Features of the angioarchitectonics of the papillary muscles and the chordae tendineae of the human heart

In persons of mature, elderly and old age vascularization of the papillary muscles and tendinous chordae in the right and left cardiac ventricles has been studied depending on peculiarities of their structure and sources of their blood supply using injection, macro-microscopical, roentgenoangiographic methods, and silver nitrate impregnation. Certain data concerning the distribution zones in the papillary muscles of the coronary artery branches at various types of the cardiac blood supply are presented. Angioarchitectonics of the papillary muscles are described along their whole extention--in the basal area, in the middle part and at the apex. Architectonic peculiarities of the blood vessels in the muscular-tendinous part of the papillary muscles and in some tendinous chordae are described.     

Variations in atrioventricular valve innervation in four species of mammals

In this series of studies, the innervation patterns of whole-mount preparations of bicuspid and tricuspid valves were studied by light microscopy in the mouse, rat, guinea pig, and opossum. The acetylcholinesterase-positive networks of nerve fibers showed many similarities in the basic patterns of valve innervation in all of the species studied, but several interspecies variations were observed. The basal zone of the valve adjacent to the fibromuscular atrioventricular ring displayed the most dense plexus of nerves, with acetylcholinesterase-positive fibers being seen across the width of the valve. In the intermediate zone of the valve, less dense plexuses of nerve fibers were found; and these were more numerous in the cuspal areas and less numerous in the intervening commissural areas. In the distal portions of the valve, nerve networks arborized extensively, with some of their nerve fibers extending toward the chordae tendineae and the free edges of the valve cusps. Only in the guinea pig and opossum did these fibers reach the free margin of the valve cusp, where they either ended directly as free nerve endings or lay parallel to the free edge of the cusp, often running between adjacent chordae tendineae. Although the patterns of innervation were similar in both bicuspid and tricuspid valves, the innervation density of the bicuspid valve was greater than that of the tricuspid valve for each species examined. A distinguishing feature of guinea pig and opossum tricuspid valves was that their chordae tendineae were relatively more prominent and more densely innervated than the bicuspid chordae tendineae. Free nerve endings with no light microscopic evidence of specialization were present throughout the bicuspid and tricuspid valves of all species studied. Some nerve endings in the opossum showed evidence of specialization, with brush-like arborizations leading to presumed free terminals seen chiefly in the distal zone of the valve cusps. Although some general tendencies were apparent, we have demonstrated that interspecies heterogeneity exists in the terminal networks of the atrioventricular valves of mouse, rat, guinea pig, and opossum.     

Anatomy of the sinoatrial node and the supply of its vascularization in man

Seventy heart preparations of persons belonging to different sex and age have been investigated, using a complex of anatomical and histological techniques. The dimensions of the sinoatrial node (SAN) vary with age and depend on various size and form of the heart. The large atrial branch of the right and left coronary arteries supplies mainly the SAN with blood. More seldom the atrial branches of both cardiac arteries, having anastomoses, realize the SAN blood supply. The character of the SAN vascularization depends on branching variations of the atrial vessels. At the right coronary variant the sources of the SAN blood supply are the SAN branch, the right intermediate or right posterior atrial branches, and at the left coronary variant--the anterior left, the posterior left and the intermediate left atrial branches. At the even variant the SAN blood supply sources are the right intermediate and the anterior left atrial or the right posterior and the left posterior atrial branches. The data obtained can be used for comparison with the results of coronography to make a skilled analysis of clinical-roentgenological observations.     

Anatomy and topography of the tracheobronchial lymph nodes in man during the postnatal period of ontogeny

Tracheobronchial lymph nodes (TBLN) have been studied in 71 corpses of persons at different ages. The TBLN are revealed by means of polychromic injection of Gerota mass into the lung tissue, or directly into the lymph nodes revealed. The number of the inferior and superior (right and left) TBLN varies within a wide range. Longitudinal dimentions of the lymph nodes increase with age. A certain age dependence in topography of the inferior and superior TBLN is stated. In persons of mature and elderly age, dextrobronchial type in arrangement of the inferior TBLN is found more often, and at younger age periods--even type of their arrangement is specific. The right superior TBLN in newborns, children and adolescents possess an evenly concentrated type of localization, and at later age periods--dispersive and unevenly concentrated. The superior left TBLN in newborns and children are mainly situated in the TB angle area, in persons of mature and elderly age--on the lateral surface of the thoracic part of the trachea. The form of the TBLN depends on their localization. A certain relation is determined between the localization of the inferior TBLN and the number of the superior (right and left) TBLN.     

