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Jensen B, Salvatori D, Schouten J, Meijborg VMF, Lauridsen H, Agger P. Trabeculations of the porcine and human cardiac ventricles are different in number but similar in total volume. Clin Anat 2024; 37:440-454. [PMID: 38217386 DOI: 10.1002/ca.24135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
An intricate meshwork of trabeculations lines the luminal side of cardiac ventricles. Compaction, a developmental process, is thought to reduce trabeculations by adding them to the neighboring compact wall which is then enlarged. When pig, a plausible cardiac donor for xenotransplantation, is compared to human, the ventricular walls appear to have fewer trabeculations. We hypothesized the trabecular volume is proportionally smaller in pig than in human. Macroscopically, we observed in 16 pig hearts that the ventricular walls harbor few but large trabeculations. Close inspection revealed a high number of tiny trabeculations, a few hundred, within the recesses of the large trabeculations. While tiny, these were still larger than embryonic trabeculations and even when considering their number, the total tally of trabeculations in pig was much fewer than in human. Volumetrics based on high-resolution MRI of additional six pig hearts compared to six human hearts, revealed the left ventricles were not significantly differently trabeculated (21.5 versus 22.8%, respectively), and the porcine right ventricles were only slightly less trabeculated (42.1 vs 49.3%, respectively). We then analyzed volumetrically 10 pig embryonic hearts from gestational day 14-35. The trabecular and compact layer always grew, as did the intertrabecular recesses, in contrast to what compaction predicts. The proportions of the trabecular and compact layers changed substantially, nonetheless, due to differences in their growth rate rather than compaction. In conclusion, processes that affect the trabecular morphology do not necessarily affect the proportion of trabecular-to-compact myocardium and they are then distinct from compaction.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Salvatori
- Department of Clinical Sciences, Anatomy and Physiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jacobine Schouten
- Department of Clinical Sciences, Anatomy and Physiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Veronique M F Meijborg
- Department of Experimental Cardiology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Henrik Lauridsen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Pérez-Riera AR, Barbosa-Barros R, Andreou AY, Fiol-Sala M, Birnbaum Y, da Silva Rocha M, Daminello-Raimundo R, de Abreu LC, Nikus K. Left septal fascicular block: Evidence, causes, and diagnostic criteria. Heart Rhythm 2023; 20:1558-1569. [PMID: 37586583 DOI: 10.1016/j.hrthm.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
The existence of a tetrafascicular intraventricular conduction system is widely accepted by researchers. In this review, we have updated the criteria for left septal fascicular block (LSFB) and the differential diagnosis of prominent anterior QRS forces. More and more evidence points to the fact that the main cause of LSFB is critical proximal stenosis of the left anterior descending coronary artery before its first septal perforator branch. The most important characteristic of LSFB that has been incorporated in the corresponding diagnostic electrocardiographic criteria is its transient/intermittent nature mostly observed in clinical scenarios of acute (ie, acute coronary syndrome including vasospastic angina) or chronic (ie, exercise-induced ischemia) ischemic coronary artery disease. In addition, the phenomenon proved to be phase 4 bradycardia rate dependent and induced by early atrial extrastimulus. Finally, we believe that intermittent LSFB has the same clinical significance as "Wellens syndrome" and the "de Winter pattern" in the acute coronary syndrome scenario.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Clínica Médica, Universidade Uninove, Mauá, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Andreas Y Andreou
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus
| | - Miguel Fiol-Sala
- Balearic Islands Institute for Health Research, Hospital Son Espases, Palma de Mallorca, Spain
| | - Yochai Birnbaum
- Department of Medicine Cardiology, Baylor College of Medicine, Houston, Texas
| | | | - Rodrigo Daminello-Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine, Tampere University, Tampere, Finland
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Fonkou R, Kengne R, Fotsing Kamgang HC, Talla P. Dynamical behavior analysis of the heart system by the bifurcation structures. Heliyon 2023; 9:e12887. [PMID: 36820178 PMCID: PMC9938421 DOI: 10.1016/j.heliyon.2023.e12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
The functioning of the heart rhythm can exhibit a wide variety of dynamic behaviours under certain conditions. In the case of rhythm disorders or cardiac arrhythmias, the natural rhythm of the heart is usually involved in the sinoatrial node, the atrioventricular node, the atria of the carotid sinus, etc. The study of heart related disorders requires an important analysis of its rhythm because the regularity of cardiac activity is conditioned by a large number of factors. The cardiac system is made up of a combination of nodes ranging from the sinus node, the atrioventricular node to its Purkinje bundles, which interact with each other via communicative aspects. Due to the nature of their respective dynamics, the above are treated as self-oscillating elements and modelled by nonlinear oscillators. By modelling the cardiac conduction system as a model of three nonlinear oscillators coupled by delayed connections and subjected to external stimuli depicting the behavior of a pacemaker, its dynamic behavior is studied in this paper by nonlinear analysis tools. From an electrocardiogram (ECG) assessment, the heart rhythm reveals normal and pathological rhythms. Three forms of ventricular fibrillation, ventricular flutter, ventricular tachycardia and atrial fibrillation are observed. The results are confirmed by the respective maximum Lyapunov exponents. Considering the cardiac nodes as microchips, using microcontroller simulation technology, the cardiac conduction system was modelled as a network of four ATmega 328P microcontrollers. A similarity with the results obtained numerically can be observed.
