Surgical anatomy of aorto-left ventricular tunnel

BACKGROUND

Owing to the rarity of aorto-left ventricular tunnel, surgical experience with this condition is generally limited. The anatomic configuration remains to be clarified in the light of better understanding of the normal aortic root.

METHODS

Two autopsied hearts with aorto-left ventricular tunnel were examined and compared with four normal heart specimens. The normal hearts were sectioned in a variety of planes to display the ventriculoarterial junction.

RESULTS

The leaflets of the pulmonary valve in both normal and abnormal hearts have semilunar attachments to a sleeve of freestanding ventricular musculature, the infundibulum. An extensive fibrofatty tissue plane then interposes between the freestanding infundibulum and the aortic sinuses. The aorto-left ventricular tunnels in the abnormal hearts pass within this tissue plane. The aortic orifice of the tunnel is distal to the level of the sinutubular junction, whereas the ventricular orifice is located within the interleaflet triangle between the right and left aortic sinuses.

CONCLUSIONS

Aorto-left ventricular tunnels bypass the normal ventriculoarterial junction but do not penetrate the septal musculature. This has implications for the fine-tuning of surgical repair.

Morphometric analysis of atrioventricular septal defect with common valve orifice

OBJECTIVES

We sought to analyze morphometric features of atrioventricular septal defect (AVSD) in autopsy specimens and to consider the developmental implications of obstruction in either ventricular outflow tract.

BACKGROUND

Left ventricular outlet obstruction (LVO) is more prevalent in patients with Rastelli type A morphology. When tetralogy of Fallot (ToF) complicates this malformation, there is usually a free-floating superior bridging leaflet. The reasons for these associations are uncertain.

METHODS

In 133 hearts with AVSD and common atrioventricular (AV) valve orifice, we measured the degrees of horizontal and anterior deviation of the great arteries from the AV valve, the diameters of the ventricular outlets and the great arteries and the degree of deficiency of the ventricular septum.

RESULTS

In Rastelli type A morphology, the great arteries were deviated more leftward than in type C morphology (p < 0.01). Type A hearts also had a relatively small aorta, with a long and narrow subaortic tract. The presence of obstruction in either ventricular outlet was associated with a more oblique arrangement of the great arteries, with the pulmonary trunk being more leftward than in hearts without LVO (p < 0.01). In combination with ToF, the aorta was dextroposed and the pulmonary trunk was located more posteriorly (p < 0.01). No heart with type A morphology showed ToF (p < 0.01).

CONCLUSIONS

The geometric arrangement of the great arteries correlated significantly with obstruction in either ventricular outflow tract and with the Rastelli subtypes. Malrotation of the developing outlet septum may be an embryologic factor producing obstruction, with horizontal deviation of the outlets also influencing the morphology of the superior bridging leaflet.

Recurrence of accessory pathway conduction after successful radiofrequency ablation: histological findings

The histological findings from a patient with Wolff-Parkinson-White syndrome (right superior paraseptal accessory pathway) who underwent successful radiofrequency ablation and had recurrence of tachycardia one month later in the absence of overt pre-excitation are reported. Histology revealed three small, oval to circular shaped, whitish, smooth areas on the right endocardial surface, the one being situated at the atrial free wall, and the other two being at the ventricular aspect. A very small hole was present in the interventricular component of the membranus septum. The accessory pathway band passed to either side of the small hole albeit disrupted by fibrous tissue in places. These findings indicate that multiple applications may cause penetration of the myocardium, and to achieve success, complete disruption of the pathway at some point along its course is required. Recurrence of retrograde accessory pathway conduction can be explained with the impedance mismatch hypothesis.

Architecture of the atrial musculature in and around the triangle of Koch: its potential relevance to atrioventricular nodal reentry

INTRODUCTION

Recent studies suggest that atrial fibers in the approaches to the AV node form part of the dual pathways recognized electrophysiologically in patients with AV nodal reentrant tachycardia (AVNRT). Our aim was to determine, by gross dissection, the arrangement of the superficial musculature in the area of the triangle of Koch in normal hearts and in hearts with documented AVNRT, hoping to ascertain anatomic features that might contribute to the debate.

