

Tbx1, the major gene underlying del22q11.2 or DiGeorge syndrome in humans, is required for normal development and septation of the cardiac outflow tract. The fibroblast growth factor 10 gene (Fgf10) and an Fgf10 enhancer trap transgene are expressed in outflow tract myocardial progenitor cells of the anterior heart field. To visualize outflow tract development in the absence of Tbx1, we have analyzed the expression profile of the Fgf10 enhancer trap transgene during outflow tract development in Tbx1(-/-) embryos. Transgene expression confirms hypoplasia of the distal outflow tract in the absence of Tbx1, and altered expression in pharyngeal mesoderm reveals loss of specific bilateral subpopulations of outflow tract progenitor cells and disruption of the posterior boundary of the anterior heart field. Our results support the conclusion that Tbx1 controls deployment of Fgf10-expressing progenitor cells during heart tube extension. Furthermore, although normal Fgf10 levels are dependent on Tbx1, loss of Fgf10 alleles does not significantly modify the cardiac phenotype of Tbx1 heterozygous or homozygous mutant embryos.     

骨形态发生蛋白-2在小鼠胚胎心流出道发育中的作用

目的 探讨骨形态发生蛋白-2(BMP-2)在小鼠胚胎心流出道发育过程中的作用。 方法 对胚龄9d(E9) ～E15（各胚龄取3～7只）小鼠心连续石蜡切片,用抗α-横纹肌肌动蛋白(α-SCA)抗体、抗胰岛素增强子结合蛋白(ISL-1)抗体、抗增殖细胞核抗原(PCNA)抗体、抗BMP-2抗体进行免疫组织化学染色。结果 E9,流出道心胶质内无细胞,心肌增殖活性低,BMP-2弱表达于流出道心肌、心内膜及心包腔背侧壁。E9～11,流出道增长,心包腔背侧壁ISL-1阳性细胞至流出道远端分化为心肌细胞后增殖逐渐减弱。E10～11,流出道嵴内间充质细胞逐渐增加,可见BMP-2、PCNA阳性细胞;流出道BMP-2表达逐渐增强达高峰,向两端延伸逐渐减弱,动脉端可及心包反折处。E12,流出道缩短,BMP-2表达减弱。E13～15,流出道隔逐渐肌化,BMP-2在心脏近大血管部心肌呈较弱表达。E10～13,流出道远段心肌呈低增殖活性,近段及右心室心肌增殖成小梁致右心室形成及扩大。结论 BMP-2诱导第二生心区(SHF)细胞分化为心肌细胞添加至心动脉端,参与心流出道嵴的发育。BMP-2抑制流出道心肌增殖,流出道近段BMP 2表达减弱重启了心肌细胞增殖,致右心室形成及流出道缩短。低水平的BMP 2可能诱导流出道隔间充质细胞向心肌分化。     

Septation and separation within the outflow tract of the developing heart

The developmental anatomy of the ventricular outlets and intrapericardial arterial trunks is a source of considerable confusion. First, major problems exist because of the multiple names and definitions used to describe this region of the heart as it develops. Second, there is no agreement on the boundaries of the described components, nor on the number of ridges or cushions to be found dividing the outflow tract, and the pattern of their fusion. Evidence is also lacking concerning the role of the fused cushions relative to that of the so-called aortopulmonary septum in separating the intrapericardial components of the great arterial trunks. In this review, we discuss the existing problems, as we see them, in the context of developmental and postnatal morphology. We concentrate, in particular, on the changes in the nature of the wall of the outflow tract, which is initially myocardial throughout its length. Key features that, thus far, do not seem to have received appropriate attention are the origin, and mode of separation, of the intrapericardial portions of the arterial trunks, and the formation of the walls of the aortic and pulmonary valvar sinuses. Also as yet undetermined is the formation of the free-standing muscular subpulmonary infundibulum, the mechanism of its separation from the aortic valvar sinuses, and its differentiation, if any, from the muscular ventricular outlet septum.     

