Histological and anatomical variations of septomarginal trabecula in bovine hearts.

The use of hearts from different animals as models in the experimental pharmacology and surgical clinic has led, in recent years, to an increase on interest of research with this organ. The heart's conducting system, from the septomarginal trabecula, presents several variations, which generates numerous controversies in the literature. So, the objective of the present study is to analyse the morphology of the septomarginal trabecula of bovine hearts, identifying possible macro- and microscopic variations. Thirty-four bovine hearts were analysed. Each trabecula was analysed macroscopically to obtain an anatomical description and measurements of its length and thickness. For histological and morphometric analysis, the samples were fixed in Bouin's solution and then subjected to histological processing. In all the analysed bovine hearts, the septomarginal trabecula presented itself as a smooth, tubular meaty structure of muscular consistency, with variable length and diameter. The anatomical variations observed included a trabecula with forked marginal fixation, and single septal fixation, in addition to a trabecula with extremely reduced or excessively thick caliber. The septomarginal trabecula consists of cardiac muscle fibres, connective tissue, vascular tissue and conduction myofibrils or Purkinje fibres. In the samples of smaller thicknesses, there was a predominance of connective tissue and scarce cardiac muscle tissue, whereas in the thicker samples the predominance was of cardiac striated muscle tissue. Therefore, there are significant macro- and microscopic differences between the bovine septomarginal trabecula concerning their diameter and constituent tissue, and that can lead to possible changes in cardiac physiology.

Crista Supraventricularis Purkinje Network and Its Relation to Intraseptal Purkinje Network.

Using transparent specimens with a dual color injection, microscopy, and computer tomography, this report shows that the right and left ventricular subendocardial Purkinje networks are connected by an extensive septal network in the bovine heart. The septal network is present along the entire septum except at a free zone below ventricular valves. Being the only communication of the basal right septum with the right free wall, the supraventricular crest is an enigmatic but not, by any means, hidden muscular structure. It is one of the last structures to be activated in human heart. It is shown here that the supraventricular crest Purkinje network connects the anterosuperior right ventricular basal free wall Purkinje network to anterior right ventricular basal septal Purkinje network. It is suggested that the stimulus initiated at middle left ventricular endocardium will activate the supraventricular crest. The intraseptal connection found between the basal left ventricular subendocardial septal Purkinje network and the right ventricular basal septal Purkinje network is, probably, the pathway for the stimulus. An anatomic basis is provided to explain why the inflow tract contracts earlier than the outflow tract in the right ventricle systole. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:1793-1801, 2017. © 2017 Wiley Periodicals, Inc.

Extracorporeal membrane oxygenation as a support for TGA/IVS with low cardiac output syndrome and pulmonary hemorrhage.

A 15-day-old neonate with complete transposition of the great arteries/intact ventricular septum was admitted with life-threatening hypoxemia and heart arrest. After successful resuscitation, heart beat recovered but blood lactate began to arise and maintained above 15 mmol/L 6 hours later. Emergency arterial switch operation was done at 20 hours after resuscitation. Planned extracorporeal membrane oxygenation support was employed postoperatively. The baby experienced severe pulmonary hemorrhage and severe hypoxemia after weaning from cardiopulmonary bypass, which were treated with extracorporeal membrane oxygenation support.

Extracorporeal membrane oxygenation as a support for TGA/IVS with low cardiac output syndrome and pulmonary hemorrhage / Oxigenação extracorpórea por membrana como suporte para TGA/IVS com síndrome de baixo débito e hemorragia pulmonar

A 15-day-old neonate with complete transposition of the great arteries/intact ventricular septum was admitted with life-threatening hypoxemia and heart arrest. After successful resuscitation, heart beat recovered but blood lactate began to arise and maintained above 15 mmol/L 6 hours later. Emergency arterial switch operation was done at 20 hours after resuscitation. Planned extracorporeal membrane oxygenation support was employed postoperatively. The baby experienced severe pulmonary hemorrhage and severe hypoxemia after weaning from cardiopulmonary bypass, which were treated with extracorporeal membrane oxygenation support.

