家猪心脏二尖瓣复合体的形态学观测

目的　观测家猪心脏二尖瓣复合体 ,为家猪心脏研究和心脏移植积累资料。方法　甲醛固定的家猪心脏 3 5例 ,解剖并观测二尖瓣复合体。结果　家猪心脏二尖瓣复合体由瓣环、瓣膜、腱索和乳突肌构成 ,瓣环周长为 73 0 0± 9 71mm ;前瓣、后瓣、前外侧连合、后外侧连合的高度分别为 17 45± 1 99mm、16 3 3±2 2 2mm、5 68± 1 3 7mm、5 3 5± 1 11mm ,前外侧连合、后内侧连合的宽度分别为 4 3 1± 0 80mm、4 40±0 63mm ,前乳头肌起始 ,腱索附着于前瓣、后瓣和后内侧连合的条数为 4 0 0± 1 3 0、5 2 1± 1 84、2 44±1 16,后乳头肌起始 ,腱索附着于前瓣、后瓣和前外侧连合的条数为 3 76± 1 78、5 3 8± 2 2 0、2 12± 0 91。结论　家猪心脏二尖瓣复合体中各结构与人类相似 ,但大小有一定差异     

山羊心脏三尖瓣复合体的解剖学特征

目的　观测山羊心脏三尖瓣复合体形态特征 ,为心脏研究和比较解剖学积累资料。方法　 1 0 %甲醛固定的山羊心脏 1 0 5例 ,解剖并观测三尖瓣复合体 ,保留隔缘肉柱和羊心腔特有结构。结果　山羊心脏三尖瓣复合体前瓣、后瓣 ,隔侧瓣的高度分别为 :8 4 3± 2 0 0mm、8 1 3± 1 90mm、7 6 8± 2 .1 0mm ;宽度分别为 :1 4 0 3± 3 1 6mm、1 4 35± 2 70mm、1 6 78± 3 4 6mm。前乳头肌腱索总条数为 :7 79± 1 72。后群乳头肌腱索条数为 :7 4 2± 2 1 7,后群乳头肌的个数为 2 36± 0 92。隔侧群乳头肌腱索总条数为 :1 0 4 2± 2 4 9,隔侧群乳头肌的个数为 4 0 5± 1 4 4。隔缘肉柱的长度为 9 5 3± 3 4 6mm。结论　山羊心脏三尖瓣复合体和人类心相似 ,但其心腔结构有其特异性     

山羊心脏二尖瓣复合体的应用解剖学研究

目的观测山羊心脏二尖瓣复合体的解剖结构,为比较解剖学积累资料。方法利用大体解剖方法观测山羊二尖瓣复合体的形态结构。结果山羊心脏二尖瓣复合体由二尖瓣瓣环、瓣膜、腱索和乳头肌构成,二尖瓣瓣环周长为47.00±7.39mm,前瓣的高度为7.93±2.03mm,宽度为21.58±4.17mm,后瓣的高度为9.89±1.90mm;宽度分别为20.61±4.22mm;前乳头肌起始点至前瓣、后瓣和后内侧连合的腱索条数分别为5.06±1.71,3.19±1.11,1.25±0.48;后乳头肌起始点附着于前瓣、后瓣和前外侧连合的腱索条数分别为4.50±1.88,4.16±1.84,1.32±0.54。结论山羊心脏二尖瓣复合体的结构与人类相似,但形态有特异性。     

三尖瓣的应用解剖学研究

用肉眼、光镜和图像分析法对35例离体心脏问(30例固定标本,5例新鲜标本)的三尖瓣及其连合进行广形态学观察和测量,并对各尖瓣基带内的心肌纤维的来源、性质及分布进行了研究.结果表明:前、后、膈尖瓣的面积分别为445.76±6354 mm~2,480.54±120.56mm~2,361.44±95.07mm~2.三尖瓣连合部可分为连合型和无连合型,前者又分为常见型、低连合型、扇叶型和网孔型,其中前隔连合的无连合型、低连合型及网孔型,为超声心动诊断提供了形态学依据,解释了正常人三尖瓣前隔连合处出现有血液返流的现象.三尖瓣基带中的心肌纤维来自心房或心室肌,前者为Purkinje纤维,多见伸至后大瓣;后者为普通心肌纤维,各有一例伸入前尖瓣和隔尖瓣、其中前尖瓣基带中的肌纤维可伸入健索内.     

