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Krawczyk-Ożóg A, Hołda MK, Batko J, Jaśkiewicz K, Dziewierz A, Zdzierak B, Zasada W, Gil K, Hołda J. Description and prevalence of ventricular mitral annular disjunction: variation of normality or pathological variant? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00129-4. [PMID: 38641167 DOI: 10.1016/j.rec.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to investigate a new variation of the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures: the ventricular mitral annular disjunction (v-MAD). This new variant is characterized by spatial displacement of the mitral leaflet hinge line by more than 2mm toward the left ventricle. METHODS We examined a cohort of autopsied human hearts (n=224, 21.9% females, 47.9±17.6 years) from patients without known cardiovascular disease to identify the presence of v-MAD. RESULTS More than half (57.1%) of the hearts showed no signs of MAD in the mural mitral leaflet or mitral commissures. However, v-MAD was found in 23.6% of cases, located within 20.1% of mural leaflets, 2.2% in superolateral commissures, and 1.3% in inferoseptal commissures. V-MAD was not uniformly distributed along the mitral annulus circumference, with the most frequent site being the P2 scallop (19.6% of hearts). The v-MAD height was significantly greater in mural leaflets than in commissures (4.4 mm±1.2 mm vs 2.1 mm±0.1 mm; P<.001). No specific variations in mitral valve morphology or anthropometrical features of donors were associated with the presence or distribution of v-MADs. Microscopic examinations revealed the overlap of the thin layer of atrial myocardium over ventricular myocardium in areas of v-MAD. CONCLUSIONS Our study is the first to present a detailed definition and morphometric description of v-MAD. Further studies should focus on the clinical significance of v-MAD to elucidate whether it represents a benign anatomical variant or a significant clinical anomaly.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland; Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland.
| | - Mateusz K Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Jakub Batko
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland
| | - Kacper Jaśkiewicz
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland; 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland. https://twitter.com/@Jakub_Batko_
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Cardoso CB, Brandão CVS, Juliani PS, Filadelpho AL, Pereira GJ, Lourenço MLG, Hataka A, Padovani CR. Morphogeometric Evaluation of the Left Ventricle and Left Atrioventricular Ring in Dogs: A Computerized Anatomical Study. Animals (Basel) 2023; 13:1996. [PMID: 37370507 DOI: 10.3390/ani13121996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
In veterinary, there is scarce availability of morphogeometric studies in normal and remodeled hearts; furthermore, ventricular geometry acts as an indicator of cardiac function. It is a highly necessary field of knowledge for the development of therapeutic protocols, especially surgical ones. The objectives of this study were: to obtain measurements of the left atrioventricular valve ring and left ventricle, to analyze the proportionality between the segments of the left cardiac chamber of normal hearts and to describe reference values for morphogeometric analysis of the left ventricle. For this, 50 hearts from small (Group 1-G1) and medium to large (Group 2-G2) dogs were laminated in the apical, basal and equatorial segments, and submitted to computer analysis to identify the perimeter of each segment and the left atrioventricular ring, wall thickness and distance from the atrioventricular sulcus to the apex. The largest internal perimeter was that of the equatorial. The basal segment had the highest mean for ventral parietal wall thickness, suggesting greater contractile reserve at that location. Considering the proportionality relationships, there was no statistical difference between the intersegmental perimeter indices for the two groups. This suggests that despite the animals' weight variations, the proportions between the left ventricular segments are maintained. Therefore, it is concluded that the data can be used as a standard of comparison for cardiac geometric assessments, as well as a basis for the development of therapeutic measures in the context of adverse cardiac remodeling.