Um recém-nascido de 15 dias de idade, com transposição completa das grandes artérias/septo ventricular intacto, foi internado com hipoxemia com risco de vida e parada cardíaca. Após a reanimação bem sucedida, o coração voltou a bater, mas o lactato elevou-se e manteve-se acima de 15 mmol/L, 6 horas após. Operação de emergência para correção da transposição das grandes artérias foi realizada 20 horas após a ressuscitação. Suporte de oxigenação por membrana extracorpórea foi empregado no pós-operatório. O bebê apresentou hemorragia pulmonar e hipoxemia graves após desconexão da circulação extracorpórea, que foram tratadas com suporte da xigenação por membrana extracorpórea.

Estudo anatômico das artérias coronárias em caprinos / Anatomic study of coronary arteries in goats

A utilização de artérias coronárias de caprinos em pesquisas experimentais com objetivos de futuras aplicações em coronárias humanas motivou o interesse em verificar semelhanças ou diferenças morfológicas das artérias coronárias de caprinos com os citados na literatura para humanos. Foram utilizados 31 corações de caprinos SRD pesando de 76,5-107,7g fixados em formalina a 10 por cento. As artérias coronárias e seus ramos eram dissecados até as ramificações visíveis sob o pericárdio. A artéria coronária esquerda presente em todos os corações era única. Seu comprimento situou-se entre 8 mm e 17mm, terminava formando os ramos: interventricular paraconal e circunflexo (90,3 por cento) ou interventricular paraconal, circunflexo e angular (9,7 por cento). O ramo interventricular paraconal, presente em todos os corações era único. Seu comprimento variou de 80 a 140mm, emitia média de 12 ramos. O ventrículo direito recebia 49,5 por cento dos ramos e o ventrículo esquerdo, 50,5 por cento, dos ramos. Essa artéria podia terminar antes de atingir o ápice do coração (22,5 por cento), no próprio ápice (22,5 por cento) ou então passava pelo ápice e terminava no sulco interventricular subsinuoso (55 por cento). O ramo circunflexo era único, comprimento variou de 61 a 106mm, emitia média de 8,2 ramos. O ventrículo esquerdo recebia 53,4 por cento dos ramos e o átrio esquerdo, 46,6 por cento. Em todos os casos essa artéria chegava e ultrapassava a Crux cordis. A artéria coronária direita, presente em todos os corações, era única. Seu comprimento variou de 35 a 86mm, emitia a média de 8,6 ramos. O ventrículo direito recebia 56,1 por cento, dos ramos e o átrio direito 43,9 por cento. Em geral era a própria artéria que se comportava como ramo marginal direito. A artéria coronária direita não atingia a Crux cordis em 93,5 por cento. O ramo interventricular subsinuoso da artéria circunflexa podia ser: a) ramo longo ocupando a maior parte do sulco; b) ramo curto ...(AU)

The coronary arteries of the goats have been used to researches about to pharmacological actions, heart failure after connection of coronary arteries and others. Twenty-seven goat hearts, both sexes, fixed in formalin at 10 percent has been used in this study that analyzed the coronary arteries pattern in goats and if the same is similar to the human coronary arteries pattern. The left coronary artery is dominant and in relation to the length demonstrated average 1.15cm emitting two branches: interventricular paraconalis and circumflex. The interventricular paraconalis branch with average length 10.5cm issued branches to the both ventricles fairly, ending more frequently in the interventricular subsinuosis sulcus. The circumflex branch with average length 8.5cm issued branches to left ventricle and right atrium fairly. The left marginal branch is not constant. The right coronary artery, with average length 6.1cm issued branches to right ventricle and right atrium fairly, but the interventricular subsinuosis branch with average length 3.1cm is variable and can present one long branch, one short branch or one double branch, with the huge part for the right ventricle.(AU)

Estudo anatômico das artérias coronárias em caprinos / Anatomic study of coronary arteries in goats

