Development of the murine pulmonary vein and its relationship to the embryonic venous sinus

BACKGROUND

Arguments concerning the development of the pulmonary vein, and its relationship to the embryonic venous sinus (sinus venosus) have continued for well over a century. Recently, attention has again been focused on the origin of the pulmonary vein. It has been suggested that, whereas the pulmonary vein originates from the left atrium in humans, in all other vertebrates it originates from the venous sinus, with subsequent transfer to the left atrium. The nature of this transfer has not, however, been elucidated, although there is speculation that the pulmonary vein is "pinched off" from the left side of the embryonic venous sinus.

METHODS

We studied closely staged hearts of normal mouse embryos from a C57BL/6 x CBAcross days 10 and 11 of gestation (plug day = day 1). Two series of embryos were collected and fixed in 2% glutaraldehyde, 1% formaldehyde, buffered with 0.05 M sodium cacodylate pH 7.4 (adjusted to 330 mOsm with NaCl). One series was wax embedded, serially sectioned, and stained with Masson's trichrome. The second series was subject to microdissection and scanning electron microscopy.

RESULTS

The atrial component of the heart tube is attached to the body of the embryo by reflections of the atrial myocardial wall. The attachment can be considered, from the outset, as the heart stalk, with the myocardial-mesodermal connections forming a horseshoe of tissue that projects ventrally into the lumen of the atrium, surrounding a single evagination in the midline of the embryo. This heart stalk is cranial to the connections of the tributaries of the embryonic venous sinus and ventral to the foregut. When traced through its developmental stages, the evagination in the centre of the stalk, which we describe as the pulmonary pit, is seen to become the portal of entry for the developing pulmonary vein.

CONCLUSIONS

The heart stalk, representing the area used by the pulmonary vein to gain access to the heart, and analogous to the dorsal mesocardium, is, from the outset, discrete from the area occupied by the orifices of the horns of the embryonic venous sinus. The pulmonary vein does not, in the mouse, develop from the tissues that form the walls of the tributaries of the systemic venous sinus. Comparisons with other studies suggest that early events in the development of the pulmonary vein are likely to be the same in all mammals, including humans.

Specification of left-right asymmetry in mammals: embryo culture studies of stage of determination and relationships with morphogenesis and growth

The internal mammalian body plan is laterally asymmetric with a consistent handedness such that some organs are placed on one side (stomach on the left, for example) and paired organs are not symmetric (for example, there are more lung lobes on the right). Some chemical teratogens can affect the development of asymmetry, and some can cause asymmetric defects in overtly symmetric structures, but the mechanisms are unknown. We have used chemical treatment of rat embryos in culture to examine the stage at which the left-right axis is determined and show that all effective treatments can affect left-right axis development up to the early headfold stage, but not from late headfold onwards. This suggests that the left-right axis is determined by the late headfold stage, even though the embryo is overtly symmetric at this stage. It appears to be much easier to induce an abnormal left-right axis from late allantoic bud and early headfold stages than the early allantoic bud stage, but we have not established the earliest stage at which a response can be induced. Complete situs inversus was the most common chemically induced abnormality, although heart looping and body turning could be inverted separately, suggesting that the two phenomena are linked but not wholly interdependent. The treatments appeared to cause a loss of handedness, rather than inducing inversion, since the incidence of an abnormal left-right axis never exceeded 50%. All treatments except methoxamine, an alpha1 adrenergic agonist, induced an abnormal left-right axis in association with other morphologic defects and growth retardation. However, there was no relationship between the severity or incidence of dysmorphology, nor growth retardation, and left-right abnormality, suggesting that although the process that specifies lateral asymmetry is labile, it is independent of general growth and morphogenesis.