METHODS AND RESULTS

We used blunt dissection to study the architecture of the superficial atrial musculature in 16 autopsied hearts from adults who died of noncardiac disease. A well-defined pattern of architecture of muscle fibers was found in the region of the triangle of Koch, showing marked variations in 7 of the 16 specimens. The relationship of these fibers to the histologically specialized AV node was confirmed by histology in three cases. Two hearts from patients with known AVNRT, treated by ablation in one, were examined further histologically. These sections showed that the site of ablation was well distant from the histologically discrete AV node.

CONCLUSION

The variability in the arrangement of the superficial atrial muscle fibers in the area of the triangle of Koch may be one of the factors influencing the route for impulses entering the AV node. Lesions that ablate nodal reentry are within these atrial fibers rather than the histologically specialized AV node.

Angiographic and morphologic features of the left ventricle in Ebstein's malformation

Quantitative and qualitative cineangiographic analysis of the left ventricle (LV) was performed in 26 patients with isolated Ebstein's malformation, having a mean age of 23 +/- 17 years. Nine autopsied hearts with isolated Ebstein's malformation were submitted to morphologic and morphometric analysis. In 4 of the cases, it was possible to make a direct correlation between the angiographic data obtained during life and the autopsy findings. On the basis of the LV end-diastolic volume we identified 3 groups of patients: 7 with volume <60 ml/m2, another 7 with volume between 60 and 80 ml/m2, and 12 with volume >80 ml/m2. The LV ejection fraction was reduced in 2 patients with normal LV end-diastolic volume and in 6 with increased LV end-diastolic volume. The ratio of ventricular mass to LV end-diastolic volume was always adequate, but a reduction of the ventricular contractive performance (end-systolic pressure to end-systolic volume ratio <3 mm Hg/ml/m2) was found only in patients with a dilated left ventricle. No correlation was demonstrated between the extent of the atrialized component of the right ventricle (mean value 67 +/- 31 cm2, range 13 to 133) and the LV dimensions. All but 2 patients showed a leftward diastolic displacement of the ventricular septum, but in only 1 did this produce an elongated shape of the left ventricle. Sixteen had anomalies of LV dynamics: 10 with hypokinesia (3 of the posterior wall, 4 of the apex, 1 of the inferior wall, 1 of the septum, and 1 global), 6 with dyskinesia (1 of the posterior wall, 2 of the apex, 1 of the posterior wall and apex, 1 of the superior part of the septum, and 1 of the anterior wall), and 8 with premature diastolic distension of the anterobasal wall. Morphometric analysis produced mean values for myocytes of 59 +/- 10%, for the interstitium of 21 +/- 4%, and for fibrous tissue of 20 +/- 9% (normal 4 +/- 1%). Five autopsied hearts had a prolapsing and/or dysplastic mitral valve.

The morphologically tricuspid valve in hypoplastic left heart syndrome

OBJECTIVE

Competence of the tricuspid valve is crucial for survival of children with hypoplastic left heart syndrome. We studied the morphology and topology of the valvar and subvalvar structures, trying to identify abnormalities which could impair valvar function.

METHODS

A total of 82 specimens with hypoplastic left heart syndrome were examined pathologically. Measurements of valvar dimensions were taken, significant dysplasia of the valvar leaflets was noted and the muscular and tendinous supporting structures determined. The findings were correlated to the subgroups of hypoplastic left heart syndrome.

RESULTS

Of the hearts, 10 (12%) showed a bileaflet right atrioventricular valve, 27 (33%) a moderately and 2 (2%) a severely dysplastic tricuspid valve. The majority of the abnormalities was found in hearts with a patent mitral valve. In 79% of the hearts with mitral atresia, the septal surface was concave instead of convex to the right ventricular lumen and the direct tendinous attachments of the septal leaflet replaced by a multitude of freestanding papillary muscles. The number of direct septal attachments was significantly higher in hearts with a patent mitral valve.