Vascular-nervous relationships in the valves of the heart]

Method of silver nitrate impregnation was used in order to study 50 preparations of not-changed atrioventricular valves of the heart of domestic bulls and 30 preparations of the same valves of adult humans. It has been shown that in heart valves there are certain relationships between striated muscle fibres, blood vessels and nerve elements. The nerve structures of the valves are represented by nerve bundles of different thickness. In their composition there are comparatively thin non-myelinated and thicker myelinated fibres. Towards the free edge of cusps the nerve bundles become thinner and the nerve trunks give off separate thin nerve fibres disposed along the vessels of a capillary type and in some places getting around them. In certain portions of cusps the nerve bundles, some of which have zigzag sinuosity, cross blood vessels in different directions. In man the major mass of blood vessels and nerve elements are disposed near the base of the valve cusps, accompanying the muscle fibre bundles penetrating from the base side. In the bull heart valves an amount of blood vessels and nerve elements is found in considerable portions of the cusps not connected with muscle fibres.     

Dependence of the topography of the hepatic veins on the external shape of the liver, its size and on age

Hepatic preparations obtained from 186 newborns, children and mature persons have been studied. In newborns and babies the size of the right and left hepatic lobes are nearly the same. Beginning from an early age, the right hepatic lobe begins to grow, and the oblongatal or oval form of the liver changes into a triangle one. With changes in its size and form, the topography of the hepatic veins changes, too. In children younger than 1 year of age having the oblongatal or oval form of their liver, the diameters of the right, middle and left hepatic veins are nearly equal. In mature persons having the triangle form of the liver, the right hepatic vein is the largest and its diameter is twice as large as that of the left hepatic vein. Additional hepatic veins flowing into the inferior vena cava, are mainly formed by the branches participating in drainage of the right hepatic lobe. In 25 cases there are additional large hepatic veins; they are observed in cases when the right hepatic vein is poorly developed.     

Biochemical characterization of individual normal, floppy and rheumatic human mitral valves.

Human mitral valves (32 floppy and 17 rheumatic) obtained at surgery were analysed and compared with 35 normal (autopsy) valves. Total amounts of collagen, proteoglycan and elastin were increased approx. 3-fold in floppy and rheumatic valves. The water content of rheumatic cusps was lower than normal. The most significant changes in floppy valves were the 59% increase in mean value of the proteoglycan content, a large increase in the ease of extractability of proteoglycans from 26.7 to 57.2% of the total and a 62% increase in mean value of the elastin content in the anterior cusps. Normal human mitral valve cusps contained a mean proportion of 29.3 (and chordae 26.6) type III collagen (as % of total types III + I collagen), the values increasing significantly to 33.2 and 36.3% respectively in chronic rheumatic disease. The ratio observed in floppy valves depended on the extent of secondary surface fibrosis, which could be demonstrated histologically; in valve cusps with considerable secondary fibrosis, the percentage of type III increased significantly (to 34.4%), whereas it decreased significantly (to 25.2%) when fibrosis was negligible. It is concluded that the ratio of collagen types in floppy valves reflects the extent of secondary fibrosis rather than the pathogenesis of the disrupted collagen in the central core of the valve.     

Venous valves in the large branches of superior vena cava

In 97 human cadavers the valves of the following blood vessels were investigated with regard to their cusps and their sizes and positions: the internal jugular veins, the subclavian veins, the brachiocephalic veins, and the superior vena cava. The cusps of each of the valves, which consist of two or three parts, are neither always of equal size nor obligatorily sufficient. Unipartite valves may be sufficient as well as insufficient. Internal jugular veins: The inferior bulb of the internal jugular vein is provided with valves which in 6% of the cases consist of three parts, in 66% of two parts, and in 15% of only one cusp. The concave margins of most of them go down as far as the venous angle. The convex edges attached to the wall of the vein extend to a higher level on the right side than on the left. In 13% there do not exist any valves. Varieties are described separately in this paper. Subclavian veins: Valves are found along the length of the vessel. Only few of them reach the venous angle. In rare cases there exist two valves: one at the beginning, the other at the end of the subclavian vein. In 4% of the cases the valves consist of three, in 75% of two cusps. In 12% they are unipartite. In 9% there are no valves to be found. The right side is more often without valves than the left. Brachiocephalic veins: Only a minority of these vessels is provided with valves. Most of these consist of one cusp, are insufficient, and are situated in the left innominate vein.(ABSTRACT TRUNCATED AT 250 WORDS)     