小鼠胚胎心流出道心内膜垫的形成与融合

目的观察不同发育时期小鼠胚胎心流出道心内膜垫的发育过程。方法对胚龄9-12d小鼠胚胎心脏连续切片进行HE染色和免疫组化染色。结果胚龄10d,流出道远端心胶质内开始观察到间充质细胞。胚龄11d,两侧流出道心内膜垫形成,心内膜垫内部分间充质细胞染色呈α-平滑肌肌动蛋白(α-SMA)阳性。胚龄12d,两侧流出道心内膜垫内部分间充质细胞聚集形成致密漩涡状结构,随着心内膜垫融合,两侧漩涡状结构融合。结论小鼠胚胎流出道心内膜垫形成于胚胎发育第11天,第12天融合,间充质细胞参与心内膜垫融合。     

小鼠胚胎心流出道的形态发生与呼吸内胚层发育耦联

目的 探讨小鼠胚胎心发育过程中前肠呼吸内胚层与第一生心区和第二生心区及胚胎心流出道的形态发生关系。方法 胚龄7.5～13d小鼠胚胎心各3个,连续石蜡切片,用抗胰岛素增强子结合蛋白1（ISL-1）、抗心肌肌球蛋白重链（MHC）、抗α-平滑肌肌动蛋白（α-SMA）、抗Nkx2.5和抗增殖细胞核抗原（PCNA）抗体进行免疫组织化学或免疫荧光染色。结果 胚胎发育7.5d,ISL-1在生心板心肌前体细胞表达并与发育中的第二生心区ISL-1阳性细胞连续。胚胎发育第10～13天, 可见ISL-1强阳性的前肠腹侧呼吸内胚层细胞增生,排列不规则,     

小鼠胚胎心流出道近段心室化形成右心室小梁部

目的探讨小鼠胚胎心流出道快速缩短及右心室形成机制。方法用抗α-横纹肌肌动蛋白(SCA)、抗肌球蛋白重链(MHC)抗体标记心肌,抗GATA-4抗体标记心肌及其前体细胞,抗α-平滑肌肌动蛋白(SMA)抗体标记早期心肌细胞,抗增殖细胞核抗原(PCNA)抗体显示增殖细胞,抗人/鼠活性Caspase-3(CAS-3)抗体检测凋亡早期细胞,对胚龄9d(E9)~E12(不同胚龄胚胎各取3~5只)小鼠胚胎心连续切片行免疫组织化学染色。结果E11时动脉囊及流出道远端心肌界退却至心包腔内,GATA-4、SCA、SMA染色示第二生心区前体细胞不断分化为心肌细胞添加在心动脉端使流出道延长。小鼠胚胎心流出道于E12缩短,缩短前及缩短过程中全长未检测到CAS-3阳性细胞。E10~12时右心室及流出道近段心肌不断增生形成小梁并侵入邻近的流出道嵴内,流出道近端嵴逐渐小梁状心肌化改建为右心室壁;E12时近段间充质性流出道嵴内出现散在的SCA、SMA阳性心肌细胞及与流出道心肌相延续的SCA、SMA弱阳性心肌细胞流,这些结果表明近段流出道心肌小梁化、流出道嵴小梁状肌化形成了右心室小梁部。结论小鼠胚胎流出道近段心室化致右心室小梁部形成及流出道快速缩短,心肌细胞凋亡及转分化对流出道快速缩短的作用甚微。     

腺苷对豚鼠左心室流出道自律细胞的电生理效应

目的 研究腺苷对豚鼠左心室流出道自律性电活动及其对肾上腺素、低氧和酸中毒电生理效应的影响.方法 采用玻璃微电极细胞内电位记录技术,分别观察腺苷对左心室流出道自发慢反应电位及对肾上腺素、低氧和酸中毒所致该电位改变的影响.结果 (1)10、50及100 μmol/L腺苷可呈剂量依赖性降低豚鼠左心室流出道自律细胞的电活动.(2)10 ixmol/L肾上腺素可明显提高左心室流出道的自律性,50μmol/L腺苷明显降低肾上腺素导致的该部位自律性升高.(3)低氧和酸中毒均可使该部位的自律性电活动明显降低,50μmol/L腺苷可使其自律性进一步降低.结论 腺苷对左心室流出道的自律性及肾上腺素、低氧和酸中毒导致的自律性异常有一定影响.     