Left-right development: mammalian phenotypes and conceptual models

Consistent left-right asymmetry in a population requires a special kind of developmental specification. Models of this process must account for the complex phenotypes seen when left-right is abnormal. In some human and mouse mutations, there appears to be a randomisation of global situs to either solitus or inversus, whereas in the inv/inv mouse essentially all are inversus. However, in these and all additional examples there are frequently other anomalies, including symmetry (isomerism) and discordance between organs (heterotaxia). Current models invoke a molecular chiral referent as the source of the primary handed information. We describe a new two-gradient model which accommodates all defects of situs whilst leaving the primary asymmetry unaltered.

The Telemedicine Information Exchange (TIE)

An on-line information service, the Telemedicine Information Exchange (TIE), was established to provide a comprehensive source of telemedicine information. The TIE comprised a number of frequently updated, searchable, linked databases, each dealing with an important aspect of telemedicine. These included an extensive bibliography on telemedicine consisting of more than 2000 citations, many with abstracts. There was also a series of topical sections describing current telemedicine projects, products and services, legislation, funding, research activities, and news in the field. The TIE was designed to exploit the features of electronic information storage: hypertext linking between related pieces of information; specialized views (technical, legal, and business) of the bibliographic database; and usage monitoring to determine which data were most frequently accessed and therefore where any enhancement should be done. The TIE was made available via the World Wide Web, by remote telnet access over the Internet, and via modern. The rapid increase in the usage of the TIE since its introduction in April 1995 indicated that the TIE satisfied a need in the telemedicine community.

Regulation of serotonin re-uptake transporter mRNA expression by ovarian steroids in rhesus macaques

It has been widely hypothesized that the ovarian steroids, estrogen (E) and progesterone (P), act on serotonin neurons to modulate mood and increase prolactin secretion in women. However, information is needed on the molecular consequences of ovarian hormone action in serotonin neurons. This study examined the effect of E and P on the expression of mRNA for the serotonin re-uptake transporter (SERT) in monkeys using in situ hybridization and a 253 bp human SERT cRNA probe. Monkeys (n=5 animals/group) were ovariectomized and hysterectomized (spayed) and then untreated (control), or treated, with E for 28 days (E treated) or treated with E for 28 days and supplemented with P for the last 14 days of the E regimen (E+P treated). Densitometric analysis of autoradiographs with gray-level thresholding was performed at five levels of the dorsal and median raphe. The number of pixels exceeding background in defined areas was obtained (pixel number). The average pixel number for spayed, E- and E+P-treated groups was 22 280+/-3517, 15 227+/-1714, and 14 827+/-2042, respectively, in the combined dorsal and median raphe. In the E- and E+P-treated groups compared to the control group, there was a 32% and 33% decrease in SERT mRNA signal represented by pixel number (ANOVA, P<0.05). Hence, E- and E+P-treated groups were significantly less than the control group, but they were not different from one another. Also, there were significantly fewer SERT mRNA-positive cells in the dorsal raphe of E- and E+P-treated groups (ANOVA, P<0.001). Therefore E, with or without P, reduces SERT mRNA expression. These results suggest that the ability of P to increase prolactin secretion in E-primed monkeys does not involve an action at the level of SERT gene transcription. Hence, the mechanism by which the CNS transduces the action of P on prolactin secretion remains to be elucidated. However, these data suggest that one action of E replacement therapy in postmenopausal women may be to decrease expression of the SERT gene.

Cardiac morphology at late fetal stages in the mouse with trisomy 16: consequences for different formation of the atrioventricular junction when compared to humans with trisomy 21

OBJECTIVE

The mouse with trisomy 16 (Ts16) is held to be a genetic model for humans with Down's syndrome (Ts21). Both trisomies are associated with atrioventricular septal defects, but the precise morphology in the mouse remains unclear. We have therefore characterised cardiac morphology in the mouse with Ts16.

METHODS

Ts16 fetuses, from a Rb(11.16)2H/Rb(16.17)7Bnr x C57BL/6J cross, were collected on gestational days 17 or 18 (full term = 19 days) and studied using scanning electron microscopy and serial sections.

