Angioarchitecture of the venous and capillary system in heart defects induced by retinoic acid in mice

BACKGROUND: Corrosion casting and immunohistochemical staining with anti‐alpha smooth muscle actin and anti‐CD34 was utilized to demonstrate the capillary plexus and venous system in control and malformed mouse hearts. METHODS: Outflow tract malformations (e.g., double outlet right ventricle, transposition of the great arteries, and common truncus arteriosus) were induced in progeny of pregnant mice by retinoic acid administration at day 8.5 of pregnancy. RESULTS: Although control hearts exhibited areas in which capillaries tended to be oriented in parallel arrays, the orientation of capillaries in the respective areas of malformed hearts was chaotic and disorganized. The major branch of a conal vein in control hearts runs usually from the left side of the conus to its right side at the root of the pulmonary trunk and opens to the right atrium below the right auricle; thus, it has a curved course. On the other hand, a conal vein in malformed hearts courses from the left side or from the anterior side of the conus and tends to traverse straight upwards along the dextroposed aorta or along the aortopulmonary groove with its proximal part located outside of the heart. Other cardiac veins in outflow tract malformations are positioned in the same locations as in control hearts. CONCLUSIONS: We postulate that the changed location of the conal vein and disorganized capillary plexus result from malformed morphogenesis of the outflow tract and/or a disturbed regulation of angiogenic growth factor release from the adjacent environment. Birth Defects Research (Part A), 2009. © 2009 Wiley‐Liss, Inc.     

Transhepatic approach for catheter ablation of accessory pathway in a child with complex congenital heart disease

We report on a 22-month-old boy with drug-resistant atrioventricular reentrant tachycardia and complex structural heart disease consisting of right atrial isomerism, mirror image orientation of the intrathoracic veins, hemi-azygos continuation to the left superior vena cava, separate drainage of the hepatic veins into the left-sided atrium, congenitally corrected transposition, pulmonary atresia, and atrial and ventricular septal defects.Access to the heart for radiofrequency (RF) ablation was obtained by percutaneous puncture of a hepatic vein, the left internal jugular vein, and femoral artery. The accessory pathway was localised to the free wall of the left-sided AV groove and successfully ablated. There were no procedure-related complications.RF ablation of an accessory pathway is feasible in young children with complex structural heart disease and abnormal systemic venous return. In such patients access to the heart must be planned with knowledge of the anatomy and judicious use of the hepatic venous approach.     

Morphological study on the thebesian veins of the right cavities of the heart in the dog.

The authors studied 48 dog hearts, using the injection-corrosion-fluorescence method to study the topography of thebesian veins in all the walls of the cardiac cavities. The thebesian veins are small, situated deep in the myocardium, opening after a short course into the cardiac cavities, by small openings with diameters in general not exceeding 1 mm, known 'foraminula'. They have a centripetal course, while every other vein in the heart has a centrifugal one, to reach the subepicardial zone. In the heart of the dog five types of thebesian veins were served: arboriform, sinuous, brush-like, canaliculated and stellate. The thebesian veins are almost regularly found in every wall of the cardiac cavities. The authors also observed that they predominated in the right ventricle (81.24%) and in the right atrium (77.43%).     

Morphological study on the human anterior cardiac veins, venae cordis anteriores.

The way in which the anterior cardiac veins end in the right atrium is very inconstant; separate opening is very rare and course and situation also changes a lot. We found the vein of Galen in about 90.59% of the cases and its ending differs from the usual. We found the anterior ventricular veins in about 91.45% of the cases; there is only one such vein in 57.00% of the cases, two in 33.64% and three in 9.34%; their origin and opening vary greatly. We saw the vein of Cruveilher in 68.37% of the cases, a lower percentage than that found by other authors. It also differs in its origin, course and opening. The vein of Zuckerkandl was found in 47.00% of the cases, lesser percentage than that found by other authors. The common canal is very important and very frequent in our cases. It opens into the right atrium by one orifice in 27.68% of the cases, by two in 63.93% and by three in 8.19%.     