Requirements for Jag1-Rbpj mediated Notch signaling during early mouse lens development

Background: During vertebrate lens development, the lens placode in the embryonic ectoderm invaginates into a lens vesicle, which then separates from the surface epithelium, followed by two waves of fiber cell differentiation. In the mouse, multiple labs have shown that Jag1‐Notch signaling is critically required during the second wave of lens fiber cell formation. However, Notch signaling appears to play no obvious role during lens induction or morphogenesis, although multiple pathway genes are expressed at these earlier stages. Results: Here, we explored functions for Notch signaling specifically during early lens development, by using the early‐acting AP2α‐Cre driver to delete Jag1 or Rbpj. We found that Jag1 and Rbpj are not required during lens induction, but are necessary for proper lens vesicle separation from the surface ectoderm. Conclusions: We conclude that precise levels of Notch signaling are essential during lens vesicle morphogenesis. In addition, AP2α‐Cre‐mediated deletion of Rbpj resulted in embryos with cardiac outflow tract and liver deformities, and perinatal lethality. Developmental Dynamics 241:493–504, 2012. © 2012 Wiley Periodicals, Inc.     

Remodeling of the Embryonic Interventricular Communication in Regard to the Description and Classification of Ventricular Septal Defects

Ventricular septal defects are the commonest congenital cardiac malformations. Appropriate knowledge of the steps involved in completion of ventricular septation should provide clues as to the morphology of the different phenotypes. Currently, however, consensus is lacking regarding the components of the developing ventricular septum, and how best to describe the different phenotypes seen in postnatal life. We have reassessed the previous investigations devoted to closure of the embryonic interventricular communication. On this basis, we discuss how studies in the early part of the 20th century correctly identified the steps involved in the remodeling of the embryonic interventricular foramen subsequent to the stage at which the outflow tract arises entirely above the cavity of the developing right ventricle. There has, however, already been remodeling of the foramen from the stage at which the atrioventricular canal is supported exclusively by the developing left ventricle. We show how these temporal changes in morphology can provide explanations for the different ventricular septal defects seen in the clinical setting. Thus, muscular defects represent inappropriate coalescence of muscular ventricular septum. The channels that are perimembranous are due to failure of closure of the persisting embryonic interventricular foramen. Those that are doubly committed and juxta-arterial reflect failure of formation of the free-standing subpulmonary muscular infundibular sleeve. The findings also point to the importance of appropriate alignment, during development, between the developing atrial and ventricular septums, and between the apical component of the ventricular septum and the ventricular outlet components. Anat Rec, 302:19–31, 2019. © 2018 Wiley Periodicals, Inc.     

利多卡因对低氧、酸中毒及肾上腺素条件下豚鼠左心室流出道心肌组织电活动的影响

 目的：研究利多卡因对豚鼠左心室流出道心肌组织电活动的影响及其对该部位自律性异常的干预作用。方法：采用标准玻璃微电极细胞内电位记录技术,观测利多卡因对豚鼠左心室流出道自发慢反应电位的影响,以及利多卡因对无糖低O2、pH 6.8 和肾上腺素 （EPI） 导致的该电位改变的影响。结果：（1）0.1、1、10 μmol/L 利多卡因可呈剂量依赖性地导致左心室流出道自发慢反应电位4相自动除极速度（VDD）、自发放电频率(RPF) 和0相最大除极速度(Vmax) 减慢,最大舒张电位（MDP）绝对值和动作电位幅度（APA）减小,复极50%和80%时间（APD50和APD80）缩短。（2）低O2可使 VDD、RPF和Vmax减慢,MDP绝对值和APA减小,APD50缩短;和低O2灌流组相比,1 μmol/L利多卡因+低O2可使VDD、RPF和Vmax进一步减慢,MDP绝对值增大,APA进一步降低。（3）pH 6.8的灌流液可使VDD、RPF和Vmax明显减慢,MDP绝对值增大,APA减小,APD50和APD80缩短;与pH 6.8灌流组相比,pH 6.8的1 μmol/L利多卡因可使 VDD、RPF和Vmax进一步减慢,MDP绝对值进一步增大,APD50和APD80延长。（4）10 μmol/L 肾上腺素可使VDD、RPF和Vmax明显加快,MDP绝对值和APA增大,APD50和APD80缩短;1 μmol/L利多卡因+10 μmol/L EPI可使VDD和RPF减慢,MDP绝对值和APA减小,APD50和APD80延长。结论：利多卡因可降低豚鼠左心室流出道的自律性,同时对低 O2、酸中毒和 EPI 所致的该部位自律性改变有一定的影响。     

