Histological study on the heart ventricle of Egyptian bovines (Bos aegyptiacus).

Background: The heart ventricles have thicker walls than atrium as they pump blood through blood vessels into all body organs. Aim: This study aimed to describe the histological changes of the heart ventricles in Egyptian bovine (Bos aegyptiacus) with special reference to Purkinje fibers. Methods: A total of 10 male Egyptian bovines of 1-10 years old were divided into three groups according to age; immature, mature, and adult animals. Results: The histological sections from all examined animals' groups revealed three different layers of the wall of both right and left ventricles; endocardium, myocardium, and epicardium. The endocardium was lined with endothelium and filled with fibrous connective tissue. The endocardium of adult bovine was the thickest. Purkinje fibers appeared of pale cytoplasm with few myofibrils. They were present in the deep layer of the endocardium and in the myocardium. The size of Purkinje fibers and the amount of their myofibrils appeared to be increased with advanced age. Bundles of cardiac muscles were the main constituent of the myocardium. The myocardial bundles were separated by fine connective tissue in immature animals that showed an increased amount in the adult animals. The hypereosinophilic cardiac muscle cells were observed in the ventricles of both mature and adult animals suggesting hypercontraction during rigor mortis. An external layer of the ventricles was the epicardium which consisted of connective tissue and covered with mesothelium. Conclusion: Overall, this study revealed histological changes in the wall of the ventricle and Purkinje fibers of Egyptian bovines (B. aegyptiacus) in relation to age. Additionally, the hypereosinophilia of the cardiac muscle cells was recorded in the ventricles of mature and adult bovines.

Anatomic Considerations for Epicardial and Endocardial Left Atrial Appendage Closure.

Left atrial appendage closure is an increasingly used means of achieving thromboprophylaxis in atrial fibrillation, particularly in patients with contraindications to anticoagulation. Left atrial appendage anatomy is highly variable, and preprocedural imaging is critical to choosing the correct device and approach for left atrial appendage closure. This article reviews the common endocardial and epicardial closure systems, including anatomic considerations, advantages and disadvantages, as well as complications to be avoided.

Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line.

Electric isolation of the left atrial appendage (LAA) and linear ablations in the area of the LAA base are gaining popularity. However, very little is known about the myocardial architecture and the presence of epicardial blood vessels within this region, which could significantly influence the course of such procedures. We examined 200 autopsied hearts (22.5% females, 46.7 ± 16.8 years old). The LAA isthmus (i.e., the line between the LAA ostium and the mitral annulus) was cut longitudinally. The myocardium was thickest at the LAA end of the isthmus (2.4 ± 0.7 mm) followed by its middle sector (2.1 ± 0.7 mm) inside the LAA, 5 mm from its ostium (1.9 ± 0.7 mm), and the mitral annulus end of the isthmus (1.8 ± 0.6 mm) (P < 0.0001). At least one artery was found in 96.5% of all samples (89.5% were single branched, 7% had two branches). The great cardiac vein was found in 77.0% and the left marginal vein in 2.5%. The artery was interposed between the endocardium and the great cardiac vein in 31.5% of cases. The smallest distance between the endocardium and the artery was 0.5 mm and between the endocardium and the vein was 0.7 mm. In total, we were able to distinguish fifteen different types of vascular arrangements within the LAA isthmus line in this study. The myocardium within the LAA isthmus is thickest at its LAA end. The left circumflex coronary artery branches are the most frequently-occurring vessels within the isthmus and are present in almost all cases, while the great cardiac vein is present in three quarters of hearts. Clin. Anat. 31:1024-1030, 2018. © 2018 Wiley Periodicals, Inc.

Histology and Immunohistochemistry of the Cardiac Ventricular Structure in the Green Turtle (Chelonia mydas).

This study describes the implications of cardiac ventricular microscopy in Chelonia mydas relating to its ability to dive. For this work, 11 specimens of the marine turtle species C. mydas found dead on the coast of Rio Grande do Norte (Northeast Brazil) were used. After necropsy, fragments of the cardiac ventricular wall were fixed in 10% buffered formaldehyde solution for 24 h and then subjected to routine processing for light and scanning electron microscopy (SEM). The ventricle in this species is formed by the epicardium, myocardium and endocardium. The subepicardial layer consists of highly vascularised connective tissue that emits septa to reinforce the myocardium surface. There is an abundant and diffuse subepicardial nerve plexus shown by immunostaining technique. The thickness of the spongy myocardium and the nature of its trabeculae varied between the heart chambers. The endocardium shows no characteristic elements of the heart conduction system. The valves have a hyaline cartilage skeleton, coated by dense irregular connective tissues characterised by elastic fibres. These findings in the green turtle ventricular microscopy are related to hypoxia resistance during diving.