CONCLUSIONS

The tricuspid valve in hypoplastic left heart syndrome can differ from the valve seen in normal patients. The subvalvar apparatus is different in hearts with mitral atresia, whereas dysplasia of the leaflets occurs more often together with mitral stenosis. These features should be considered in reconstructive operations as well as during diagnostic procedures.

[Effects of intraventricular and epicardial application of adenosine on electrical activity of medullary PGL neurons]

The effects of intraventricular injection and epicardial application of adenosine on spontaneous electrical activity of nucleus paragigantocellularis lateralis (PGL) neurons in rostral ventrolateral medulla (RVLM) were examined in 35 anesthetized rats with sinoaortic denervation and vagotomy. The results obtained were as follows: (1) The spontaneous discharge of 121 PGL neurons (mean discharge rate: 22.5 +/- 1.9 spikes/s) were recorded in 35 rats. (2) In response to intraventricular injection of adenosine (0.5 mumol/kg), mean arterial pressure (MAP) was initially increased by 1.7 +/- 0.2 kPa(P < 0.001) and subsequently decreased by 4.6 +/- 0.5 kPa(P < 0.001), while the heart rate (HR) was decreased by 126.5 +/- 12.3 bpm (P < 0.001). Of 35 PGL spontaneous discharge units responsive to intraventricular injection of adenosine, 30 showed an average increase from 21.9 +/- 2.6 to 29.2 +/- 3.4 spikes/s (P < 0.001), 3 with no change, while 2 with a decrease. (3) Following epicardial application of 20 mmol/L adenosine, the BP and HR were not significantly changed, while the spontaneous discharge of 22 PGL neurons were increased from 18.8 +/- 1.9 to 26.9 +/- 2.8 spikes/s (P < 0.001), and that of 3 neurons was not changed. (4) The excitatory response of PGL neurons to intraventricular injection or epicardial application of adenosine was completely inhibited by pretreatment with selective adenosine A1-receptor antagonist 8-cyclopentyl-1, 3-dipropylxanthine (DPCPX, 500 micrograms/kg). (5) Following epicardial application of phenol or bilateral stellate ganglionectomy, adenosine failed to affect the activity of PGL neurons. The results obtained indicate that adenosine may stimulate cardiac sympathetic afferents through adenosine A1-receptor, thereby resulting in the activation of PGL neurons.

[Effects of no precursor and donor on neuronal activity of rat hippocampal slices]

Using extracellular recording technique, the effects of L-arginine (L-arg), N-nitro-L-arginine (L-NNA), SIN-1 and methylene blue (MB) on spontaneous discharges of neurons in CA1 area of hippocampal slices were examined to determine the role of L-arg: NO pathway and the possible underlying mechanism. The results were as follows: (1) In response to the application of L-arg (1 mmol/L) into the superfusate for 2 min, spontaneous discharge rate (SDR) of 42/54 (77.8%) neurons was decreased significantly, while that of 12/54 (22.2%) neurons showed no change. Following the application of L-NNA (0.15 mmol/L) into the superfusate for 2 min, SDR of 25/29 (86.2%) neurons was increased markedly and that of 4/29 (13.8%) neurons was not affected. The effect of L-NNA might be reversed by pretreatment with L-arg. (2) With application of NO donor SIN-1 (5 mmol/L), SDR of 25 (100%) neurons was decreased in a dose-dependent manner. (3) After superfusing the brain slice with guanylate cyclase inhibitor, MB (3 mumol/L) for 30 min, SDR of 10 units showed significant increase as compared with control. However, MB failed to abolish the effect of L-arg on hippocampal neurons. Taken together, it is likely that NO is released during the resting state of hippocampal neurons and may inhibit the activity of hippocampus, an effect not mediated by the action of guanylate cyclase.