RESULTS

The hearts showed a spectrum of deficient atrioventricular septation which we categorised into two types. In one, a common atrioventricular junction was separated into right and left orifices by a tongue of tissue joining two valvar leaflets that bridged the ventricular septum to varying extent. In the other, a common atrioventricular junction was connected exclusively to the left ventricle. All hearts had ostium primum atrial and ventricular septal defects, together with abnormal ventriculo-arterial connections. No heart had the typical morphology seen in the human with Down's syndrome, namely a balanced common atrioventricular junction, guarded by a common valve, with the aorta connected exclusively to the left ventricle.

CONCLUSIONS

The cardiac defects seen in Ts16 mice show marked differences from the typical anatomy in human Ts21, suggesting more complex mechanisms of cardiac dysmorphogenesis in Ts16. The mouse model will prove valuable in elucidating the mechanism of normal expansion of the atrioventricular junctions, and help in charting the precise steps involved in atrial and ventricular septation.

Gene expression domains as markers in developmental toxicity studies using mammalian embryo culture

We are examining the hypothesis that expression domains of developmental control genes may be informative markers in mammalian embryo culture studies of developmental toxicity. Expression domains might be altered directly by chemical exposure, or might reflect developmental abnormality prior to any overt morphological defect. Whole-mount in situ hybridization using digoxygenin-labeled RNA probes was used to monitor the regions of expression of Hoxb-4, Pax-3 and Emx-2. These genes were selected because of their different restrictions within the developing CNS; Hoxb-4 for its anterior margin in the hindbrain, Pax-3 for its dorso-ventral pattern in the spinal cord, and Emx-2 for being restricted to a portion of the forebrain. Valproic acid was used as a prototype developmental toxicant because of its known actions on neural tube closure and on segmentation. For patterns of expression, we made three comparisons, between: rat in vivo developed embryos and published descriptions for mouse; rat cultured and in vivo; control and valproate exposed. For these genes, there were no differences between domains of expression in rat and mouse, nor between rat cultured and in vivo embryos. In valproate-exposed embryos, some domains were spatially abnormal, for example Pax-3 in the neural crest, but this was coincident with structural defects induced by the treatment. There was no indication, for these three genes, and this teratogen, that treatment caused any shifts in boundaries of expression, nor induced any ectopic domains, even though exposures induced overt malformation.

Embryonic asymmetry: left TGFbeta at the right time?

Vertebrates have consistent differences between their left and right sides. In all species, nodal, a transforming growth factor beta superfamily signalling protein, is involved in a late step in the pathways that specify such asymmetry in the embryo. Earlier components seem not so well conserved.

Decentration of 5.1 mm intraocular lenses after continuous curvilinear capsulorhexis and in-the-bag fixation

PURPOSE

To determine the incidence of decentration in eyes with 5.1 mm optic intraocular lenses (IOLs) and to assess the effect on vision.

SETTING

Clinical Cataract Research Unit, Oxford Eye Hospital, Oxford, England.

METHODS

Patients having phacoemulsification and small IOL implantation over 12 months were identified and invited for assessment. Intraocular lens decentration was measured geometrically using a modified, digital, retroillumination camera. The expected incidence of symptoms caused by decentration was estimated by determining the presence of an IOL edge within an artificial pupil overlaid on the digital image.

RESULTS

In 13 eyes (20%), IOL decentration was more than 0.5 mm. Symptoms were expected in 38 patients (59%) but occurred in only 14 (22%).

CONCLUSION

Decentration of the 5.1 mm optic IOL caused fewer clinical problems than anticipated, although the results raise concerns that such IOLs may be inappropriate in patients who need excellent vision in scotopic illumination.