A utilização de artérias coronárias de caprinos em pesquisas experimentais com objetivos de futuras aplicações em coronárias humanas motivou o interesse em verificar semelhanças ou diferenças morfológicas das artérias coronárias de caprinos com os citados na literatura para humanos. Foram utilizados 31 corações de caprinos SRD pesando de 76,5-107,7g fixados em formalina a 10 por cento. As artérias coronárias e seus ramos eram dissecados até as ramificações visíveis sob o pericárdio. A artéria coronária esquerda presente em todos os corações era única. Seu comprimento situou-se entre 8 mm e 17mm, terminava formando os ramos: interventricular paraconal e circunflexo (90,3 por cento) ou interventricular paraconal, circunflexo e angular (9,7 por cento). O ramo interventricular paraconal, presente em todos os corações era único. Seu comprimento variou de 80 a 140mm, emitia média de 12 ramos. O ventrículo direito recebia 49,5 por cento dos ramos e o ventrículo esquerdo, 50,5 por cento, dos ramos. Essa artéria podia terminar antes de atingir o ápice do coração (22,5 por cento), no próprio ápice (22,5 por cento) ou então passava pelo ápice e terminava no sulco interventricular subsinuoso (55 por cento). O ramo circunflexo era único, comprimento variou de 61 a 106mm, emitia média de 8,2 ramos. O ventrículo esquerdo recebia 53,4 por cento dos ramos e o átrio esquerdo, 46,6 por cento. Em todos os casos essa artéria chegava e ultrapassava a Crux cordis. A artéria coronária direita, presente em todos os corações, era única. Seu comprimento variou de 35 a 86mm, emitia a média de 8,6 ramos. O ventrículo direito recebia 56,1 por cento, dos ramos e o átrio direito 43,9 por cento. Em geral era a própria artéria que se comportava como ramo marginal direito. A artéria coronária direita não atingia a Crux cordis em 93,5 por cento. O ramo interventricular subsinuoso da artéria circunflexa podia ser: a) ramo longo ocupando a maior parte do sulco; b) ramo curto ...

The coronary arteries of the goats have been used to researches about to pharmacological actions, heart failure after connection of coronary arteries and others. Twenty-seven goat hearts, both sexes, fixed in formalin at 10 percent has been used in this study that analyzed the coronary arteries pattern in goats and if the same is similar to the human coronary arteries pattern. The left coronary artery is dominant and in relation to the length demonstrated average 1.15cm emitting two branches: interventricular paraconalis and circumflex. The interventricular paraconalis branch with average length 10.5cm issued branches to the both ventricles fairly, ending more frequently in the interventricular subsinuosis sulcus. The circumflex branch with average length 8.5cm issued branches to left ventricle and right atrium fairly. The left marginal branch is not constant. The right coronary artery, with average length 6.1cm issued branches to right ventricle and right atrium fairly, but the interventricular subsinuosis branch with average length 3.1cm is variable and can present one long branch, one short branch or one double branch, with the huge part for the right ventricle.

Anatomy of the tendinous cords of the interventricular septum of the human heart.

There are frequent citations in the literature stating that lesions of the tendinous cords cause functional disorders of the heart valves. This led us to conduct the present investigation on the anatomy of the tendinous cords. Our objective was to focus on the morphological characteristics of tendinous cords that are inserted directly into the interventricular septum, such as their frequency, number, dimensions and This study was conducted on 50 hearts from adults of both sexes that had been fixed in 10% formaldehyde. The right ventricle was opened by means of an incision parallel to the anterior interventricular groove, and the left ventricle was opened by means of a longitudinal incision in the middle of the pulmonary (left) surface. Our results showed that, in the right ventricle, these tendinous cords constantly appeared without the involvement of papillary muscles (98%). They ranged in number from one to ten, and between two and five was the most common (72%). They were short, mostly ranging from 0.3 to 1.9 cm in length (81.5%) and were preferentially located in the upper third of the interventricular septum (71.4%). They were usually attached to the septal cusp (76.7%) and sometimes to the anterior cusp (21.3%). The cusp insertion sites were the free edge (62%), ventricular surface (32%) and basal edge (6%). It was exceptional to find tendinous cords in the ventricular septum of the left ventricle. Tendinous cords directly inserted into the atrioventricular septum were constantly present in the right ventricle, with varying numbers. They were predominantly short because they were inserted into the upper third of the septum and most often headed towards the septal cusp. It was exception to find tendinous cords in the atrioventricular septum of the left ventricle.

Echocardiographic reference values in a sample of asymptomatic adult Brazilian population.