[Numerical Simulation of Propagation of Electric Excitation in the Heart Wall Taking into Account Its Fibrous-Laminar Structure].

The propagation of excitation wave in the inhomogeneous anisotropic finite element model of cardiac muscle is investigated. In this model, the inhomogeneity stands for the rotation of anisotropy axes through the wall thickness and results from a fibrous-laminar structure of the cardiac muscle tissue. Conductivity of the cardiac muscle is described using a monodomain model and the Aliev-Panfilov equations are used as the relationships between the transmembrane current and transmembrane potential. Numerical simulation is performed by applying the splitting algorithm, in which the partial differential solution to the nonlinear boundary value problem is reduced to a sequence of simple ordinary differential equations and linear partial differential equations. The simulation is carried out for a rectangular block of the cardiac tissue, the minimal size of which is considered to be the thickness of the heart wall. Two types of distribution of the fiber orientation angle are discussed. The first case corresponds 'to the left ventricle of a dog. The endocardium and epicardium fibers are generally oriented in the meridional direction. The angle of fiber orientation varies smoothly through the wall thickness making a half-turn. A circular layer, in which the fibers are oriented in the circumferential direction locates deep in the cardiac wall. The results of calculations show that for this case the wave form strongly depends on a place of initial excitation. For the endocardial and epicardial initial excitation one can see the earlier wave front propagation in the endocardium and epicardium, respectively. At the intramural initial excitation the simultaneous wave front propagation in the endocardium and epicardium occurs, but there is a wave front lag in the middle of the wall. The second case refers to the right ventricle of a swine, in which the endocardium and epicardium fibers are typically oriented in the circumferential direction, whereas the subepicardium fibers undergo an abrupt change in the angle of orientation. For this case the dependence of the wave front on the location of initial excitation is weak. One can see the earlier wave front propagation in the middle of the wall. However, the wave front formation rate is different: with highest velocity for intramural initial excitation and with lowest one during excitation on the endocardial surface.

Electrical wave propagation in an anisotropic model of the left ventricle based on analytical description of cardiac architecture.

We develop a numerical approach based on our recent analytical model of fiber structure in the left ventricle of the human heart. A special curvilinear coordinate system is proposed to analytically include realistic ventricular shape and myofiber directions. With this anatomical model, electrophysiological simulations can be performed on a rectangular coordinate grid. We apply our method to study the effect of fiber rotation and electrical anisotropy of cardiac tissue (i.e., the ratio of the conductivity coefficients along and across the myocardial fibers) on wave propagation using the ten Tusscher-Panfilov (2006) ionic model for human ventricular cells. We show that fiber rotation increases the speed of cardiac activation and attenuates the effects of anisotropy. Our results show that the fiber rotation in the heart is an important factor underlying cardiac excitation. We also study scroll wave dynamics in our model and show the drift of a scroll wave filament whose velocity depends non-monotonically on the fiber rotation angle; the period of scroll wave rotation decreases with an increase of the fiber rotation angle; an increase in anisotropy may cause the breakup of a scroll wave, similar to the mother rotor mechanism of ventricular fibrillation.

Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes), noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter), and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression), activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa), a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments) and 0.96 (simulation) between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments) and 0.92 (simulation) between ATa values. Despite distance (balloon-atrial wall) and dimension reduction (64 electrodes), some information about atrial repolarization remained present in noncontact signals.

Comparison of treadmill exercise stress cardiac MRI to stress echocardiography in healthy volunteers for adequacy of left ventricular endocardial wall visualization: A pilot study.

PURPOSE: To compare exercise stress cardiac magnetic resonance (cardiac MR) to echocardiography in healthy volunteers with respect to adequacy of endocardial visualization and confidence of stress study interpretation. MATERIALS AND METHODS: Twenty-eight healthy volunteers (age 28 ± 11 years, 15 males) underwent exercise stress echo and cardiac MR one week apart assigned randomly to one test first. Stress cardiac MR was performed using an MRI-compatible treadmill; stress echo was performed as per routine protocol. Cardiac MR and echo images were independently reviewed and scored for adequacy of endocardial visualization and confidence in interpretation of the stress study. RESULTS: Heart rate at the time of imaging was similar between the studies. Average time from cessation of exercise to start of imaging (21 vs. 31 s, P < 0.001) and time to acquire stress images (20 vs. 51 s, P < 0.001) was shorter for cardiac MR. The number of myocardial segments adequately visualized was significantly higher by cardiac MR at rest (99.8% vs. 96.4%, P = 0.002) and stress (99.8% vs. 94.1%, P = 0.001). The proportion of subjects in whom there was high confidence in the interpretation was higher for cardiac MR than echo (96% vs. 60%, P = 0.005). CONCLUSION: Exercise stress cardiac MR to assess peak exercise wall motion is feasible and can be performed at least as rapidly as stress echo.