Hepatitis-B-virus resistance to lamivudine given for recurrent infection after orthotopic liver transplantation

BACKGROUND

Orthotopic liver transplantation for end-stage hepatitis-B-virus (HBV) infection is commonly complicated by recurrence of HBV. Lamivudine, a cytosine nucleoside analogue, has been shown to suppress HBV infection. We report the development of resistance to lamivudine in three patients who underwent transplantation for end-stage liver disease secondary to hepatitis B.

METHODS

Two of the patients received lamivudine for recurrent HBV infection after transplantation, whereas the third patient began treatment 1 month before transplantation in an attempt to prevent HBV recurrence after transplantation. The three patients initially responded well to treatment, but viral recurrence occurred after 9-10 months of treatment in all patients. HBV DNA was amplified from serum and sequenced through a conserved polymerase domain-the tyrosine, methionine, aspartate, aspartate (YMDD) locus. We assessed the susceptibility of HBV to lamivudine by infecting primary human hepatocytes with serum taken before the start of treatment and after recurrence in varying concentrations of lamivudine.

FINDINGS

DNA sequencing showed a common mutation within the YMDD locus of the HBV polymerase gene in all patients during lamivudine treatment. In hepatocyte cultures infected with pretreatment serum, HBV DNA concentrations were reduced to less than 6% of those in control cultures by addition of lamivudine in concentrations as low as 0.03 mumol/L. By contrast, in cultures treated with serum taken after recurrence, HBV DNA concentrations did not fall below 20% of control values, even with lamivudine at 30 mumol/L.

INTERPRETATION

Resistance to lamivudine has been reported in HIV patients with mutations in the YMDD locus of the polymerase gene. Our findings indicate a common mechanism of lamivudine resistance for HIV and HBV that involves similar point mutations in homologous domains of the viral polymerases.

Ovarian steroid regulation of tryptophan hydroxylase mRNA expression in rhesus macaques

Progesterone (P) stimulates prolactin secretion through an unknown neural mechanism in estrogen (E)-primed female monkeys. Serotonin is a stimulatory neurotransmitter in prolactin regulation, and this laboratory has shown previously that E induces progestin receptors (PR) in serotonin neurons. Therefore, we questioned whether E and/or E+P increased serotonin neural function. The expression of mRNA for tryptophan hydroxylase (TPH) was examined in ovariectomized (spayed) control, E-treated (28 d), and E+P-treated monkeys (14 d E and 14 d E+P) using in situ hybridization and a 249 bp TPH cRNA probe generated with RT-PCR (n = 5 animals/group). Densitometric analysis of film autoradiographs revealed a ninefold increase in TPH mRNA in E-treated macaques compared to spayed animals (p < 0.05). With supplemental P treatment, TPH mRNA signal was increased fivefold over spayed animals (p < 0.05), but was not significantly different compared to E-treated animals. These results were verified by grain counts from photographic emulsion-coated slides. There were significantly higher single-cell levels of TPH mRNA in serotonergic neurons of the dorsal raphe in E- and E+P-treated groups (p < 0.05). These data indicate that E induces TPH gene expression in nonhuman primates and that the addition of P has little additive effect on TPH gene expression. Thus, the action of P on prolactin secretion is probably not mediated at the level of TPH gene transcription. However, because P increases raphe serotonin content in E-primed rodents, the possibility remains that P may have other actions on post-translational processing or enzyme activity.

Steroid regulation of estrogen and progestin receptor messenger ribonucleic acid in monkey hypothalamus and pituitary