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Affiliation(s)
- Catarina Borges Cardoso
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Cláudia Valéria Seullner Brandão
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Paulo Sérgio Juliani
- Cardiovascular Surgery Service, WeVets Veterinary Hospital, São Paulo 02511-000, SP, Brazil
| | - André Luis Filadelpho
- Institute of Biosciences, Department of Anatomy-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Geovane José Pereira
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Maria Lúcia Gomes Lourenço
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Alessandre Hataka
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Carlos Roberto Padovani
- Institute of Biosciences, Department of Biostatistics-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
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Lis M, Krawczyk-Ożóg A, Hołda J, Tyrak K, Dudkiewicz D, Yakovliev A, Strona M, Bolechała F, Jakiel R, Jakiel M, Hołda MK. Pulmonary valve morphometry revisited: Clinical implications for valvular and supravalvular interventions. Clin Anat 2023; 36:234-241. [PMID: 36193818 DOI: 10.1002/ca.23959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
In this cadaver-based study, we aimed to present a novel approach to pulmonary valve (PV) anatomy, morphometry, and geometry to offer comprehensive information on PV structure. The 182 autopsied human hearts were investigated morphometrically. The largest PV area was seen for the coaptation center plane, followed by basal ring and the tubular plane (626.7 ± 191.7 mm2 vs. 433.9 ± 133.6 mm2 vs. 290.0 ± 110.1 mm2 , p < 0.001). In all leaflets, fenestrations are noted and occur in 12.5% of PVs. Only in 31.3% of PVs, the coaptation center is located in close vicinity of the PV geometric center. Similar-sized sinuses were found in 35.7% of hearts, in the remaining cases, significant heterogeneity was seen in size. The mean sinus depth was: left anterior 15.59 ± 2.91 mm, posterior: 16.04 ± 2.82 mm and right anterior sinus: 16.21 ± 2.81 mm and the mean sinus height: left anterior 15.24 ± 3.10 mm, posterior: 19.12 ± 3.79 mm and right anterior sinus: 18.59 ± 4.03 mm. For males, the mean pulmonary root perimeters and areas were significantly larger than those for females. Multiple forward stepwise regression model showed that anthropometric variables might predict the coaptation center plane (sex, age, and heart weight; R2 = 33.8%), tubular plane (sex, age, and BSA; R2 = 20.5%) and basal ring level area (heart weight and sex; R2 = 17.1%). In conclusion, the largest pulmonary root area is observed at the coaptation center plane, followed by the basal ring and tubular plane. The PV geometric center usually does not overlap valve coaptation center. Significant heterogeneity is observed in the size of sinuses and leaflets within and between valves. Anthropometric variables may be used to predict pulmonary root dimensions.
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Affiliation(s)
- Maciej Lis
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Kamil Tyrak
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Artem Yakovliev
- Institute of Nuclear Physics, Polish Academy of Sciences, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Rafał Jakiel
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Jakiel
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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Dudkiewicz D, Zhingre Sanchez JD, Hołda J, Bolechała F, Strona M, Kopacz P, Iaizzo PA, Koziej M, Hołda MK, Konieczyńska M. Aortic valve fenestrations: Macroscopic assessment and functional anatomy study. Clin Anat 2023; 36:612-617. [PMID: 36597994 DOI: 10.1002/ca.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
Aortic valve fenestrations are defined as a loss of aortic valve leaflet tissue. They are a common but overlooked finding with unclear significance. The aim of this study was to investigate the varied functional anatomies of aortic valve fenestrations. A total of 400 formalin-fixed autopsied human hearts were macroscopically assessed and the function of the aortic valve of 16 reanimated human hearts were imaged using Visible Heart® methodologies. Aortic valve leaflet fenestrations were present in 43.0% of autopsied hearts (in one leaflet in 24.0%, in two leaflets 16.0%, in all leaflets 3.0%). Fenestrations were mostly present in left (25.5%) followed by right (23.3%) and noncoronary leaflet (16.3%). In 93.8% of cases, the fenestrations form clusters and were mainly located at the free edge of the leaflet in the commissural area (95.4%). Hearts with aortic valve fenestrations had significantly larger aortic valve diameters and aortic valve areas (p < 0.001). The average surface area sizes of fenestrations were 23.8 ± 16.6 mm2 , and the areas were largest for left followed by right and noncoronary leaflet fenestrations (p < 0.001). The fenestration areas positively correlated with donor age (r = 0.31; p = 0.02). Significant hypermobility and subjective weakening of the leaflet adhesion levels of the fenestrated regions were observed. In conclusion, fenestrations of the aortic leaflets are frequent, and their sizes may be significant. They occur in all age groups, yet their size increase with aging. Fragments of leaflets with fenestrations show different behaviors during the cardiac cycle versus unchanged areas.
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Affiliation(s)
- Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jorge D Zhingre Sanchez
- Visible Heart® Laboratories, Departments of Biomedical Engineering and Surgery, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paul A Iaizzo
- Visible Heart® Laboratories, Departments of Biomedical Engineering and Surgery, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.,Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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Mutual Arrangements of Coronary Blood Vessels within the Right Atrial Appendage Vestibule. J Clin Med 2021; 10:jcm10163588. [PMID: 34441885 PMCID: PMC8396902 DOI: 10.3390/jcm10163588] [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: 06/27/2021] [Revised: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The aim of our study was to investigate the presence and mutual relationships of coronary vessels within the right atrial appendage (RAA) vestibule. Methods: We examined 200 autopsied hearts. The RAA vestibule was cross-sectioned along its isthmuses (superior, middle, and inferior). Results: The right coronary artery (RCA) was present in 100% of the superior RAA isthmuses but absent in 2.0% of hearts within the middle isthmus and in 6.5% of hearts within the inferior RAA isthmus. Its diameter was quite uniform along the superior (2.6 ± 0.8 mm), middle (2.9 ± 1.1 mm), and inferior (2.7 ± 0.9 mm) isthmuses (p = 0.12). The location of the RCA varied significantly, and it was sometimes accompanied by other accessory coronary vessels. In all the isthmuses, the RCA ran significantly closer to the endocardial surface than to the epicardial surface (p < 0.001). At the superior RAA isthmus, the artery was furthest from the right atrial endocardial surface and this distance gradually decreased between the middle RAA isthmus and the inferior RAA. Conclusions: This study was the most complex analysis of the mutual arrangements and morphometric characteristics of coronary blood vessels within the RAA vestibule. Awareness of additional blood vessels within the vestibule can help clinicians plan and perform safe and efficacious procedures in this region.