三尖瓣装置的应用解剖研究Ⅰ.瓣膜、腱索和乳头肌的生化成分

选用脑死亡2～4小时后成年男性(20～40岁)新鲜心脏的三尖瓣瓣叶、腱索和乳头肌标本各20例,用生物化学方法测定了瓣叶、腱索、乳头肌尖部和乳头肌基部内羟脯氨酸(hydroxyprolin,HX)和氨基已糖(aminohexose,AH)的含量(μg/100mg组织),结果依次为1435.00±138.46和1670.33±358.39.2156.26±309.38和2156.26±309.38和1324.16±428.37、543.25±115.94和1267.50±105.23、347.50±80.48和1238.00±202.71.上述各部内HP的含量比值依次为1:1.50:0.39:0.24;AH为1:0.79:0.76:0.74.HP在腱索内含量最高,瓣叶内次之,乳头肌内最低.AH在瓣叶内含量最高.结果提示腱索和瓣叶是富含HP和AH的组织,这与形态学上观察到的腱索和瓣叶内胶原纤维密集的结果相符.此结果为进一步研究瓣膜装置的生化成分和对心瓣膜疾病的诊断、治疗提供参考资料.     

成人房室隔的研究

利用56例成人心脏标本和4例心脏切片对人心房室隔进行了观察和测量.认为房室隔位于右房与左室之间,上界为二尖瓣前瓣环和主动脉后瓣环与右瓣环,下界为三尖瓣隔侧瓣附着缘.前界为室上嵴后缘,后界为冠状窦口.房室隔分为前部与后部,分别与左室流出道和流入道相对应.测量了房室隔的下缘下、前部长和后部长,分别为2.95±0.08,1.62±0.07和1.33±0.07cm;测量后缘宽、中部宽和前部宽,分别为1.61±0.05,1.04±0.04和0.49±0.04cm.描述了各部的组织结构.对房室隔的命名、机能和临床意义进行了讨论.     

左室假腱索的解剖学研究及其临床意义

目的　为临床提供有关左室假腱索的解剖学基础。方法　采用 44例成人心脏标本 ,观察左室假腱索的出现率、附着点和形态 ,并对其长度和直径进行测量。结果　 44例心脏中 33例 (75 % )出现左室假腱索共 75条 ,平均每例 2 .2 7± 1 .38条。左室假腱索多附着于室间隔和后乳头肌、乳头肌和游离室壁之间。左室假腱索的长度和直径分别为 1 4 .62± 7.2 9mm和 0 .69± 0 .64mm。结论　左室假腱索是心内正常解剖结构 ,了解其形态特征 ,有助于临床的诊断     

成人正常心脏二尖瓣瓣膜复合器形态学研究

本文对29例法医尸检后的成人正常心脏二尖瓣瓣膜复合器形态结构进行了调查,结果表明左房室口周径平均86.9±9.9mm。依据主乳头肌尖端指向、腱索形态并结合心外标志确定瓣膜连合,测得前外侧连合平均宽8.4±1.3mm,深5.7±1.7mm;后内侧连合平均宽9.2±2.3mm,深6.2±     

心脏室上嵴形态观察

观察了102例中国人心脏室上嵴,室上嵴由漏斗隔、隔带和壁带组成.漏斗隔长3.09±0.51cm;隔带呈Y形.其主干长2.14±0.58cm,宽1.38±0.33cm.主动脉右窦最高点位于肺动脉右瓣下方,主动脉右窦下缘,在漏斗隔的上方.锥状乳头肌有1～3个,隔缘肉柱可终止于前乳头肌根部、右室前壁或两者.     