The regulation of estrogen and progestin receptor (ER and PR, respectively) messenger RNA (mRNA) and protein by their cognate hormones was examined in the hypothalamus and pituitary of steroid-treated monkeys. Rhesus macaques (Macaca mulatta) were ovariectomized, hysterectomized (spayed), and implanted with SILASTIC brand capsules containing 17 beta-estradiol (E) or progesterone (P). The spayed control group received empty capsules. The E-treated group received E-filled capsules for 28 days. The E + P-treated animals received an E-filled capsule for 28 days and then a P-filled capsule for the last 14 of the 28 days. Steroid regulation of ER and PR mRNA levels in the hypothalamus and pituitary was examined with in situ hybridization. In the hypothalamus, ER and PR immunodetectable proteins were also examined in nearby sections. In the pituitary, mRNA levels were compared to previous ER and PR protein analysis of identically treated animals. E treatment induced PR mRNA in the medial basal hypothalamus and pituitary. Supplemental P treatment had no effect on PR mRNA levels in the hypothalamus, but markedly reduced PR mRNA in the pituitary. There was excellent agreement with PR protein detection by immunocytochemistry. E treatment had no effect on ER mRNA in the hypothalamus or pituitary. Supplemental P treatment decreased ER mRNA in the ventromedial nucleus, but not in the arcuate nucleus or pituitary. There was agreement between ER mRNA and ER protein in these areas. In summary, there is cell-specific regulation of PR by P in the hypothalamus and pituitary, where P down-regulates PR in the pituitary without affecting ER. However, P has no significant effect on PR expression in the hypothalamus even though P decreases ER in the ventromedial nucleus. Although these observations suggest diverse cell-specific regulatory mechanisms, they are consistent with ER- and PR-mediated physiological events, such as PRL secretion and sexual behavior.

The anatomy of the heart revisited

BACKGROUND

There is a marked conservative tendency to be found in anatomic descriptions, with a seeming reluctance on the part of acknowledged experts to test new theories by returning to direct studies of gross anatomy. This tendency has become manifest to us during recent attempts to review the structure and function of the heart.

METHODS

We have reviewed our recent experience in trying to describe the structure and development of the atrial septum and arterial roots, attempting at the same time to establish the place of semantic as opposed to morphologic factors in disagreements on these topics.

RESULTS

Dissection of the structures separating the right atrium from the left atrium shows a fundamental difference between the infolded superior rim of the oval foramen, made up of the atrial walls, versus the make up of the sinus and atrioventricular septums, which are true septal structures. Analysis of the arterial roots shows that the major feature is the semilunar attachment of the valvar leaflets, an arrangement not ideally described in terms of an annulus.

CONCLUSIONS

Understanding of details of cardiac anatomy, as set out in standard textbooks, is hindered by a reluctance on the part of some to accept material presented on the basis of straightforward gross dissection. Instead, there is a seeming desire to depend on conventional wisdom, often unsupported by anatomic fact. Such controversies can be ameliorated by appropriate recognition to contributions of gross morphology and by using simple words to describe the observed anatomic features.

Endocardial cushion development and heart loop architecture in the trisomy 16 mouse

Murine trisomy 16 (Ts16) is a model for Down's syndrome and has close to a 100% incidence of atrioventricular septal defects (AVSDs). These have been proposed to result from abnormal development of the endocardial cushions, but the mechanisms are unknown. We aim to identify the initial defects in Ts16 hearts, both to characterise the pathogenesis of AVSDs and as a first step in the search for molecular mechanisms. In 38 litters from an Rb(11.16)2H/Rb(16.17)7Bnr x C57BL/6J cross, which was examined on days 10 and 11 of gestation, 28.4% of embryos were trisomic. Trisomic embryos were uniformly retarded compared to their normal litter mates, having on average 3.3 fewer somite pairs. All further comparisons were made between embryos of the same somitic stage. Twenty-one trisomic and 21 normal embryos of between 15 and 43 somites were serially sectioned, and stereomorphometric methods were used to reconstruct the volumes of the endocardial cushions and to count their number of mesenchymal cells. There were fewer cells in Ts16 superior and inferior cushions. In contrast, the volumes of trisomic cushions were significantly greater than normal. Thus, cell density was markedly lower in trisomic cushions. Importantly, the volumes of the cushions in trisomic embryos were already greater than normal at the 18 somite stage, prior to the invasion of cushions by mesenchymal cells. The architecture of Ts16 heart tubes in 15-25 somite embryos was subtly abnormal. This was reflected in the angle between the axis of the atrioventricular canal and the first pharyngeal cleft, which was significantly larger in trisomic hearts and showed a different relationship to somite stage when compared to normal embryos. These observations suggest that the primary cardiac defect in Ts16 mice may be localised to the myocardium, thus influencing the shape of the heart tube, with changes in the mesenchymal population of the endocardial cushions being later events. Whether AVSDs arise from one or both of these abnormalities remains to be established.