Dual role for neural crest cells during outflow tract septation in the neural crest-deficient mutant Splotch2H

Splotch^2H ( Sp^2H ) is a well-recognized mouse model of neural crest cell (NCC) deficiency that develops a spectrum of cardiac outflow tract malformations including common arterial trunk, double outlet right ventricle, ventricular septal defects and pharyngeal arch artery patterning defects, as well as defects in other neural-crest derived organ systems. These defects have been ascribed to reduced NCC in the pharyngeal and outflow regions. Here we provide a detailed map of NCC within the pharyngeal arches and outflow tract of Sp^2H/Sp^2H embryos and fetuses, relating this to the development of the abnormal anatomy of these structures. In the majority of Sp^2H/Sp^2H embryos we show that deficiency of NCC in the pharyngeal region results in a failure to stabilize, and early loss of, posterior pharyngeal arch arteries. Furthermore, marked reduction in the NCC-derived mesenchyme in the dorsal wall of the aortic sac disrupts fusion with the distal outflow tract cushions, preventing the initiation of outflow tract septation and resulting in common arterial trunk. In around 25% of Sp^2H/Sp^2H embryos, posterior arch arteries are stabilized and fusion occurs between the dorsal wall of the aortic sac and the outflow cushions, initiating outflow tract septation; these embryos develop double outlet right ventricle. Thus, NCC are required in the pharyngeal region both for stabilization of posterior arch arteries and initiation of outflow tract septation. Loss of NCC also disrupts the distribution of second heart field cells in the pharyngeal and outflow regions. These secondary effects of NCC deficiency likely contribute to the overall outflow phenotype, suggesting that disrupted interactions between these two cell types may underlie many common outflow defects.     

小鼠胚胎呼吸内胚层形态发生与咽前间充质发育及流出道分隔的关系

目的 探讨呼吸内胚层与咽前间充质细胞发育的关系及对小鼠胚胎心流出道分隔的影响。方法 45只胚龄8~13d小鼠胚胎心连续石蜡切片,用抗胰岛因子1（ISL-1）、抗α-平滑肌肌动蛋白（α-SMA）、抗音猬因子（音速波状蛋白, Shh）、抗patched（Ptc1）、抗patched 2（Ptc2）、抗smoothened（Smo）及抗心肌肌球蛋白重链（MHC）抗体进行免疫组织化学及免疫荧光染色。 结果 胚龄8～9d,ISL-1阳性细胞分布在心包腔背侧壁及前肠两侧间充质,并延伸至原始心管动脉端,心管心肌显较强的Ptc1和Ptc2阳性表达。胚龄10~13d,呼吸内胚层向腹侧延伸,Ptc1和Ptc2呈较强表达,ISL-1阳性咽前间充质细胞围绕呼吸内胚层形成对称的特征性锥体形结构,经动脉囊背侧壁伸入动脉囊腔,形成主肺动脉隔。胚龄12d,主肺动脉隔ISL-1阳性表达基本消失,大部分细胞转变为α-SMA阳性细胞。 结论 呼吸内胚层的分化发育与咽前ISL-1阳性间充质细胞的发育聚集密切耦联。发育中的呼吸内胚层可能作为组织中心,通过Shh信号通路对ISL-1阳性细胞的聚集提供位置信息。呼吸内胚层的正常腹侧延伸不但可诱导ISL 1阳性细胞的正常迁移和流出道的正常分隔,对流出道的正常形态发生及有效的肺循环建立起重要作用。     

SOST expression is restricted to the great arteries during embryonic and neonatal cardiovascular development.

Spatial-temporal regulation of bone morphogenetic protein (BMP) and Wnt activity is essential for normal cardiovascular development, and altered activity of these growth factors causes maldevelopment of the cardiac outflow tract and great arteries. In the present study, we show that SOST, a Dan family member reported to antagonize BMP and Wnt activity, is expressed within the medial vessel wall of the great arteries containing smooth muscle cells. The ascending aorta, aortic arch, brachiocephalic artery, common carotids, and pulmonary trunk were all associated with SOST expressing smooth muscle cells, while the heart itself, including the valves, and more distal arteries, that is, pulmonary arteries, subclavian arteries, and descending aorta, were negative. SOST was expressed from embryonic day 15.5 up to the neonatal period. SOST expression, however, did not correspond with inhibition of Smad-dependent BMP activity or beta-catenin-dependent Wnt activity in the great arteries. Activity of both signaling pathways was already down-regulated before induction of SOST expression.     