Anatomy of the atrioventricular junctions with regard to ventricular preexcitation

In the normal heart, the atrioventricular junctions surround the orifices of the mitral and tricuspid valves. The septal area of the junctions is much smaller than generally thought, being made up of the fibrous membranous septum and the muscular atrioventricular septum. The left atrioventricular junction gives the potential for muscular atrioventricular contiguities only in relation to the mural leaflet of the mitral valve. The right junction extends from the area posterior to the muscular atrioventricular septum to the supraventricular crest of the right ventricle. Anomalous pathways for conduction, which produce pre-excitation, can be found anywhere within these atrioventricular junctions. The pathways usually are the muscular accessory connections responsible for the Wolff-Parkinson-White syndrome, which can exist in the left, septal, or right junctions. Specific muscular connections are found in the presence of Purkinje cell tumors, diverticulums of the coronary sinus, or when taking origin from nodes of Kent at the acute margin of the ventricular mass. The latter connections are responsible for most examples of so-called Mahaim conduction, and are also described as atriofascicular tracts. The true Mahaim fibers are best described as nodoventricular or fasciculo-ventricular connections, while the pathway previously labelled as atriofascicular by the European Study Group is now best distinguished as an atrio-Hisian tract. The slow and fast pathways into the atrioventricular node are composed or ordinary atrial myocardium, the orientation of the fibers probably producing preferential conduction.

The aortic root in supravalvular aortic stenosis: the potential surgical relevance of morphologic findings

OBJECTIVE

We aimed to elucidate the structural basis of supravalvular aortic stenosis in the context of its surgical repair.

METHODS

We examined retrospectively the angiograms and echocardiograms of 37 patients and compared them with those of control groups. Additionally, we studied 8 pathologic specimens.

RESULTS

Partial adhesion of the leaflets to the stenosing ridge was observed in 54% of the cases and the leaflets were thickened and less mobile in 30%. Forty-five percent of the angiograms showed evidence of coronary orificial stenosis. The sinuses of Valsalva were significantly enlarged in 75% of the cases. Changes in dimensions of the aortic root were demonstrated more clearly by angiography than by echocardiography. In all anatomic specimens, a marked redundancy of the leaflets was observed and quantified.

CONCLUSIONS

Our data demonstrate that the entire valvular apparatus is always affected by the so-called supravalvular stenosis. Anatomic restoration of the aortic root should ideally take into account all of the deformed components by enlarging all three sinuses of Valsalva at the sinotubular junction.

Evaluation of lipid-coated microbubbles as a delivery vehicle for Taxol in brain tumor therapy

OBJECTIVE

This work evaluates the potential of lipid-coated microbubbles (LCM) as a delivery vehicle for lipid-soluble antineoplastic agents. We have shown, in rats, the selective affinity of intravenously administered LCM for tumor cells. They are internalized by the tumor cells both in vitro and in vivo. The specificity of LCM for tumors and subsequent incorporation into the cytoplasm could significantly reduce the systemic effects of an agent incorporated into the bubbles, such as Taxol.

METHODS

The in vitro methods were as follows. C6 cells (10(5) cells) were treated with Taxol-LCM (6 micrograms/ml), Taxol-Cremophore (6 micrograms/ml), or LCM alone for 8 or 24 hours. Cell death was determined by staining the cells with nuclear staining. Abnormalities of microtubule structures were ascertained by confocal microscopy. The in vivo methods were as follows. Two rat tumor models (C6 and 9L) were used. Rats were treated with single bolus injections or with repetitive (two or three) treatment courses, with respective control animals. Each course consisted of one daily tail vein injection for 5 consecutive days and then 2 days of rest.

RESULTS

When compared with either a saline control group or a group receiving Taxol in an oil vehicle, Taxol-LCM reduced tumor progression in Fischer 344 rats inoculated with 9L glioma. The most profound effect was observed with rats treated with three treatment cycles (five daily injections/cycle) separated by two rest periods (2 d/period).

CONCLUSION

Both in vitro and in vivo data indicate that Taxol can be incorporated into LCM, can be delivered to the tumor site, and can exert a measurable antitumor biological effect.

Anomalous papillary muscle as a cause of left ventricular outflow tract obstruction in an adult

Left ventricular outflow tract obstruction may be caused by abnormalities of the various structures comprised by the outflow tract. Hypertrophic cardiomyopathy is one of the more common causes, but many are rare anomalies, a collection of which we have compiled. We present a case of left ventricular outflow tract obstruction mimicking aortic stenosis in an adult. This was found to be due to abnormal insertion of a hypertrophied papillary muscle, successfully corrected by mitral valve replacement.