Innate collateral segments are predominantly present in the subendocardium without preferential connectivity within the left ventricular wall.

Functional collateral vessels often stem from outward remodelling of pre-existing connections between perfusion territories. Knowledge of the distribution and morphology of innate collateral connections may help in identifying myocardial areas with protection against risk for ischaemia. The coronary network of six healthy canine hearts was investigated with an imaging cryomicrotome. Innate collateral connections ranged from 286 to 1015 µm in diameter. Left ventricular collateral density (number per gram of tissue) was about five in the subendocardium vs. 2.5 in the mid-myocardium (P < 0.01) and 1.3 in the epicardium (P < 0.01). Subendocardial collateral connections were oriented parallel to the long axis of the heart. For the major coronary arteries, five times more intracoronary than intercoronary connections were found, while their median diameter and interquartile range were not significantly different, at 96.1 (16.9) vs. 94.7 (18.9) µm. Collateral vessels connecting crowns from sister branches from a stem are denoted intercrown connections and those within crowns intracrown connections. The number of intercrown connections was related to the mean tissue weight of the crowns (y = 0.73x - 0.33, r2 = 0.85, P < 0.0001). This relation was likewise found to describe intercoronary connections. The median collateral diameter and length were independent of the tissue volumes bridged. We conclude that connectivity and morphology of the innate collateral network are distributed with no preference for intra- or intercrown connections, independent of stem diameter, including epicardial arteries. This renders all sites of the myocardium equally protected in case of coronary artery disease. The orientation of subendocardial collateral vessels indicates the longitudinal direction of subendocardial collateral flow.

Perfusion territories subtended by penetrating coronary arteries increase in size and decrease in number toward the subendocardium.

Blood flow distribution within the myocardium and the location and extent of areas at risk in case of coronary artery disease are dependent on the distribution and morphology of intramural vascular crowns. Knowledge of the intramural vasculature is essential in novel multiscale and multiphysics modeling of the heart. For this study, eight canine hearts were analyzed with an imaging cryomicrotome, developed to acquire high-resolution spatial data on three-dimensional vascular structures. The obtained vasculature was skeletonized, and for each penetrating artery starting from the epicardium, the dependent vascular crown was defined. Three-dimensional Voronoi tessellation was applied with the end points of the terminal segments as center points. The centroid of end points in each branch allowed classification of the corresponding perfusion territories in subendocardial, midmyocardial, and subepicardial. Subendocardial regions have relatively few territories of about 0.5 ml in volume having their own penetrating artery at the epicardium, whereas the subepicardium is perfused by a multitude of small perfusion territories, in the order of 0.01 ml. Vascular volume density of small arteries up till 400 µm was 3.2% at the subendocardium territories but only 0.8% in the subepicardium territories. Their higher volume density corresponds to compensation for flow impeding forces by cardiac contraction. These density differences result in different scaling law properties of vascular volume and tissue mass per territory type. This novel three-dimensional quantitative analysis may form the basis for patient-specific computational models on coronary perfusion and aid the interpretation of image-based clinical methods for assessing the transmural perfusion distribution.

Cardiac right ventricular segmentation via point correspondence.

This study presents an approach to the segmentation of the right ventricle (RV) from a sequence of cardiac magnetic resonance (MR) images. Automatic delineation of the RV is difficult because of its complex morphology, thin and ill-defined borders, and the photometric similarities between the connected cardiac regions such as papillary muscles and heart wall. Further, geometric/photometric models are hard to build from a finite training set because of the significant differences in size, shape, and intensity between subjects. In this study, we propose to use a non-rigid registration method developed recently to obtain the point correspondence in a sequence of cine MR images. Given the segmentation on the first frame, the proposed method segments both endocardial and epicardial borders of the RV using the obtained point correspondence, and relaxes the need of a training set. The proposed method is evaluated quantitatively on common data set by comparison with manual segmentation, which demonstrated competitive results in comparison with recent methods.

Snakes with an ellipse-reproducing property.