The structure of the mouse heart in late fetal stages

Because of the opportunities for genetic manipulation, the mouse has become the major species for models of human disease. Recently, targeted and insertional mutations have induced many novel models of developmental abnormality, including several of congenital heart defects. Interpretation and use of such models requires a precise understanding of the similarities and differences between mouse and human in terms of cardiac development and structure. To this end, we have characterised the late fetal mouse heart using scanning electron microscopy and serial histological sections. Right atrial anatomy is dominated by the venous valves, which separate the orifices of the caval veins from the musculature of the primary atrium. Their structure and location suggest that the pulmonary vein is unlikely to develop from the venous sinus. The pectinated wall of the appendage serves to distinguish the morphologically right atrium, in that it runs around the atrioventricular junction, from the left atrium in which this vestibular region is smooth-walled. The persistence of the left superior caval vein draining to the right atrium, along with a solitary opening for the pulmonary vein in the left atrium, distinguishes the atrial anatomy of the mouse from that of the human. The flap valve of the oval foramen is extensive and represents the embryonic primary atrial septum. The superior rim of the foramen is an infolding of the atrial roof, as has been described in the human, showing that, contrary to orthodox opinion, there is no extensive formation of a secondary atrial septum. The region of the membranous septum seen in the human heart is a relatively thick structure in the late fetal mouse, and is located exclusively in an atrioventricular position. Unlike the human, there is little distinction between the apical trabeculations of the left and right ventricles of the mouse heart.

Cell proliferation in mammalian gastrulation: the ventral node and notochord are relatively quiescent

During gastrulation, the node of the mammalian embryo appears to be an organising centre, homologous to Hensen's node in the chick and the dorsal lip of the amphibian blastopore. In addition, the node serves as a precursor population for the head process, notochord and foregut endoderm. We have studied node architecture and cell morphology by electron microscopy, and cell proliferation using bromodeoxyuridine incorporation and mitotic counts. The dorsal (ectodermal) and ventral (endodermal) components of the node are two distinct populations, separated by a basement membrane. The ventral node, contiguous with the head process, is characterised by a relatively low proliferation rate, with only approximately 10% of cells incorporating BrdU over 4 hr, compared to > 95% in surrounding mesodermal and ectodermal tissues. This is the case from the beginning of node formation, at the no-allantoic-bud stage, until the 7 somite stage, and is not compatible with the idea that the ventral node is a stem cell population. The dorsal node is highly proliferative, its rate of division being indistinguishable from the neurectoderm, with which it is contiguous. In the ventral node, two regions can be recognised: cells in the "pit" are columnar and all monociliated; around them lies a "crown" of cells arranged radially in a horseshoe shape and less often ciliated. Node derivatives share common features with the ventral node; the head process and the notochord are relatively quiescent; and some head process cells are also monociliated. Node and head process monocilia are immotile and appear to be associated with non-proliferation. We suggest that the ventral node contains all the properties of the organiser, while the dorsal node is indistinct from the surrounding epiblast. The cranial end of the foregut pouch, the thyroid diverticulum, and the promyocardium of early somite stage embryos are also areas of low cell division. All the described regions of relative quiescence are sites of expression of members of the TGF beta family, which may be involved in maintaining non-proliferation.