一氧化氮对缺血再灌注豚鼠左心室流出道自律性电活动的影响

目的:研究一氧化氮(NO)对豚鼠左心室流出道自发电活动的影响及其对缺血/再灌注(I/R)时自发电活动改变的影响。方法:采用标准玻璃微电极细胞内电位记录技术观测外源性NO供体硝普钠(SNP)对豚鼠左心室流出道自发慢反应电位的影响及其对I/R时该电位改变的影响。结果:1、10、100μmol/L SNP呈浓度依赖性地导致4相自动除极速度(VDD)和自发放电频率(RPF)明显增加,但1 000μmol/L SNP的效应不明显。SNP呈浓度依赖性地导致最大舒张电位(MDP)绝对值和动作电位幅度(APA)增大,0相最大除极速度(Vmax)加快,复极50%和90%时间(APD50和APD90)缩短。缺血10 min组VDD和RPF明显减慢,APA和Vmax明显增大,APD50和APD90明显延长。与缺血10 min组相比,再灌注10 min组VDD和RPF明显加快,且常出现节律不齐,MDP绝对值和APA明显减小,APD50和APD90明显缩短。1、10、100μmol/L SNP再灌注时可明显改善缺血造成的VDD和RPF减慢以及再灌注造成的节律不齐,1 000μmol/L SNP的上述效应不明显。各浓度SNP再灌注时均可使缺血造成的APA和APD的改变恢复至对照组水平。结论:SNP可呈浓度依赖性地增加左心室流出道的自律性,并可明显改善I/R导致的自发慢反应电位的改变。     

胺碘酮对低O_2、酸中毒及肾上腺素条件下豚鼠左心室流出道自律细胞电活动的影响

目的:研究胺碘酮对豚鼠左心室流出道自律细胞电活动的影响以及胺碘酮对低O2、酸中毒和肾上腺素(EPI)所致该部位自律性改变的影响。方法:采用标准玻璃微电极细胞内电位记录技术,分别观测胺碘酮对豚鼠左心室流出道自发慢反应电位的影响,以及胺碘酮对无糖低氧、pH6.8和EPI导致的该电位改变的影响。结果:(1)0.1μmol/L胺碘酮可使左心室流出道自发慢反应电位自发放电频率(RPF)减慢,最大舒张电位(MDP)绝对值减小,复极80%时间(APD80)延长(P0.05);1μmol/L胺碘酮可引起4相自动除极速度(VDD)和0相最大除极速度(Vmax)减慢,动作电位幅度(APA)减小,复极50%时间(APD50)延长(P0.05),RPF减慢,MDP减小和APD80延长(P0.01);10μmol/L胺碘酮可使VDD进一步减慢,APA进一步减小(P0.01),其它指标的改变维持1μmol/L胺碘酮灌流时的水平。(2)低O2可使VDD、RPF和Vmax减慢,MDP和APA减小,APD50缩短(P0.05);和低O2组相比,1μmol/L胺碘酮+低O2可使RPF和Vmax进一步减慢,MDP增大,APD80延长(P0.05),VDD进一步减慢,APD50延长(P0.01)。(3)pH6.8的灌流液可使VDD和RPF减慢,APD80缩短(P0.05),Vmax减慢,APA减小(P0.01);与pH6.8组相比,pH6.8的1μmol/L胺碘酮可使RPF进一步减慢,MDP和APA进一步减小,APD80延长(P0.05),VDD进一步减慢,APD50延长(P0.01)。(4)10μmol/LEPI可使VDD、RPF和Vmax加快,MDP增大,APD50和APD80缩短(P0.05),APA增大(P0.01);1μmol/L胺碘酮+10μmol/LEPI可使VDD和RPF减慢,MDP和APA减小,Vmax减慢,APD50和APD80延长(P0.05,P0.01)。结论:胺碘酮可降低豚鼠左心室流出道的自律性,同时对低O2、酸中毒和EPI所致的该部位自律性改变有一定的影响。     

