Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts
Atrioventricular (AV) nodal injury which results in cardiac conduction disorders is one of the potential complications of heart valve surgeries and radiofrequency catheter ablations. Understanding the topography of the AV conduction system in relation to the tricuspid and mitral valves will help in...
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| Veröffentlicht in: | Cardiovascular pathology 2017-09, Vol.30, p.38-44 |
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| creator | Randhawa, Arpandeep Gupta, Tulika Aggarwal, Anjali Sahni, Daisy Singh, Rana Sandip |
| description | Atrioventricular (AV) nodal injury which results in cardiac conduction disorders is one of the potential complications of heart valve surgeries and radiofrequency catheter ablations. Understanding the topography of the AV conduction system in relation to the tricuspid and mitral valves will help in reducing these complications.
A tissue block of 3cmx4cm, which contain the AV node, bundle of His and the AV nodal extensions, was excised at the AV septal junction in 20 apparently normal human hearts. The block was divided into three equal segments through vertical incisions perpendicular to the insertion of the septal leaflet of the tricuspid valve. Each segment was processed and stained with H&E and Gomori to study the different parts of the AV conduction system.
The lower pole of the AV node was located vertically above the tricuspid septal leaflet (TSL) in 100% (20/20) of cases and at the level of the muscular interventricular septum in 65% (13/20) of cases. The upper pole of the compact AV node was located at the level of the mitral valve leaflet (MVL) in 50% (10/20) of cases. The penetrating bundle of His was seen at the level of the TSL, while the branching bundle of His was situated 1.9±1.5 mm inferior to the TSL. The right and left posterior extensions of the AV node spanned from the MVL to 2.9±1.3 mm above the TSL.
A rectangular area (2.5 mm × 12 mm) in the Koch's triangle was devoid of AV nodal tissue and could be labeled as a safe area with no risk of conduction defects during valve surgeries. Information on the separation of AV nodal extensions from the TSL, MVL and muscular interventricular septum may play a crucial role in guiding and improving the safety of radiofrequency ablations.
•Compact atrioventricular (AV) node-mitral valve leaflet (MVL) distance |
| doi_str_mv | 10.1016/j.carpath.2017.06.005 |
| format | Article |
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A tissue block of 3cmx4cm, which contain the AV node, bundle of His and the AV nodal extensions, was excised at the AV septal junction in 20 apparently normal human hearts. The block was divided into three equal segments through vertical incisions perpendicular to the insertion of the septal leaflet of the tricuspid valve. Each segment was processed and stained with H&E and Gomori to study the different parts of the AV conduction system.
The lower pole of the AV node was located vertically above the tricuspid septal leaflet (TSL) in 100% (20/20) of cases and at the level of the muscular interventricular septum in 65% (13/20) of cases. The upper pole of the compact AV node was located at the level of the mitral valve leaflet (MVL) in 50% (10/20) of cases. The penetrating bundle of His was seen at the level of the TSL, while the branching bundle of His was situated 1.9±1.5 mm inferior to the TSL. The right and left posterior extensions of the AV node spanned from the MVL to 2.9±1.3 mm above the TSL.
A rectangular area (2.5 mm × 12 mm) in the Koch's triangle was devoid of AV nodal tissue and could be labeled as a safe area with no risk of conduction defects during valve surgeries. Information on the separation of AV nodal extensions from the TSL, MVL and muscular interventricular septum may play a crucial role in guiding and improving the safety of radiofrequency ablations.