Valves of the small coronary veins in porcine hearts

The aim of the study was to investigate the existence of valves in small peripheral coronary veins of porcine hearts. The study was performed on 20 porcine hearts using standard histological methods. The veins in the subepicardial and intramyocardial regions of the anterior and posterior parts of the interventricular septum and in the wall of the right atrium were studied. Valves were present in intramyocardial veins (diameter of 75–180 μm), in the veins located just beneath the external surface of the myocardium (diameter 120–170 μm) and in the terminal segments of the ventricular veins (diameter 250 μm) opening into the stems of the anterior interventricular vein and middle cardiac vein. Valves were also recorded in most veins of the subepicardial space. The described rich presence of valves in the small coronary veins may contribute to a better comprehension of their hemodynamic properties. These findings may also help to improve the understanding of the efficacy of retrograde application of medications, a novel technique in cardiology and cardiac surgery.     

Left superior vena cava, a remnant of embryological development

A 46-year-old Brugada syndrome patient underwent insertion of a dual-chamber implantable cardioverter- defibrillator (ICD), revealing a left-sided superior vena cava (SVC), (figure 1), running, characteristically, left from the sternum and flowing into the great cardiac vein. Following this course, the atrial lead was placed in the right atrium (RA) (figure 2, arrow, note dorsal position). The ventricular lead was inserted through the connecting anonymous vein between left and right SVC (figure 1, double arrow), into the right SVC and right ventricle (RV). The presence of a left superior vena cava results from the persistence of the embryonic left anterior cardinal vein. This anomaly is present in approximately 0.5% of the general population and in 3 to 5% of persons with other congenital heart defects, as established by autopsy.     

The outflow tract of the heart is recruited from a novel heart-forming field.

As classically described, the precardiac mesoderm of the paired heart-forming fields migrate and fuse anteriomedially in the ventral midline to form the first segment of the straight heart tube. This segment ultimately forms the right trabeculated ventricle. Additional segments are added to the caudal end of the first in a sequential fashion from the posteriolateral heart-forming field mesoderm. In this study we report that the final major heart segment, which forms the cardiac outflow tract, does not follow this pattern of embryonic development. The cardiac outlet, consisting of the conus and truncus, does not derive from the paired heart-forming fields, but originates separately from a previously unrecognized source of mesoderm located anterior to the initial primitive heart tube segment. Fate-mapping results show that cells labeled in the mesoderm surrounding the aortic sac and anterior to the primitive right ventricle are incorporated into both the conus and the truncus. Conversely, if cells are labeled in the existing right ventricle no incorporation into the cardiac outlet is observed. Tissue explants microdissected from this anterior mesoderm region are capable of forming beating cardiac muscle in vitro when cocultured with explants of the primitive right ventricle. These findings establish the presence of another heart-forming field. This anterior heart-forming field (AHF) consists of mesoderm surrounding the aortic sac immediately anterior to the existing heart tube. This new concept of the heart outlet's embryonic origin provides a new basis for explaining a variety of gene-expression patterns and cardiac defects described in both transgenic animals and human congenital heart disease.     

Alternative venous drainage of heart ventricles in rabbits

The objective of this study was to describe the uncommon connections between cardiac veins, alternative pathways within cardiac venous circulation and complex variability of the venous system in the heart ventricles. The study was carried out on 30 adult New Zealand White rabbits. The arrangement of the cardiac veins was studied by using the corrosion casts prepared with the Spofacryl® and by perfusion of coloured latex. The presence and organization of principal veins of the heart ventricles was relatively constant with a great variability in the mode of opening and forming a common trunk. The highest variations were observed in the region of the paraconal interventricular vein, the left and right marginal vein and the left distal ventricular vein. The left proximal ventricular vein was an inconstant tributary of the left circumflex vein and was seen in 17% of cases. The left distal ventricular vein was visible as one (13% of cases) or two veins (87% of cases). Angular vein was observed in 20% of cases. Numerous anastomosis were found among cardiac veins.     

Ostium of the collection stem of the anterior cardiac veins (vv. cardiacae anteriores) in the vena cava, inferior

In 1 of 150 studied cases, we found the collection stem of anterior cardiac veins that emptied into the inferior vena cava. This collection stem had eight tributaries: two right atrial veins, five anterior cardiac veins and a right marginal vein. The caliber of the collection stem was increasing gradually from its beginning (2.8 mm) to its orifice (4.5 mm). The orifice of the collection stem was in the inferior vena cava, at a distance of 10 mm from its ostial valve, and was itself provided with a semilunar valve.     