Is there such a thing as the "tendon of the infundibulum" in the heart?

The fibrous skeleton of the heart has featured prominently in anatomical and surgical descriptions, although all its purported components are difficult to demonstrate. In descriptions of the skeleton, there have been repeated references to the presence of a tendon (or ligament) between the aortic and pulmonary roots. Such a tendon is rarely, if ever, discussed in the context of surgical procedures being carried out on the ventricular outflow tracts. Our study was undertaken, therefore, to investigate the existence and nature of such a tendon or ligament. Serial transverse sections were made through roots of aorta and pulmonary trunk in an intact fetal heart. In addition, ten normal adult hearts were dissected to display the components of the fibrous skeleton of the heart. No discrete fibrous or elastic structure could be detected in the tissue plane between the aortic sinuses and the subpulmonary muscular infundibulum, although a fascial strand was observed in one heart. Apart from this specimen, the space between the free-standing muscular subpulmonary infundibulum and the sinuses of aorta hearing the coronary arteries was occupied only by loose fibroareolar tissue. The initial presence of the ligament was described following studies of animal and macerated human hearts. Subsequently, it would seem its existence has been passed down through generations of morphologists and surgeons without its presence being reconfirmed. We have been unable to demonstrate any structure approximating to the initial illustrations.

Location of the coronary arterial orifices in the normal heart

We examined the coronary arterial orifices in relation to the aortic valve to determine the range of normality in 23 normal hearts from autopsied adults. We determined the position of the zones of apposition between leaflets, the size of the leaflets, the number, position, and shape of the coronary arterial orifices, and their relation to the sinutubular junction. The aortic valve had three leaflets in all specimens, nearly equally spaced around the aorta. The left coronary artery arose within the left posterior aortic sinus (of Valsalva) in 16 (69%) specimens, above the sinutubular junction in five (22%), and at the level of the junction in two (9%). The distance of the left orifice from the zone of apposition between the left posterior and anterior aortic leaflets was between 13% and 61% of the width of the aortic sinus at the sinutubular junction. The right coronary artery arose within the anterior aortic sinus in 18 (78%) specimens, above the junction in three (13%), and at the level of the junction in two (9%). The distance of the orifice from the zone of apposition between the leaflets hinged from the anterior and right posterior aortic sinuses was between 5% and 62% of the width of the aortic sinus at the sinutubular junction. An accessory coronary orifice was found in the anterior aortic sinus in 17 (74%) specimens, whereas a third orifice in this sinus was found in five hearts. The coronary arterial orifices are usually located within the aortic sinuses below the sinutubular junction, but are rarely centrally located. Accessory coronary arterial orifices are found in the majority of the anterior aortic sinuses.

The affinity of lipid-coated microbubbles for maturing brain injury sites

The availability of a vehicle to deliver lipid soluble agents to a brain injury site may be of potential value in management of brain injury. This work describes the aggregation of intravenously administered Lipid-Coated Microbubbles (LCM) in the injury site following an experimental radiofrequency rat brain lesion. The bubbles can be identified around the region of the injury after the lesion has matured at least 48 h. The greatest bubbles density is evident after the lesion has matured for 10 days. This bubble density, reflecting "affinity," decreases to a plateau level from the second to the third week after injury. In order to investigate the potential relationship of bubble influx to posttraumatic astrocytosis and to cell turnover in the region, we utilized dual-channel laser-scanning confocal microscopy to track both bubble influx into the region and concomitant Glial Fibrillary Acidic Protein (GFAP) expressing astroctyte cell distribution. Cell turnover was assayed in separate sections using immunohistochemical staining of Proliferating Cell Nuclear Antigen (PCNA). We suggest a relationship between the LCM affinity and reactive astrocytes, but found no affinity of LCM for cells which stained positive with PCNA.