Age-related aspects of the anatomy and topography of the human tubal tonsil

The tubal tonsil (TT) has been investigated in 60 preparations of the auditory tube (right and left), obtained from 30 corpses of persons at various age, those died from traumas and having neither any pathological changes in their acoustic organs, nor chronic inflammatory diseases by the time of death. The TT is presented as a solid or interrupted lymphoid tissue plate, situating in the mucosal membrane in the area of the pharyngeal opening to some extent in the inferior, posterior and anterior walls of the auditory tube. In newborns the TT is presented as a diffuse lymphoid tissue, where lymphoid nodules begin to form. The greatest amount of the lymphoid nodules in the TT are revealed in the infantile age and this sign is kept during subsequent age periods, including the first period of mature age. During these age periods on the surface of the mucosal membrane in the area of the pharyngeal opening numerous small eminences are seen--tubercles, corresponding in their position to lymphoid nodules under them. Beginning from the second mature period and up to old age the amount and size of the lymphoid nodules in the TT decreases. At that time on the surface of the mucosal membranes in the area of TT only single tubercles are revealed.     

The microscopic anatomy of the human pharyngeal tonsil in the postnatal period of ontogeny

Histological sections of the pharyngeal tonsil (PhT) have been investigated in 55 corpses of persons of both sex and various age, that had no disease connected with lesions of the PhT by the time of their death. The aim of the work is to determine relative areas of each structural element of the PhT in comparison to the whole section area taken as 100%. The PhT lymphoid tissue reached its maximal relative development at the first childhood. Then the lymphoid tissue area in the PhT histological sections decreases gradually, making already in the second mature age one half of the tonsil section area, and in the elderly age--nearly one-fourth. The decrease of the relative lymphoid tissue area takes place at the expense of decreasing area of the lymphoid nodules. The relative area of the connective stroma increases inversely to the relative decrease of the lymphoid tissue area parameters. The germinative centers in the lymphoid nodules are absent in newborns and old persons. The greatest value of the relative area of the germinative centers falls to the early infancy. The lymphoid nodules with the germinative centers, according to their relative area during all age periods, besides the newborn period, the second mature, elderly and old age periods, essentially exceed the area, that occupy the nodules without the germinative centers on the PhT sections.     

Structure of the jugular fossa

In 111 skulls and in saw-cuts of 119 pairs of the temporal bones of persons belonging to various age groups, age and individual changeability of the volume, form, thickness and foramina in the wall of the jugular fossa have been studied. During the postnatal period the jugular fossa increases in its volume twice and average meaning of its volume predominates on the right in the all age groups. The deepest place of the jugular fossa in more than half cases is displaced backward and laterally. The jugular fossa wall in the area of the inferior wall of the tympanic cavity is less thick on the right than on the left side. The foramina in the inferior wall of the tympanic cavity are found in mature persons in 6%, on the right 3 times as often as on the left; in children of younger age--in 45% and on the right more than 2 times as often as on the left.     

Determination in the system of the neuromuscular relations of the coronary arteries at stages in human postnatal development

By means of micromorphometric method in transversal sections of electively stained right and left coronary arteries the data, characterizing the area of the middle and external sheaths, amount of myelin fibers in nerves, accompanying the artery have been obtained in men of 8 age groups (from birth up to old age), who died from causes not connected with the cardiovascular pathology. The summary amount of all classes of myelin fibers increases synchronously with an increase of the muscle sheath area from newborn up to 35-45 years of age. After this age the amount of the myelin fibers decreases together with decreasing area of the middle sheath. Minimal values of these indices are observed in the old age (85-90 years). The external sheath area increases permanently from birth up to the old age. The correlative analysis reveals a positive and significant connection of various degree between the myelin fibers number and value of the middle arterial sheath in persons of juvenile, mature and elderly age: amount of the muscular layer is adequate to the myelin fibers amount. In other age groups the correlative connections are either small, or not significant. Alternative, corresponding to each age quantitative gradations of the nervous connections are determined by means of the peripheral substrate. Its role in the vessels investigated is performed, to a definite degree, by the muscle sheath.     