Functional anatomy of the heart of the harbor porpoise, Phocaena phocaena.

Thirty-six harbor porpoises, Phocaena phocaena, were caught off the coast of Southern New Brunswick and Nova Scotia as part of a study of the biology and ecology of these animals. The formalin-preserved heart was examined first in situ, then measured and studied in detail. If the weight of the thick layer of blubber is discounted, the heart is heavy relative to the total body weight as may be expected in an animal capable of fast swimming, great agility and frequent emergence from the water to breathe. The shape of the heart, the relative size of atria and atrial appendages, the morphology of the ventricular septum, the thickness of the walls of the sinus and conus of the right ventricle and the anatomy of the pulmonary veins were found to be constant for this animal and unlike that of non-cetaceans. It is suggested that the absence of respiratory movements during diving may lead to these modifications of cardiac structure in an animal that is particularly well adapted to a totally aquatic existence.     

Development of the Epicardium in the Dogfish (Scyliorhinus canicula)

The development of the epicardium has been described in mammals, including man, birds and amphibians. However, there is no information concerning this morphogenetic process in fishes. A study carried out in embryos of the dogfish ( Scyliorhinus canicula ) showed that, in this elasmobranch species, the precursors of the epicardium originate from two mesothelial anlagen, the right and left, that initially lie at the ventrolateral parts of the liver. These two anlagen, which will be referred to as the proepicardium, later shift to the right and left parts of the pericardial aspect of the transverse septum. The proepicardium comprises numerous spheric, smooth-contoured cells and a relatively small amount of extracellular matrix. The proepicardium is not covered by an epithelial layer.
Cells detaching from the proepicardium adhere to the surface of the heart and develop into epicardial cells. They firstly ensheathe the atrioventricular groove as well as the dorsal and lateral aspects of the ventricle, and the ventral and lateral aspects of the atrium. Both the sinus venosus and conus arteriosus become lined later.
In spite of the phylogenetic distance between elasmobranchs and mammals, the mechanism by which the epicardium develops is similar in both groups. This similarity relies principally on the arrangement and location of the proepicardium and the way in which the epicardial precursors reach and invest the heart.     

Paracardioscopy provides endoscopic visualization of the heart

Paracardioscopy provides totally endoscopic access to the heart via a transabdominal, transdiaphragmatic approach. Structures such as the pulmonary veins, inferior vena cava, left and right atrial appendage, and posterior left atrium can be visualized. Epicardial cardiac procedures, such as ablation procedures for atrial fibrillation, can be successfully performed using this development. This report describes paracardioscopy.     

An Angiocardiographic Analysis of the Central Circulation in the Air Breathing Teleost Channa argus

The unique anatomy of the double ventral aorta outflow system in the air breathing teleost Channa argus (Ophiocephalus) showing an anterior and posterior ventral aorta is described. The marked trabeculation of the ventricle and bulbus arteriosus and the arrangement of central veins are used as a basis for the hypothesis that Channa may selectively channel the well oxygenated blood draining the air breathing organs via the anterior cardinal vein to the posterior ventral aorta, which forms the systemic arterial circulation. An angiocardiographic technique was used to test this hypothesis, as well as to delineate the functional role of the heart chambers in the cardiac cycle. No reflux of contrast to the sinus venosus during atrial filling and no ventricular filling before atrial contraction were apparent, which makes the atrium the main determinant of the ventricular end-diastolic volume. Ventricular contraction left a small or no residual volume. The ventricular ejectate was initially nearly completely absorbed by the very elastic bulbus arteriosus, acting as a pressure chamber (Windkessel) stabilizing and prolonging ventral aortic blood flow. Contrast medium was not selectively passed from the anterior cardinal vein to the posterior ventral aorta. However, the diameter of this vessel and its density of contrast were greater than in the anterior aorta, suggesting a preference for a greater blood flow from the air breathing organ through the heart to the posterior aorta.     