呼吸内胚层相关第二生心区与小鼠胚胎流出道远端的形态发生

目的探讨小鼠胚胎呼吸内胚层相关第二生心区(PSHF)发育与流出道远端形态发生的关系。方法用免疫蛋白印迹法检测抗胰岛因子-1(ISL-1)在80例胚龄10~14 d小鼠胚胎心脏标本的表达。另用抗ISL-1、抗α-平滑肌肌动蛋白(α-SMA)及抗心肌肌球蛋白重链(MHC)抗体,对36例胚龄11~13 d小鼠胚胎心连续石蜡切片进行免疫组织化学或免疫荧光染色。结果胚龄11~12 d是ISL-1蛋白在小鼠胚胎心脏表达的高峰时段。胚龄11 d,来自鳃弓或心包腔背侧壁等处PSHF的ISL-1阳性细胞延伸进入流出道远端管壁,流出道远端管壁则失去MHC表达,呈α-SMA阳性表达;来自PSHF的ISL-1阳性细胞则围绕呼吸内胚层呈对称性锥体结构分布,锥体顶端突入动脉囊腔呈ISL-1阳性突起。胚龄11.5 d,PSHF锥体顶端进入动脉囊头侧和尾侧管壁,形成流出道远端管壁上对称的ISL-1阳性柱结构;而动脉囊腔尚未分隔,流出道远端仍为单一管道。胚龄12 d,PSHF锥体突起失去ISL-1表达,呈较强的α-SMA表达。在PSHF锥体突起与流出道嵴融合前,两者之间出现主-肺动脉孔;两者融合后则形成α-SMA阳性的暂时性主-肺动脉隔,将动脉囊分隔成MHC阴性的心包内的主动脉和肺动脉。胚龄13 d,主-肺动脉隔逐渐消失,心包内主动脉和肺动脉分离。在MHC阴性的心包内大动脉管壁上出现了α-SMA阳性的平滑肌层,仍可见少量PSHF的ISL-1阳性细胞延伸进入心包内大动脉管壁。结论在小鼠胚胎发育11~13 d,PSHF将动脉囊分隔成心包内的主动脉和肺动脉,并参与心包内大动脉的侧面管壁和对侧面管壁的分化形成。     

Functions of cilia in cardiac development and disease

Errors in embryonic cardiac development are a leading cause of congenital heart defects (CHDs), including morphological abnormalities of the heart that are often detected after birth. In the past few decades, an emerging role for cilia in the pathogenesis of CHD has been identified, but this topic still largely remains an unexplored area. Mouse forward genetic screens and whole exome sequencing analysis of CHD patients have identified enrichment for de novo mutations in ciliary genes or non-ciliary genes, which regulate cilia-related pathways, linking cilia function to aberrant cardiac development. Key events in cardiac morphogenesis, including left–right asymmetric development of the heart, are dependent upon cilia function. Cilia dysfunction during left–right axis formation contributes to CHD as evidenced by the substantial proportion of heterotaxy patients displaying complex CHD. Cilia-transduced signaling also regulates later events during heart development such as cardiac valve formation, outflow tract septation, ventricle development, and atrioventricular septa formation. In this review, we summarize the role of motile and non-motile (primary cilia) in cardiac asymmetry establishment and later events during heart development.     

The anatomic basis for ventricular arrhythmia in the normal heart: What the student of anatomy needs to know

The traditional route for teaching cardiac anatomy involves didactic instruction, cadaver dissections, and familiarization with the main structure and relationships of the cardiac chambers, valves, and vasculature. In contemporary cardiac electrophysiology, however, a very different view of anatomy is required including details rarely appreciated with a general overview. In this review, we discuss the critical advances in cardiac electrophysiology that were possible only because of understanding detailed anatomic relationships. While we briefly discuss the clinical relevance, we explain in depth the necessary structural information for the student of clinical anatomy. Interspersed through the text are boxes that highlight and summarize the critical pieces of knowledge to be borne in mind while studying the fascinating structural anatomy of the human heart. Clin. Anat. 27:885–893, 2014. © 2014 Wiley Periodicals, Inc.