正常人二尖瓣装置的应用解剖研究Ⅱ腱索的形态和组织结构

作者对脑死亡2小时或25分钟以内的31例(男,20～40岁)正常新鲜心脏的二尖瓣腱索应用显微外科解剖技术、组织学或电镜等方法进行了研究。二尖瓣腱索平均18.73±4.36支,其中连于前乳头肌的平均8.56±2.55支;连于后乳头肌的9.96±3.71支。I、Ⅱ、Ⅲ级腱索分别为11.24±3.12、4.48±1.67、1.88±1.09支。Ⅰ、Ⅱ、Ⅲ级腱索的比例为1∶0.4∶0.2。连于前、后乳头肌腱索的长度分别为14.09±2.98.15.16±3.64mm。中部横径分别是0.78±0.35mm、0.67±0.28mm。HE染色的组织切片上见腱索主要由胶原纤维组成,见到核呈椭圆形的成纤维细胞和圆形的肌细胞核。VG染色的切片上见腱索内的胶原纤维束深入于乳头肌肌束之间、腱索和肌纤维外膜互相移行。在扫描电镜照片上观察了腱索内胶原、弹力、网状纤维的形态和排列。在透射电镜照片上观察了胶原纤维的形态与排列。     

Quantitative morphology of the normal human tricuspid valve: Autopsy study of 24 cases

Objective: To describe thoroughly and quantitatively the morphologic features of the human tricuspid valve, to define and classify classify certain prominent normal variations, and to offer a clear and concise terminology for describing its morphology. Background. In recent years there has been growing interest in the tricuspid valve. Noninvasive imaging is now commonplace and remarkably detailed. Surgical interventions involving the tricuspid valve have become increasingly common. These factors underscore the need variations. Methods. Quantitative and anatomic features of the tricuspid valve were studied in 24 normal hearts at autopsy from subject evenly distributed by age and sex. Leaflet length, surface area, chordal number, and leaflet morphology were recorded. Results. Valves demonstrated some degree of leaflet subdivision in 92% of cases. Mean tricuspid valve length was 11.3 ± 0.1 cm and the surface area was 21.0 ± 1.1 cm². Mean lengths and surface areas were similar for the anterior, posterior, and septal leaflets (38–42 mm and 5.9–7.8 cm², respectively). However, for a given valve, the longest leaflet could be twice the length and three times the area of the smallest. Calculated valvular diameter was 2.13 ± 0.03 cm/m². The tricuspid valve was served by and average of 170 ± 36 chordae tendineae, 49% inserted on the free edge of the valve, 44% on the undersurface, and 7% on the basal regions. Chordal density (number of chordae/cm²) was greater in women than men (9.9 ± 0.5 vs. 7.3 ± 0.7 chordae/cm², P < 0.02). The septal leaflet had the greatest chordal density and the anterior leaflet the lowest (12.7 ± 0.9 vs. 5.9 ± chordae/cm²). Conclusions. The concept of chordal density for the tricuspid valve has not been previously described and may be clinically relevant in the pathogensis of valvular prolapse. Modifications of existing tricuspid valve nomenclature are suggested. © 1993 Wiley-Liss, Inc.     

Papillary muscles and tendinous cords of the right ventricle of the human heart morphological characteristics

A series of 79 normal human hearts was studied focusing on the morphological characteristics of the papillary muscles of the right ventricle and their tendinous cords (chordae tendineae). The number, incidence, length and shape of the anterior, septal and posterior papillary muscles were observed. The tendinous cords attached to each papillary muscle were counted at their origin. The papillary muscles and the tendinous cords were measured in situ and after the removal of the right atrioventricular valve (tricuspid valve). The anterior and posterior papillary muscles (apm, ppm) were present in 100% of the cases. The septal papillary muscle (spm) was absent in 21.5% of the hearts. The apm presented 1 head in 81% and 2 heads in 19% it was 19.16 mm in length. The spm was one-headed in 41.7% and presented two heads in 16.5% the presence of a 3 and 4 heads appeared in 12.7% and 7.6% respectively the spm was 5.59 mm in length. The ppm had 1 head in 25.4%, 2 heads in 46.8%, 3 heads in 21.5% and 4 heads in 6.3% of the cases it was 11.53 mm in length. Tendinous cords (TC) varied as follows from 1 to 11 TC originated in the apm (mean 4.74) from 1 to 8 TC originated in the ppm (mean 2.67) and from 1 to 5 TC originated in the spm (mean 1.77).     