On the development of the venous system in Polyptems senegalus (Pisces)

In Polyptems senegalus a peculiar venous system exists. The pattern is symmetrical in embryos and in early-larval stages, but soon the asymmetrical development of the Cuvierian ducts, originating from vitelline veins, causes a predominance of the system to the right side. The two posterior cardinal veins coalesce except in the anterior region, where the right vein becomes the direct continuation of the single vein; in later stages the single posterior cardinal vein acquires a peculiar disposition, partially in the left and partially in the right kidney. The inferior jugular veins become asymmetrical as well. The anterior cardinal veins are replaced by lateral cephalic veins. A special vein in the abdomen may be considered as being a vena cava. Other peculiar items are the pulmonary veins. Other veins are more or less similar to those of other fishes.     

Regulation of air and blood flow through the booklungs of the desert scorpion, Paruroctonus mesaensis

Injections of dye, latex and India ink were used to reveal the path of hemolymph circulation through the scorpion booklungs. Fine, branched arteries carry blood directly to muscle and other organs. The blood returns through venous channels to the ventral mesosoma where it passes laterally through the booklungs and into the pneumocardial veins just beneath the pleural cuticle. Blood flows dorsally through these veins to the pericardial sinus and heart. The scorpion has four pairs of booklungs located in the anterior segments of the ventral mesosoma. Each booklung has a spiracle which opens into an atrium enclosed by cuticular membrane. Air passes from the atrium into the booklung lamellae. Agitation of the animal or application of CO(2) causes retraction of the anterior and posterior atrial membrane. This expands the atrial chamber and allows gas exchange in the booklung lamellae. The posterior atrial membrane has a specialized region which forms a springy valve. This normally closes the spiracle unless pulled open by contraction of the attached poststigmaticus muscle. The pectens and receptors within the atrium may mediate the responses to CO(2). Slender hypocardial ligaments containing muscle fibers extend from the heart (dorsal mesosoma) to the booklungs in the ventral mesosoma. Heart movements thus cause dorso-ventral movement of the booklungs. The significance of these movements is as yet unclear. They may increase ventilation, help force blood to the heart and/or agitate the blood and booklung lamellae and thereby aid gas exchange. Passage of blood through the booklungs is regulated by dorsal and ventral muscles attached to the atrium at the lateral edge of the booklung. Contraction of the ventral atrial muscle closes the excurrent channel for passage of blood from the booklung into the pneumocardial vein. Electrical stimulation of the segmentai nerves from the subesophageal and first three abdominal ganglia causes spiracle opening and contraction of muscles attached to the atrial membrane. A previous study showed that these same segmental nerves also modulate heart activity. They thus provide a major pathway for regulation of the respiratory and circulatory systems.     

Capsaicin-sensitive neural pathway mediates atrial natriuretic factor (ANF) release in response to physiological stimuli

Increases in intravascular volume are detected by mechanoreceptors situated at the junctions of the great veins with the atria. We had previously shown that localized distension of the superior vena caval/right atrial junction, simulating increased cardiac preload, elicits release of ANF remotely from the atrial appendage. We proposed that ANF secretion is stimulated via intrinsic neural pathways running from the venoatrial junctions to the appendage. We developed a technique whereby non-adrenergic, non-cholinergic sensory nerves could be selectively destroyed in the heart of adult rats by instilling capsaicin into the pericardial space. Four days later, the animals were killed, and isolated perfused atria were prepared with small balloons positioned so that the superior vena caval/right atrial junction could be discretely stretched. Immunoreactive ANF secretion into the perfusate was measured. Although distension of the venoatrial junction increased ANF secretion from the control atria, there was no such response in the denervated atria. We conclude (A) that local application of capsaicin to the heart of adult rats induces selective functional neural deficits and (B) that information regarding distension of the junction of the great veins and the atria is normally transmitted across the atrium via these nerves to stimulate ANF secretion from peptide stores located in the atrial appendage. We propose that these pathways are crucial to ensure appropriate ANF secretion in response to an increase in circulating blood volume.     