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Affiliation(s)
- R.F. Fonkou
- Condensed Matter, Electronics and Signal Processing Research Unit, University of Dschang, B.P. 67, Dschang, Cameroon
- Laboratoire de Physique et Sciences de l'ingénieur, Institut Universitaire de la Côte, S/c BP 3001, Douala, Cameroon
- UR de Mécanique et de Modélisation des Systèmes Physiques (UR-2MSP), UFR/DSST, Université de Dschang, BP 67, Dschang, Cameroon
- Corresponding author.
| | - Romanic Kengne
- Condensed Matter, Electronics and Signal Processing Research Unit, University of Dschang, B.P. 67, Dschang, Cameroon
| | - Herton Carel Fotsing Kamgang
- Condensed Matter, Electronics and Signal Processing Research Unit, University of Dschang, B.P. 67, Dschang, Cameroon
| | - P.K. Talla
- UR de Mécanique et de Modélisation des Systèmes Physiques (UR-2MSP), UFR/DSST, Université de Dschang, BP 67, Dschang, Cameroon
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The Interventricular Septum: Structure, Function, Dysfunction, and Diseases. J Clin Med 2022; 11:jcm11113227. [PMID: 35683618 PMCID: PMC9181036 DOI: 10.3390/jcm11113227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023] Open
Abstract
Vertebrates developed pulmonary circulation and septated the heart into venous and arterial compartments, as the adaptation from aquatic to terrestrial life requires more oxygen and energy. The interventricular septum (IVS) accommodates the ventricular portion of the conduction system and contributes to the mechanical function of both ventricles. Conditions or diseases that affect IVS structure and function (e.g., hypertrophy, defects, other) may lead to ventricular pump failure and/or ventricular arrhythmias with grave consequences. IVS structure and function can be evaluated today using current imaging techniques. Effective therapies can be provided in most cases, although definitions of underlying etiologies may not always be easy, particularly in the elderly due to overlap between genetic and acquired causes of IVS hypertrophy, the most common being IVS abnormality. In this review, state-of-the-art information regarding IVS morphology, physiology, physiopathology, and disease is presented.
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Tretter JT, Spicer DE, Sánchez-Quintana D, Back Sternick E, Farré J, Anderson RH. Miniseries 1-Part III: 'Behind the scenes' in the triangle of Koch. Europace 2022; 24:455-463. [PMID: 34999775 DOI: 10.1093/europace/euab285] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS To take full advantage of the knowledge of cardiac anatomy, structures should be considered in their correct attitudinal orientation. Our aim was to discuss the triangle of Koch in an attitudinally appropriate fashion. METHODS AND RESULTS We reviewed our material prepared by histological sectioning, along with computed tomographic datasets of human hearts. The triangle of Koch is the right atrial surface of the inferior pyramidal space, being bordered by the tendon of Todaro and the hinge of the septal leaflet of the tricuspid valve, with its base at the inferior cavotricuspid isthmus. The fibro-adipose tissues of the inferior pyramidal space separate the atrial wall from the crest of the muscular interventricular septum, thus producing an atrioventricular muscular sandwich. The overall area is better approached as a pyramid rather than a triangle. The apex of the inferior pyramidal space overlaps the infero-septal recess of the subaortic outflow tract, permitting the atrioventricular conduction axis to transition directly to the crest of the muscular ventricular septum. The compact atrioventricular node is formed at the apex of the pyramid by union of its inferior extensions, which represent the slow pathway, with the septal components formed in the buttress of the atrial septum, thus providing the fast pathway. CONCLUSIONS To understand its various implications in current cardiological catheter interventions, the triangle of Koch must be considered in conjunction with the inferior pyramidal space and the infero-septal recess. It is better to consider the overall region in terms of a pyramidal area of interest.