We present a new class of continuously defined parametric snakes using a special kind of exponential splines as basis functions. We have enforced our bases to have the shortest possible support subject to some design constraints to maximize efficiency. While the resulting snakes are versatile enough to provide a good approximation of any closed curve in the plane, their most important feature is the fact that they admit ellipses within their span. Thus, they can perfectly generate circular and elliptical shapes. These features are appropriate to delineate cross sections of cylindrical-like conduits and to outline bloblike objects. We address the implementation details and illustrate the capabilities of our snake with synthetic and real data.

The structure of the atrioventricular node in the heart of the female laying ostrich (Struthio camelus).

The electrical impulse for cardiac contraction is generated in the Sinoatrial node (SA node), subsequently spreads to the Atrioventricular node (AV node) and continues in the Atrioventricular bundle (AV bundle). The AV node may not always be present in different avian species and seems to differ in location and contents between species. In this study, the anatomy and histology of the AV node were studied five female adult ostriches (Struthio camelus). Routine paraffin sectioning and transmission electron microscopic method were performed. The study showed that in the ostrich, the AV node is located in the endocardium of the atrial surface of the right atrioventricular valve adjacent to the fibrous ring. The parenchyma of the AV node is formed by small specialized muscle fibres that are spread within a loose connective tissue network. The AV node is not covered by a connective tissue sheath and some arterioles are present. Nerve fibres are seen related to the node. Ultrastructurally, they stain lighter and contain fewer organized myofibrils than usual myocardial cells. The myofibril bundles run parallel to one another and have interspersed mitochondria, which display distinct cristae. The cells have a large euchromatic nucleus with a clear perinuclear area, and they connected by desmosomes. The ostrich is, thus, one of the birds that have the AV node, whose position varies from the other birds.

Endocardial border detection in cardiac magnetic resonance images using level set method.

Segmentation of the left ventricle in MRI images is a task with important diagnostic power. Currently, the evaluation of cardiac function involves the global measurement of volumes and ejection fraction. This evaluation requires the segmentation of the left ventricle contour. In this paper, we propose a new method for automatic detection of the endocardial border in cardiac magnetic resonance images, by using a level set segmentation-based approach. To initialize this level set segmentation algorithm, we propose to threshold the original image and to use the binary image obtained as initial mask for the level set segmentation method. For the localization of the left ventricular cavity, used to pose the initial binary mask, we propose an automatic approach to detect this spatial position by the evaluation of a metric indicating object's roundness. The segmentation process starts by the initialization of the level set algorithm and ended up through a level set segmentation. The validation process is achieved by comparing the segmentation results, obtained by the automated proposed segmentation process, to manual contours traced by tow experts. The database used was containing one automated and two manual segmentations for each sequence of images. This comparison showed good results with an overall average similarity area of 97.89%.

Visualization of human heart conduction system by means of fluorescence spectroscopy.

The conduction system of the heart is a specific muscular tissue, where a heartbeat signal originates and initiates the depolarization of the ventricles. The muscular origin makes it complicated to distinguish the conduction system from the surrounding tissues. A surgical intervention can lead to the accidental harm of the conduction system, which may eventually result in a dangerous obstruction of the heart functionality. Therefore, there is an immense necessity for developing a helpful method to visualize the conduction system during the operation time. The specimens for the spectroscopic studies were taken from nine diverse human hearts. The localization of distinct types of the tissue was preliminary marked by the pathologist and approved histologically after the spectral measurements. Variations in intensity, as well as in shape, were detected in autofluorescence spectra of different heart tissues. The most distinct differences were observed between the heart conduction system and the surrounding tissues under 330 and 380 nm excitation. The spectral region around 460 nm appeared to be the most suitable for an unambiguous differentiation of the human conduction system avoiding the absorption peak of blood. The visualization method, based on the intensity ratios calculated for two excitation wavelengths, was also demonstrated.

Construction of a computational anatomical model of the peripheral cardiac conduction system.

A methodology is presented here for automatic construction of a ventricular model of the cardiac conduction system (CCS), which is currently a missing block in many multiscale cardiac electromechanic models. It includes the His bundle, left bundle branches, and the peripheral CCS. The algorithm is fundamentally an enhancement of a rule-based method known as the Lindenmayer systems (L-systems). The generative procedure has been divided into three consecutive independent stages, which subsequently build the CCS from proximal to distal sections. Each stage is governed by a set of user parameters together with anatomical and physiological constrains to direct the generation process and adhere to the structural observations derived from histology studies. Several parameters are defined using statistical distributions to introduce stochastic variability in the models. The CCS built with this approach can generate electrical activation sequences with physiological characteristics.