Variations in coronary artery anatomy: Normal versus abnormal

We offer a comprehensive classification of coronary artery anomalies, together with angiographic examples of each entity. Minimal requirements for normality include the following criteria: (1) the dual aortic origin is from right and left coronary ostia; (2) the course of the right coronary artery follows the right atrioventricular groove; (3) the course of the left coronary artery follows the left atrioventricular groove and anterior interventricular groove; (4) the posterior descending branch originates from either the right or left coronary artery; (5) the major coronary branches flow epicardially; and (6) the coronary arteries terminate at the myocardial capillary level. This conception of "normal" coronary arteries has determined the classification of abnormalities presented here. Early and correct diagnosis of anomalies that may compromise the myocardial blood supply is stressed, and possible surgical solutions are offered. Selective coronary angiography is the technique of choice for precise visualization of the coronary artery system.     

Endothelial deletion of ADAM17 in mice results in defective remodeling of the semilunar valves and cardiac dysfunction in adults

Global inactivation of the metalloproteinase ADAM17 during mouse development results in perinatal lethality and abnormalities of the heart, including late embryonic cardiomegaly and thickened semilunar and atrioventricular valves. These defects have been attributed in part to a lack of ADAM17-mediated processing of HB-EGF, as absence of soluble HB-EGF results in similar phenotypes. Because valvular mesenchymal cells are largely derived from cardiac endothelial cells, we generated mice with a floxed Adam17 allele and crossed these animals with Tie2-Cre transgenics to focus on the role of endothelial ADAM17 in valvulogenesis. We find that although hearts from late-stage embryos with ablation of endothelial ADAM17 appear normal, an increase in valve size and cell number is evident, but only in the semilunar cusps. Unlike Hbegf^?/? valves, ADAM17-null semilunar valves do not differ from controls in acute cell proliferation at embryonic day 14.5 (E14.5), suggesting compensatory processing of HB-EGF. However, levels of the proteoglycan versican are significantly reduced in mutant hearts early in valve remodeling (E12.5). After birth, aortic valve cusps from mutants are not only hyperplastic but also show expansion of the glycosaminoglycan-rich component, with the majority of adults exhibiting aberrant compartmentalization of versican and increased deposition of collagen. The inability of mutant outflow valve precursors to transition into fully mature cusps is associated with decreased postnatal viability, progressive cardiomegaly, and systolic dysfunction. Together, our data indicate that ADAM17 is required in valvular endothelial cells for regulating cell content as well as extracellular matrix composition and organization in semilunar valve remodeling and homeostasis.     

Surgical anatomy of subaortic conus of the normal heart]

One hundred and fourty-three normal hearts have been studied. The conoid septum, supraventricular crest, bulboventricular fold, area of the fibrous tissue between the aortal and mitral valves and the anterior interventricular septum make the walls (frontal view, in the direction of the hour hand) of the left ventricular cone. In the normal heart there is no real contact between the fibrous rings of the aortal and mitral valves. They are connected by means of a strip of the fibrous tissue, its size varies. The subaortal cone and deferent part of the left ventricular axes make an obtuse angle; the axes of the subpulmonary and subaortal cones have a cross direction. The geometrically definitive left ventricular cone is seen as obliquely-sectioned overturned isosceles cone, with its big base directed upward, right and back, and the small one forward and left.     

Age and features of the content of myelinated fibers in nerves of the splenic plexus of man

The amount of the myelin fibers (MF) has been calculated in transversal serial sections of the nervous-vascular complexes of the splenic artery in newborns, in persons of mature (the 1st and 2d periods), elderly and old ages. In each age group 20 complexes have been studied. The total amount of the MF in persons of mature age (the 1st period) in 4.2-6 times greater (initial--terminal parts of the plexus) than in newborns, in the persons of old age it is 4-2.1 times less than in persons of mature age (in both cases P less than 0.001). Thin MF predominate, their relative contents in the aggregate of all classes of the MF in newborns are 92%, in mature persons--87%, in old persons--65%. Decreasing part of the thin MF together with increase of their absolute amount in the mature persons, comparing to the newborns, depends on higher rates in differentiation of middle and thick MF. Phenotyping peculiarities and stages of productive development, stabilization (the 1st-2d periods of the mature age), involutions of the nerve connections are defined in the splenic artery. The amount of the MF predominates in the nerves of the initial part of the plexus comparing to its terminal part. There is a direct correlative dependence between the amount of the MF in the plexus nerves and the size of the lumen in the splenic artery. Changes in the amount of the MF of different classes reflects qualitative differences of the splenic innervation relations at certain stages of the human postnatal development.     