Anatomic study of the tricuspid valve in children

We performed an anatomic study of the right atrioventricular valve in children under one year of age using a conservative method of dissection of the heart valve. The main aspects studied were the number of cusps and their morphometric characteristics, such as the width of the base and the depth of the cusps. Other parameters studied were the number of papillary muscles, number of tendinous cords, and diameter of the fibrous ring and the last one were divided in three regions, anterior, posterior and septal for localization of cusps. Our results showed that the number of cusps varied from two to four. Three cusps was the commonest finding and the fourth cusp, if present, was classified as anterolateral in location. The anterior and septal cusps had bases bigger than those of the posterior and anterolateral cusps; the septal cusp was deeper than the others; and the number of tendinous cords was greater for the anterior and septal cusps than for the posterior and anterolateral cusps. In addition, the posterior region showed great variability: in 35.7% it was occupied by undeveloped valve tissue and the posterior valve in these cases was located anteriorly.     

山羊心脏房间隔、室间隔的观测及解剖学特征

目的　观测山羊心脏房间隔、室间隔的形态及其位置关系,为心脏研究提供比较解剖学资料。方 法　用大体解剖法观测山羊房间隔的卵圆窝、室间隔膜部和肌部。结果　卵圆窝纵轴长9.63±2.18mm,横 轴长6.85±1.54mm,卵圆窝中心点距冠状窦口中心点9.09±2.10mm,距三尖瓣隔侧瓣中点12.81±2.34 mm,距二尖瓣前瓣中点8.94±2.65mm。卵圆窝上缘厚1.26±0.50mm,下缘厚1.80±0.40mm,前缘厚2.39 ±1.78mm,后缘厚2.29±0.89mm。室间隔膜前部宽2.94±1.13mm,中部宽4.66±1.15mm,后部长6.13 ±1.41mm,后部宽9.62±1.83mm,下缘长15.06±2.63mm。室间隔肌部上缘长37.63±4.48mm,前缘长 52.84±6.22mm,后缘长33.77±2.96mm,厚度9.34±1.69mm。结论　山羊心脏房间隔和室间隔与成人相 似,是心外科房间隔、室间隔修复的良好材料。     

Two unusual congenital anomalies of the tricuspid valve

We describe two unusual congenital anomalies of the tricuspid valve discovered incidentally at autopsy. One is an abnormal attachment of the tricuspid septal leaflet to one of two posterior papillary muscles with a concomitant fusion of the right ventricular septal and anterior papillary muscles in a patient with ectodermal dysplasia. The other involves a fenestration defect of the septal leaflet of the tricuspid valve in a patient with aortic stenosis, coronary artery atherosclerosis, and cardiac amyloidosis.     

颈椎椎间孔与脊神经的形态观察

对30例成年男性颈椎颈2到胸1间的348个椎间孔和相应神经根形态位置进行了观察,对其径线进行了测量。测量结果:椎间孔平均值:前后径5.17±0.81mm,上下径为7.58±1.15mm。神经根平均值:前后径为4.01±0.65mm,上下径为5.60±0.93mm。颈4到颈7间榷间孔与相应神经根之间的间隙较小。本文结合临床和有关文献进行了讨论。     

Variations in atrioventricular valve innervation in four species of mammals

In this series of studies, the innervation patterns of whole-mount preparation 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 opposum. In spite of the questions raised regarding the significance of valve innervation in light of the success of valve prostheses, there is relatively high morbidity and mortality associated with heart valve replacement, partly due to deterioration in ventricular function. We and other investigators have reported that valvar nerves extend to the chordae and papillary muscles, varying with valve and species. This anatomical information about normal valves helps to lay the foundation for future studies of the role of valve innervation in the regulation of cardiac function and dysfunction. Such knowledge should be applicable for the control and management of myocardial infarction, valve disease, valve replacement, valvuloplasty, cardiac transplantation, administration of drugs, etc.