Torsion of the human left ventricle: experimental analysis and computational modeling.

We set a twofold investigation: we assess left ventricular (LV) rotation and twist in the human heart through 3D-echocardiographic speckle tracking, and use representative experimental data as benchmark with respect to numerical results obtained by solving our mechanical model of the LV. We aim at new insight into the relationships between myocardial contraction patterns and the overall behavior at the scale of the whole organ. It is concluded that torsional rotation is sensitive to transmural gradients of contractility which is assumed linearly related to action potential duration (APD). Pressure-volume loops and other basic strain measures are not affected by these gradients. Therefore, realistic torsional behavior of human LV may indeed correspond to the electrophysiological and functional differences between endocardial and epicardial cells recently observed in non-failing hearts. Future investigations need now to integrate the mechanical model proposed here with minimal models of human ventricular APD to drive excitation-contraction coupling transmurally.

Molecular morphology of the chick heart visualized by MALDI imaging mass spectrometry.

Utilization of MALDI-MS (matrix-assisted laser desorption/ionization mass spectrometry) for tissue imaging is a relatively new proteomic technique that simultaneously maps the spatial distribution of multiple proteins directly within a single frozen tissue section. Here, we report the development of a methodology to apply MALDI tissue imaging to chick heart tissue sections acquired from fixed and paraffin-embedded samples. This protocol produces molecular images that can be related to the high-quality histological tissue sections. Perfused term chick hearts were fixed in acidic ethanol and embedded in paraffin wax. Tissue sections (15 microm) were collected onto conductive slides, deparaffinized with xylene, and transitioned into water with graded ethanol washes and allowed to air dry. In separate experiments, three different MALDI matrices were applied to chick heart tissue sections through repeated cycles from a glass nebulizer. Tissue sections were then analyzed by MALDI mass spectrometry using a raster step-size of 75-100 microm, and molecular images for specific m/z ratios reconstituted. MALDI tissue imaging revealed spatially resolved protein signals within single heart sections that are specific to structures or regions of the heart, for example, vessels, valves, endocardium, myocardium, or septa. Moreover, no prior knowledge of protein expression is required as is the case for immunohistochemistry and in situ hybridization methodologies. The ability to simultaneously localize a large number of unique protein signals within a single tissue section, with good preservation of histological features, provides cardiovascular researchers a new tool to give insight into the molecular mechanisms underlying normal and pathological conditions.

Anatomic evaluation of the left phrenic nerve relevant to epicardial and endocardial catheter ablation: implications for phrenic nerve injury.

BACKGROUND/OBJECTIVE: The purpose of this study was to clarify the spatial relationship between the left phrenic nerve (LPN) and key cardiac structures in order to minimize the risk of phrenic nerve injury during interventions. METHODS: The course and relationship of the LPN to various cardiac structures were examined by gross dissection and histologic sections of 22 human cadavers. RESULTS: The nerve descended on the fibrous pericardium along one of three courses: over the anterior surface of the left ventricle (18%), over the lateral margin of the left ventricle (59%), and in a posteroinferior direction (23%). The endocardium of the roof of the left atrial appendage was <4 mm from the LPN in 2 (9%) specimens. The nerve passed <2.5 mm from the epicardium of the apex of the left atrial appendage in 7 (31%) specimens. Regardless of the position of the nerve in relation to the high left ventricular wall, the nerve was <3 mm from the epicardial surface in 8 (36%) specimens and passed <6 mm from the epicardium of the right ventricular outflow tract in 2 (9%) specimens. CONCLUSION: During electrophysiologic interventions, the LPN is especially at risk when procedures are performed in the vicinity of the left atrial appendage and high left ventricular wall.

The clockwise rotation of myocardial fiber orientation from epicardial to endocardial surface in left ventricular free wall in a post-mortem human heart.

Following fixation and MRI imaging a post-mortem human heart was sliced at the sagittal plane. Each anatomical section was then cut into smaller segments and each one was objected to classical histology process. The resulting microscopy slides were digitalized with a scanner. The histological section reconstruction was achieved using Adobe Photoshop CS2(R). Using specific software, called FiberCad, the user can define and draw (with the assistance of optical microscope) those fibers that are parallel and those fibers that are vertical to the slides plane. To better align the histological 3D reconstruction, the software is equipped with an option that allows the user to make best possible fit between histological and MRI slices. We present the consequent sagittal sections of LV free wall (from epicardial to endocardial surface), whereby the clockwise rotation of the mean orientation of the fibers that are on the plane of sectioning is clearly evident. We present a post mortem analysis of the complete LV free wall of a human heart.