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Affiliation(s)
- Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Diane E Spicer
- Department of Pediatric Cardiology, University of Florida, Gainesville, FL, USA
| | | | | | - Jerónimo Farré
- Fundación Jiménez Díaz University Hospital and Institute of Biomedical Research, Madrid, Spain
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
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Macías Y, de Almeida MC, Tretter JT, Anderson RH, Spicer DE, Mohun TJ, Sánchez-Quintana D, Farré J, Back Sternick E. Miniseries 1-Part II: the comparative anatomy of the atrioventricular conduction axis. Europace 2022; 24:443-454. [PMID: 34999788 DOI: 10.1093/europace/euab291] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS The arrangement of the conduction axis is markedly different in various mammalian species. Knowledge of such variation may serve to question the validity of using animals as prospective models for design of systems for clinical use. METHODS AND RESULTS We compared the arrangement of the atrioventricular conduction axis in human, murine, canine, porcine, and bovine hearts, examining serially sectioned datasets from 20 human, 16 murine, 3 porcine, 5 canine, and 1 bovine hearts. We also analysed computed tomographic datasets obtained from bovines and one human heart. Unlike the situation in the human heart, there is no formation of an atrioventricular fibrous membranous septum in the murine, canine, porcine, nor bovine hearts. Canine, porcine, and bovine hearts also lack an infero-septal recess, when defined as a fibrous plate supporting the buttress of the atrial septum. In these species, half of the non-coronary leaflet is directly opposed to the ventricular septal surface. CONCLUSION There is a long right-sided non-branching component of the axis, which skirts the attachment of the non-coronary sinus of the aortic root. In the bovine heart, moreover, the left bundle branch usually extends intramyocardially as a solitary tape before surfacing and ramifying on the left ventricular septal surface. The difference in the atrioventricular conduction axis between species may influence the anatomical substrates for atrioventricular re-entry tachycardia, as well as providing inferences for assessing the risks of transcatheter implantation of the aortic valve. Further studies are now needed to assess these possibilities.
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Affiliation(s)
- Yolanda Macías
- Department of Medical and Surgical Therapeutics, Veterinary Faculty, University of Extremadura, Cáceres, Spain
| | - Marcos C de Almeida
- Department of Genetics and Morphology, Brasilia's University, Campus Asa Norte, Brasilia, Brazil
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Timothy J Mohun
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Damián Sánchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Jerónimo Farré
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Institute, Nova Lima, Minas Gerais, Brazil
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de Almeida MC, Macías Y, Tretter JT, Sánchez-Quintana D, Cabrera JA, Spicer DE, Anderson RH. Similarities and differences in the arrangement of the atrioventricular conduction axis in the canine compared to the human heart. Heart Rhythm 2021; 18:1990-1998. [PMID: 34339846 DOI: 10.1016/j.hrthm.2021.07.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Subtle differences exist between dog and human, despite use of the dog as a model for cardiac surgical and electrophysiological research. OBJECTIVE The purpose of this study was to investigate the differences in the atrioventricular conduction axis and adjacent structures between dogs and humans. METHODS We prepared 33 human and 5 canine hearts for serial histologic sections of the atrioventricular conduction axis, making correlations with gross anatomic findings. We additionally examined and photographed 15 intact normal human hearts obtained from infants undergoing autopsy. Furthermore, we interrogated a computed tomographic dataset from a human adolescent and from 2 autopsied canine hearts, both with normal cardiac anatomy. RESULTS All canine hearts lacked an inferoseptal recess, with the noncoronary leaflet of the aortic valve and the right fibrous trigone having direct attachments to the septal surface of the left ventricular outflow tract. This correlated with an extensive nonbranching component of the ventricular conduction axis, which skirted half of the noncoronary aortic sinus. This anatomic arrangement was observed in 2 of 15 of autopsied infant hearts. In the human hearts with an inferoseptal recess, the relatively shorter nonbranching bundle is embedded within the fibrous tissue forming its right wall. CONCLUSION We found a major difference between canine and the majority of human hearts, namely, the presence or absence of an inferoseptal recess. When this recess is absent, as in the canine heart and in some human hearts, a greater proportion of the atrioventricular conduction axis is found within the circumference of the subaortic outflow tract.
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Affiliation(s)
- Marcos C de Almeida
- Department of Genetics and Morphology, Brasilia's University, Campus Asa Norte, Brasilia, Brazil
| | - Yolanda Macías
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, Cáceres, Spain
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Damián Sánchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - José-Angel Cabrera
- Division of Cardiology, Hospital Universitario Quirón Salud, European University of Madrid, Madrid, Spain
| | - Diane E Spicer
- Congenital Heart Center, University of Florida, Gainesville, Florida; Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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