Involvement of G-protein alpha il subunits in activation of G-protein gated inward rectifying K+ channels (GIRK1) by human NPY1 receptors

This study investigated the type of G-protein alpha subunit(s) that human neuropeptide Y (NPY)1 receptors preferentially utilize when activating G-protein gated K+ currents. Two electrode voltage-clamp recordings were made from Xenopus oocytes that had been injected with cDNAs encoding either human NPY1 or D2(short) dopamine receptors, and GIRK1 a cloned rat brain K+ channel. These receptors were also co-injected with G-protein alpha i1, alpha i2, alpha i3 and alpha o1 subunits to determine which subunit(s) modulate the efficiency of signal transduction. In NPY1 receptor injected cells neuropeptide Y (100 nM) caused a 53 +/- 10 nA inward current (n = 14; EC50 = 3 nM) and this effect was blocked by pertussis toxin (500 ng ml-1 24 h). Activation of GIRK1 currents by neuropeptide Y was selectively potentiated by alpha i1 subunit cDNA whereas coupling dopamine of D2 receptors to this channel was not.

Absence of effect of simvastatin on the progression of lens opacities in a randomised placebo controlled study. Oxford Cholesterol Study Group

AIMS

A detailed assessment of ophthalmic effects of an HMG CoA reductase inhibitor, simvastatin, was performed.

METHODS

Six hundred and twenty one individuals considered to be at increased risk of coronary heart disease were randomised, following an 8 week placebo 'run in' period, to receive 40 mg daily simvastatin, 20 mg daily simvastatin, or matching placebo. Patients with a baseline corrected visual acuity better than 6/24 and without a history of cataract were eligible for detailed ophthalmic assessment at 6 months (539 patients assessed) and at 18 months (474 patients assessed).

RESULTS

No significant differences between the treatment groups were detected at the 6 month or 18 month visit in the refractive condition of the eye or in the mean intraocular pressure. Nor were there clear differences in the Oxford grading system scores for various measures of the major types of cataract (cortical spokes, posterior subcapsular cataract, nuclear brunescence, white scatter) or for other morphological features visible within the lens (fibre folds or focal dots). Scheimpflug slit image photographs and retroillumination analysis of the percentage of cataract within a defined region of the lens were also performed at each visit, with no clear differences observed between the treatment groups.

CONCLUSION

This single centre double blind study found no good evidence of any adverse effects of 18 months of simvastatin treatment on lens opacity formation, using a variety of validated techniques to assess cataract development. Routine clinic follow up of visual symptoms and admission to hospital for ophthalmic procedures over 5 years of treatment was also reassuring, with no excess adverse outcomes observed with simvastatin.

Morphology of the sinus node in human and mouse hearts with isomerism of the atrial appendages

BACKGROUND

The location of the sinus node is known to be at best abnormal, or at worst unknown, in patients with isomerism of the morphologically left atrial appendage. In contrast, the sinus node is known to be an excellent histological marker of the morphologically right appendage, being duplicated in those with right isomerism. The aim of the study was to investigate this condition further in fetal human and mouse hearts.

METHODS

Serial histological sections of the area anticipated to contain the sinus node were studied in hearts with isomerism of the atrial appendages taken from 14 human fetuses and 13 iv/iv mice, using 12 mouse hearts with normally arranged or mirror imaged atrial chambers for controls.

RESULTS

All hearts with isomerism of the right appendages (two human and four mouse) had bilateral sinus nodes. The cases with isomerism of the left appendages (12 human and nine mouse) showed absence of a recognisable sinus node except in four cases (19%) in which a small remnant of the node was found. In three of these cases, it was related postero-inferiorly to the superior cavoatrial junction.

CONCLUSIONS

The concept of isomerism of the atrial appendages is endorsed by findings on the morphology of the sinus node, this being the most reliable histological criterion for existence of a morphologically right atrium. A small proportion of hearts with left isomerism had a structure resembling the sinus node, but it was hypoplastic and displaced postero-inferiorly, distant from its expected position had the hearts possessed an incompletely formed morphologically right appendage.