OBJECTIVE: To determine echocardiographic reference values for cardiac chambers, left ventricular mass, and left ventricular (LV) mass indexes in an asymptomatic adult population sample. METHODS: This was an observational study based on a randomly selected population sample from the city of Vitória, Brazil. Two hundred and ninety-five volunteers (61.7% women) with no past history of cardiovascular disease underwent transthoracic echocardiography. The following M-mode echocardiographic parameters were measured: ventricular diameters, interventricular septal thickness, LV posterior wall thickness, LV mass, left ventricular mass indexes, plus aortic and left atrial diameters. Values were expressed as mean and standard deviation and percentiles, with a 95% confidence interval. RESULTS: Echocardiographic values were slightly influenced by gender and age. Overall, cardiac measurements were higher in the male gender. LV posterior wall thickness, mass indexes corrected for height and diastolic diameter were influenced by age. The 95% percentiles of interventricular septum and LV posterior wall were 9.9 mm and 9.6 mm for men, respectively, and 9.3 mm for septum and posterior wall for women. CONCLUSION: The 95% percentile values of interventricular septum and posterior wall and, therefore, of both absolute and indexed left ventricular mass found in our study conducted in the Vitória population are lower than those reported in previous studies. In this framework, our results will be useful as a reference, since they are consistent with the new limits suggested in the literature for the echocardiographic diagnosis of left ventricular hypertrophy.

Valores de referência de medidas ecocardiográficas em amostra da população brasileira adulta assintomática / Echocardiographic reference values in a sample of asymptomatic adult Brazilian population

OBJETIVO: Determinar as medidas ecocardiográficas de referência das cavidades cardíacas, da massa e dos índices de massa do ventrículo esquerdo (VE) em amostra da população adulta assintomática. MÉTODOS: Estudo observacional realizado em amostra aleatória da população da cidade de Vitória, Brasil. Foi realizado ecocardiograma transtorácico em 295 indivíduos voluntários (61,7 por cento mulheres), sem história pregressa de doença cardiovascular. Os diâmetros dos ventrículos, a espessura do septo interventricular e da parede posterior do VE, a massa e os índices de massa VE e os diâmetros da aorta e do átrio esquerdo foram avaliados por ecocardiograma unidimensional. As medidas foram descritas por média e desvio padrão, por percentis, com intervalo de confiança de 95 por cento. RESULTADOS: Sexo e idade influenciaram discretamente os valores ecocardiográficos. Em geral, os valores das medidas cardíacas foram maiores no sexo masculino. A espessura da parede posterior, os índices de massa corrigidos pela altura e o diâmetro diastólico foram influenciados pela idade. Os valores de percentil de 95 por cento de septo interventricular e parede posterior do VE para homens foram 9,9 mm e 9,6 mm, respectivamente, e 9,3 mm para septo e parede posterior para mulheres. CONCLUSÃO: Os valores do percentil de 95 por cento do septo interventricular e da parede posterior e, conseqüentemente, de massa ventricular esquerda absoluta e indexada encontrados em nosso estudo na população de Vitória são inferiores aos valores encontrados em estudos prévios. Nesse aspecto, os resultados deste estudo serão úteis como referência, pois estão de acordo com os novos limites sugeridos na literatura para o diagnóstico ecocardiográfico de hipertrofia ventricular esquerda.

OBJECTIVE: To determine echocardiographic reference values for cardiac chambers, left ventricular mass, and left ventricular (LV) mass indexes in an asymptomatic adult population sample. METHODS: This was an observational study based on a randomly selected population sample from the city of Vitória, Brazil. Two hundred and ninety-five volunteers (61.7 percent women) with no past history of cardiovascular disease underwent transthoracic echocardiography. The following M-mode echocardiographic parameters were measured: ventricular diameters, interventricular septal thickness, LV posterior wall thickness, LV mass, left ventricular mass indexes, plus aortic and left atrial diameters. Values were expressed as mean and standard deviation and percentiles, with a 95 percent confidence interval. RESULTS: Echocardiographic values were slightly influenced by gender and age. Overall, cardiac measurements were higher in the male gender. LV posterior wall thickness, mass indexes corrected for height and diastolic diameter were influenced by age. The 95 percent percentiles of interventricular septum and LV posterior wall were 9.9 mm and 9.6 mm for men, respectively, and 9.3 mm for septum and posterior wall for women. CONCLUSION: The 95 percent percentile values of interventricular septum and posterior wall and, therefore, of both absolute and indexed left ventricular mass found in our study conducted in the Vitória population are lower than those reported in previous studies. In this framework, our results will be useful as a reference, since they are consistent with the new limits suggested in the literature for the echocardiographic diagnosis of left ventricular hypertrophy.