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Hołda J, Słodowska K, Malinowska K, Strona M, Mazur M, Jasińska KA, Matuszyk A, Koziej M, Walocha JA, Hołda MK. Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures. Diagnostics (Basel) 2021; 11:960. [PMID: 34073631 PMCID: PMC8227200 DOI: 10.3390/diagnostics11060960] [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: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.
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Affiliation(s)
- Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna Słodowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Karolina Malinowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, 31-007 Cracow, Poland;
| | - Małgorzata Mazur
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Aleksandra Matuszyk
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
- Department of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
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Hołda J, Słodowska K, Tyrak K, Bolechała F, Jasińska KA, Koziej M, Hołda MK, Walocha JA. Topographical anatomy of the right atrial appendage vestibule and its isthmuses. J Cardiovasc Electrophysiol 2020; 31:3199-3206. [PMID: 33010077 DOI: 10.1111/jce.14767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures. METHODS AND RESULTS We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001). CONCLUSIONS This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
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Affiliation(s)
- Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Słodowska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Kamil Tyrak
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna A Jasińska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland.,Department of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jerzy A Walocha
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Szczepanek E, Bolechała F, Koziej M, Jasińska KA, Hołda MK. Morphometric characteristics of myocardial sleeves of the pulmonary veins. J Cardiovasc Electrophysiol 2020; 31:2455-2461. [PMID: 32621361 DOI: 10.1111/jce.14651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The pulmonary veins are covered by a myocardial layer, which is often an electrical substrate for atrial fibrillation. The aim of this study was to study the morphologic characteristics of the myocardial sleeves of pulmonary veins by examining a large group of freshly autopsied human material. METHODS AND RESULTS The study macroscopically examined a total of 498 pulmonary veins draining the left atrium (120 unpreserved human hearts). In 75.0% of specimens, a classical pulmonary venous pattern was observed. The remainder of specimens either had an additional middle right pulmonary vein (20.0% of cases) or a common left pulmonary vein (5.0% of cases). Among all the veins seen in the classical pulmonary venous drainage type, the left superior pulmonary vein had the longest myocardial sleeves (9.4 ± 4.6 mm; coverage = 60.1 ± 19.4%), followed by the left inferior pulmonary vein (6.6 ± 3.5 mm; coverage = 47.6 ± 18.3%), the right superior pulmonary vein (6.0 ± 2.7 mm; coverage = 50.5 ± 13.9%) and then the right inferior pulmonary vein (5.0 ± 2.8 mm; coverage = 45.6 ± 16.2%; analysis of variance p < .001). In hearts with an additional right pulmonary vein, this vessel had the shortest myocardial sleeves (2.7 ± 1.1 mm; coverage = 36.0 ± 11.6%). In hearts with a common left pulmonary vein, the myocardial sleeves had the longest course for the common vein (13.7 ± 4.4 mm; coverage = 79.7 ± 4.9%). CONCLUSIONS Myocardial sleeves of the pulmonary veins were seen in each examined specimen, however, their length varied significantly. In hearts with a classical venous drainage pattern, the left superior pulmonary vein had the longest sleeves. When present, an additional middle right pulmonary vein had the shortest myocardial sleeves, while the left common pulmonary vein had the longest sleeves.
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Affiliation(s)
- Elżbieta Szczepanek
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna A Jasińska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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Piątek‐Koziej K, Hołda J, Tyrak K, Bolechała F, Strona M, Koziej M, Lis M, Jasińska KA, Hołda MK. Anatomy of the left atrial ridge (coumadin ridge) and possible clinical implications for cardiovascular imaging and invasive procedures. J Cardiovasc Electrophysiol 2019; 31:220-226. [DOI: 10.1111/jce.14307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/15/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Katarzyna Piątek‐Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Kamil Tyrak
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Filip Bolechała
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Marcin Strona
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Maciej Lis
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
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