The innervation of the human esophagus

There are usually 3 left and 4 right esophageal branches of the sympathetic chains. Besides a direct approach to the organ, they form a delicate network between aorta and esophagus. This network exchanges fibers with the vagus nerves. The vagal supply of the cranial third is rather poor. It is richest in the middle third. As a rule, the left anterior, left posterior, right anterior and right posterior main branches can be prepared. There are relatively few communications between right and left ramuli. Above the esophageal hiatus, always quite distinct anterior vagal chords are found, while posteriorly there are usually only very thin nerve bundles.     

Atrioventricular valves development in human heart: the Paris embryological collection revisited

29 human embryos staging from stage 15 to stage 23 (post-somitic period, collection of the UER Biomedicale des Saints-Péres, Université René Descartes Paris V) have been studied. The most important morphological events of the atrioventricular valves development have been reinvestigated and photographed. This is a complementary information about cardiac development analysing this french collection of human embryos (Mandarim-de-Lacerda, in press). At stage 15, we can observe the gelatinous reticulum well organized when cardiac valves will become established; progressively the fused endocardial cushions and right and left lateral cushions encircle the atrioventricular channels indicating the site of the tricuspid valves. These cushions, however, have a temporary influence being replaced gradually by atrial and ventricular myocardium. At stage 23, the heart presents a complete atrioventricular valvular structure.     

Pitx2c patterns anterior myocardium and aortic arch vessels and is required for local cell movement into atrioventricular cushions

Inactivation of the left-right asymmetry gene Pitx2 has been shown, in mice, to result in right isomerism with associated defects that are similar to that found in humans. We show that the Pitx2c isoform is expressed asymmetrically in a presumptive secondary heart field within the branchial arch and splanchnic mesoderm that contributes to the aortic sac and conotruncal myocardium. Pitx2c was expressed in left aortic sac mesothelium and in left splanchnic and branchial arch mesoderm near the junction of the aortic sac and branchial arch arteries. Mice with an isoform-specific deletion of Pitx2c had defects in asymmetric remodeling of the aortic arch vessels. Fatemapping studies using a Pitx2 cre recombinase knock-in allele showed that daughters of Pitx2-expressing cells populated the right and left ventricles, atrioventricular cushions and valves and pulmonary veins. In Pitx2 mutant embryos, descendents of Pitx2-expressing cells failed to contribute to the atrioventricular cushions and valves and the pulmonary vein, resulting in abnormal morphogenesis of these structures. Our data provide functional evidence that the presumptive secondary heart field, derived from branchial arch and splanchnic mesoderm, patterns the forming outflow tract and reveal a role for Pitx2c in aortic arch remodeling. Moreover, our findings suggest that a major function of the Pitx2-mediated left right asymmetry pathway is to pattern the aortic arches, outflow tract and atrioventricular valves and cushions.     

Variability in the myeloarchitectonics of the nerves of the thyroid arteries during postnatal human development

Serial transversal sections on the nerve-vascular complexes of four thyroid arteries in newborns, in persons of the 1st and 2d periods of mature age, in elderly and old persons (40 complexes in each age group) are stained after Weigert--Pahl. Amount of myelin fibers (MF) of three dimensional classes are defined micromorphometrically. Total amount of the MF in the nerves of all thyroid plexuses is the greatest in the persons belonging to the second mature period of age: it is 2.7 times as great as in the newborns. In the elderly persons it is 1.5 times, and in the old persons--1.8 times as little as in the persons of the second period of maturity. Thin MF make the absolute majority. The amount of the MF with middle caliber in the thyroid nerves of the mature persons is 6.6 times as great as in the newborns. Their amount in the old persons is 1.7 times as little as in the mature persons. Thick MF are absent in the newborns; in the mature and elderly persons they are observed now and then. The thick MF are characterized by a high variation coefficient (up to 84%). According to the criteria of absolute and relative contents of both total and group composition of the MF in postnatal period, three stages in development of the thyroid innervational connections performed by the MF are revealed: productive, stabilization and involution. The correlative analysis reveales a direct dependence in the system diameter of each thyroid artery--number of the MF in nerves of its plexus in the newborns and mature persons. This dependence becoms negative in the elderly and old persons.(ABSTRACT TRUNCATED AT 250 WORDS)