[Ischemic preconditioning and exogenous L-arginine reduce infarct size in rabbit heart]

The effects of NO donor--L-arginine (L-arg) and ischemic preconditioning (IP) on the hemodynamics and myocardial infarct size were examined in the anesthetized rabbit subjected to myocardial ischemia-repefusion to define whether exogenous L-arg could exert a beneficial effect in this pathological model, and whether the L-arg-NO pathway was involved in the cardioprotection provided by IP. The results obtained were as follows: (1) During the course of ischemia (30 min)-reperfusion (180 min), blood pressure, heart rate and myocardial oxygen consumption decreased progressively, and the myocardial infarct size occupied 33.9 +/- 2.4% of the whole left ventricle. (2) The myocardial infarct size could be reduced to 20.1 +/- 2.2% (P < 0.01) by pretreatment with L-arg (300 mg/kg). This myocardial protective effect of L-arg was abolished by NO synthesis inhibitor--Nitro-L-arginine (L-NNA), thereby indicating the involvement of L-arg-NO pathway. (3) IP significantly reduced the infarct size to 21.9 +/- 2.1% (P < 0.01), indicating the prominent cardioprotective effect of such an intervention. Since L-NNA showed no effect on the cardioprotection afforded by IP, it was implied that the L-arg-NO pathway was not involved in the cardioprotective mechanism of IP. (4) Exogenous L-arg might markedly augment cardioprotection provided by IP. The above results strongly suggested that the cardioprotective effect of L-arg on ischemia-reperfused myocardium was mediated by L-arg-NO pathway, which, however, was not involved in the cardioprotection provided by IP.

Anatomy of the aortic root with particular emphasis on options for its surgical enlargement

BACKGROUND AND AIMS OF THE STUDY

The aortic root is a frequent site of surgical intervention, both in adults and children, yet there is ambiguity about the precise nature and relation of the various structures composing the aortic root. The present review aims to clarify these ambiguities and to explain the morphological basis of surgical procedures for enlargement of the aortic root.

MATERIALS AND METHODS

Using autopsied specimens of normal hearts, the morphology of the attachment of the leaflets, the interleaflet triangles and the circular ventriculo-arterial junction of the aortic root were studied in detail, paying special regard to fibrous and muscular continuity, relation to the atrioventricular conduction axis, and the coronary arterial branching. Surgical dissections and incisions required for enlargement of the aortic root were simulated in these specimens.

RESULTS

It was evident that the locus of attachment of aortic valvar leaflets takes the form of three (semilunar) crescents. This attachment is not circular, as the word 'annulus' suggests, neither does it correspond to the anatomical ventriculo-arterial junction. During implantation of a mechanical valve in the aortic position, a circular prosthetic valve ring is sutured on to the attachments of the native valvar leaflets. This must entail some distortion when the sutures are tied. Analysis of autopsied specimens showed that, on completion of the process of suturing, the location of the prosthetic valve is close to the anatomic ventriculo-arterial junction-one of the true annular regions of the aortic root.

CONCLUSIONS

The continuity of the aortic valvar leaflets and the interleaflet triangles with structures such as the aortic (anterior) leaflet of the mitral valve posteriorly, and with the muscular ventricular septum anteriorly, provide an opportunity for surgeons to enlarge the aortic root by widening of the anatomic ventriculo-arterial junction.

Fibrous matrix of ventricular myocardium in tricuspid atresia compared with normal heart. A quantitative analysis

BACKGROUND

The collagen matrix is a small component of the myocardium, but it provides a supportive framework. An increase in collagen in the pressure-overloaded ventricle is known to cause myocardial stiffness. However, little is known about the collagen matrix in the volume-overloaded ventricle, particularly in relation to congenital heart disease.

METHODS AND RESULTS

We examined a total of 53 hearts with tricuspid atresia and 58 normal hearts matched for age. Using a microscopic-morphometric method, we analyzed the percentage per field area occupied by interstitial fibrous tissue in four sites in the ventricular mass for each specimen. A comparison of sampling sites showed no significant variations between normal and malformed hearts. Results from a homogeneity of regression co-efficients analysis suggested that the two groups shared the same basic relation of proportion of fibrosis with age. The use of ANCOVA, however, revealed a clear separation between the extents of fibrous tissue in the two groups of hearts.