Functional Morphology of the Heart in Fishes

The systemic heart of fishes consists of four chambers in series,the sinus venosus, atrium, ventricle, and conus or bulbus. Valvesbetween the chambers and contraction of all chambers exceptthe bulbus maintain a unidirectional blood flow through theheart. The heart is composed of typical vertebrate cardiac muscle,although there may be minor differences in the distributionof spontaneously active cells, the rate and nature of spreadof excitatory waves, and the characteristics of resting andaction potentials between different fish and other vertebrates.Cholinergic fibers innervate the heart, except in hagfish whichhave aneural hearts. Fish hearts lack sympathetic innervation.The level of vagal tone varies considerably, and is affectedby many factors. In some fish the heart is essentially aneural(without vagal tone) during exercise and may resemble an isolatedmammalian ventricle with increased venous return causing increasedcardiac output. There are many mechanisms that could increasevenous return in exercising fish. rß-adrenergic receptorshave been located on the hearts of some fish, and changing levelsof catecholamines may play a role in regulating cardiac activity.Changes in cardiac output in fish are normally associated withlarge changes in stroke volume and small cha-nges in heart rate.     

Umbilical vein variations: review of the literature and a case report of a persistent right umbilical vein

A case of a ligamentum teres formed from an obliterated right umbilical vein is described. It passed to the right branch of the portal vein. The quadrate and left lobes of the liver were not separated by the usual fissure. Very few cases of anomalous umbilical veins or persistent right umbilical veins have been recorded. Of these, several have been recorded only in the umbilical cord, while in others the persistent right umbilical vein has been found intra-abdominally, in an extrahepatic position, and passing directly to the right atrium or to the inferior vena cava. Its presence is generally associated with severe congenital abnormalities, in contrast with the present case. In view of the high incidence of congenital defects associated with aberrant or accessory umbilical veins, when these are detected either in the umbilical cord or in the abdomen by umbilical phlebography, it is suggested that the patient should be carefully investigated for other congenital abnormalities.     

The anatomical components of the cardiac outflow tract of chondrichthyans and actinopterygians

The outflow tract of the fish heart is the segment interposed between the ventricle and the ventral aorta. It holds the valves that prevent blood backflow from the gill vasculature to the ventricle. The anatomical composition, histological structure and evolutionary changes in the fish cardiac outflow tract have been under discussion for nearly two centuries and are still subject to debate. This paper offers a brief historical review of the main conceptions about the cardiac outflow tract components of chondrichthyans (cartilaginous fish) and actinopterygians (ray‐finned fish) which have been put forward since the beginning of the nineteenth century up to the current day. We focus on the evolutionary origin of the outflow tract components and the changes to which they have been subject in the major extant groups of chondrichthyans and actinopterygians. In addition, an attempt is made to infer the primitive anatomical design of the heart of the gnathostomes (jawed vertebrates). Finally, several areas of further investigation are suggested. Recent work on fish heart morphology has shown that the cardiac outflow tract of chondrichthyans does not consist exclusively of the myocardial conus arteriosus as classically thought. A conus arteriosus and a bulbus arteriosus, devoid of myocardium and mainly composed of elastin and smooth muscle, are usually present in cartilaginous and ray‐finned fish. This is consistent with the suggestion that both components coexisted from the onset of the gnathostome radiation. There is evidence that the conus arteriosus appeared in the agnathans. By contrast, the evolutionary origin of the bulbus is still unclear. It is almost certain that in all fish, both the conus and bulbus develop from the embryonic second heart field. We suggest herein that the primitive anatomical heart of the jawed vertebrates consisted of a sinus venosus containing the pacemaker tissue, an atrium possessing trabeculated myocardium, an atrioventricular region with compact myocardium which supported the atrioventricular valves, a ventricle composed of mixed myocardium, and an outflow tract consisting of a conus arteriosus, with compact myocardium in its wall and valves at its luminal side, and a non‐myocardial bulbus arteriosus that connected the conus with the ventral aorta. Chondrichthyans have retained this basic anatomical design of the heart. In actinopterygians, the heart has been subject to notable changes during evolution. Among them, the following two should be highlighted: (i) a decrease in size of the conus in combination with a remarkable development of the bulbus, especially in teleosts; and (ii) loss of the myocardial compact layer of the ventricle in many teleost species.