CONCLUSIONS

The myocardium of hearts with tricuspid atresia is consistently more fibrotic than normal heart and is probably an inherent part of the malformation. This difference could explain, at least in part, the clinical observation that the left ventricle is frequently abnormal, even at an early age.

Ventricular myoarchitecture in tetralogy of Fallot

BACKGROUND

Little attention has been paid to the architecture of the muscle fibres of the ventricular walls in congenitally malformed hearts. In this study the gross pattern of myocardial fibres in normal hearts was compared with that in cases of tetralogy of Fallot.

METHODS AND RESULTS

After morphological examination nine specimens with tetralogy were dissected to study the ventricular myoarchitecture. Changes were found in the shape of the malformed ventricles. The ventricular walls were arranged in layers in all hearts. Superficial and deep layers were present in both ventricles, with the superficial layer showing a more oblique orientation in the specimens with tetralogy than in normal hearts. Modifications of muscle fibre that were related to the type of malformation were seen in the deep layer. A middle layer was present in the left ventricles of normal hearts and specimens with tetralogy: this showed a horizontal orientation in both groups. In contrast, a middle layer was found in the right ventricle only in specimens showing tetralogy.

CONCLUSIONS

The malformed hearts showed modifications in ventricular shape, in the arrangement of muscle in the right ventricle, and in the overall myoarchitecture. These changes could well be the consequence of the same agent (or agents) that caused the structural defect.

[Effects of microinjection of L-NNA and SNP into ventrolateral medulla on blood pressure, heart rate and renal sympathetic nerve activity in rats]

The effects of microinjection of a NO synthase inhibitor--N-nitro-L-arginine (L-NNA) and NO donor-sodium nitroprusside (SNP) into ventrolateral medulla on blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RSNA) were examined in anesthetized rats to define the role of L-arginine: NO pathway in the central regulation of BP and to explore the underlying mechanism. The results obtained were as follows: (1) Following microinjection of L-NNA into rostral ventrolateral medulla (RVLM), both of MAP and RSNA were increased. The effects lasted for more than 30 min and could be reversed by prior intravenous injection of L-arginine. (2) In response to microinjection of SNP into RVLM, MAP and RSNA were decreased, while HR showed no significant change. (3) During microinjection of L-NNA into caudal ventrolateral medulla (CVLM), MAP, HR and RSNA were decreased. (4) Upon injection of SNP into CVLM, MAP and RSNA were increased, but HR showed no significant change. The above-mentioned results indicate that the L-arginine: NO pathway may exhibit a modulatory action on the activity of ventrolateral medulla neurons.

[Effects of L-NNA and NO donors on spontaneous activity of rostral ventrolateral medulla neurons]

The effects of intravenous injection of a NO synthase inhibitor--N-nitro-L-arginine (L-NNA) and NO donors--sodium nitroprusside (SNP) and SIN-1 on blood pressure (BP), heart rate (HR) and spontaneous activity of rostral ventrolateral medulla (RVLM) neurons were examined in 22 anesthetized rats to define the action site of L-arginine: NO pathway in BP regulation. The results obtained were as follows. (1) Following i.v. injection of L-NNA, mean artery pressure (MAP), HR and spontaneous discharge rate of 14 RVLM neurons were all increased, all effects starting at 5 min after administration of L-NNA and lasting for more than 30 min. (2) In response to i.v. injection of SNP, MAP was decreased with concomitant increase in HR and the discharge rate of 23 RVLM neurons decreased in a dose-dependent manner. These effects were rapid in onset and also disappeared promptly. To exclude the effect of cerebral ischemia induced by decreased of BP, the effects of intracarotid injection of SNP were examined. Following i.a. injection, MAP was only slightly decreased and HR showed no significant change, but the discharge rate of 14 RVLM neurons was significantly decreased. (3) During i.v. injection of another NO donor--SIN-I, MAP and the spontaneous discharge rate of 11 RVLM neurons were decreased. The above results indicate that the L-arginine: NO pathway may exert a modulatory action on the blood pressure through rostral ventrolateral medulla.