•Compact atrioventricular (AV) node-mitral valve leaflet (MVL) distance <2.5 mm in 50%.•Compact AV node and its extensions were at level of MVL in 50% and 100% cases.•Compact and right posterior extension was 2–3 mm above Tricuspid septal leaflet (TSL).•Distance AV extension – TSL, MVL, MIVS (muscular interventricular septum) – 3 mm, 0 mm, 2 mm.•A rectangular area (2.5×12mm) in Koch's triangle was devoid of AV nodal tissue.</description><identifier>ISSN: 1054-8807</identifier><identifier>EISSN: 1879-1336</identifier><identifier>DOI: 10.1016/j.carpath.2017.06.005</identifier><identifier>PMID: 28759818</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Atrioventricular node ; Atrioventricular Node - anatomy & histology ; Atrioventricular Node - injuries ; Atrioventricular Node - surgery ; Atrioventricular node extensions ; Bundle of His - anatomy & histology ; Bundle of His - injuries ; Bundle of His - surgery ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Female ; Heart Valve Diseases - surgery ; Humans ; Intraoperative Complications - prevention & control ; Koch's triangle ; Male ; Middle Aged ; Mitral Valve - anatomy & histology ; Mitral Valve - surgery ; Mitral valve leaflet ; Models, Anatomic ; Models, Cardiovascular ; Safety ; Tricuspid septal leaflet ; Tricuspid Valve - anatomy & histology ; Tricuspid Valve - surgery</subject><ispartof>Cardiovascular pathology, 2017-09, Vol.30, p.38-44</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-3552b3b8a872a4ef2979c17d3901ec78f064f85aad304cb7ca1b4795b74f9c983</citedby><cites>FETCH-LOGICAL-c431t-3552b3b8a872a4ef2979c17d3901ec78f064f85aad304cb7ca1b4795b74f9c983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1054880717301151$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28759818$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Randhawa, Arpandeep</creatorcontrib><creatorcontrib>Gupta, Tulika</creatorcontrib><creatorcontrib>Aggarwal, Anjali</creatorcontrib><creatorcontrib>Sahni, Daisy</creatorcontrib><creatorcontrib>Singh, Rana Sandip</creatorcontrib><title>Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts</title><title>Cardiovascular pathology</title><addtitle>Cardiovasc Pathol</addtitle><description>Atrioventricular (AV) nodal injury which results in cardiac conduction disorders is one of the potential complications of heart valve surgeries and radiofrequency catheter ablations. Understanding the topography of the AV conduction system in relation to the tricuspid and mitral valves will help in reducing these complications.
A tissue block of 3cmx4cm, which contain the AV node, bundle of His and the AV nodal extensions, was excised at the AV septal junction in 20 apparently normal human hearts. The block was divided into three equal segments through vertical incisions perpendicular to the insertion of the septal leaflet of the tricuspid valve. Each segment was processed and stained with H&E and Gomori to study the different parts of the AV conduction system.
The lower pole of the AV node was located vertically above the tricuspid septal leaflet (TSL) in 100% (20/20) of cases and at the level of the muscular interventricular septum in 65% (13/20) of cases. The upper pole of the compact AV node was located at the level of the mitral valve leaflet (MVL) in 50% (10/20) of cases. The penetrating bundle of His was seen at the level of the TSL, while the branching bundle of His was situated 1.9±1.5 mm inferior to the TSL. The right and left posterior extensions of the AV node spanned from the MVL to 2.9±1.3 mm above the TSL.
A rectangular area (2.5 mm × 12 mm) in the Koch's triangle was devoid of AV nodal tissue and could be labeled as a safe area with no risk of conduction defects during valve surgeries. Information on the separation of AV nodal extensions from the TSL, MVL and muscular interventricular septum may play a crucial role in guiding and improving the safety of radiofrequency ablations.
•Compact atrioventricular (AV) node-mitral valve leaflet (MVL) distance <2.5 mm in 50%.•Compact AV node and its extensions were at level of MVL in 50% and 100% cases.•Compact and right posterior extension was 2–3 mm above Tricuspid septal leaflet (TSL).•Distance AV extension – TSL, MVL, MIVS (muscular interventricular septum) – 3 mm, 0 mm, 2 mm.•A rectangular area (2.5×12mm) in Koch's triangle was devoid of AV nodal tissue.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrioventricular node</subject><subject>Atrioventricular Node - anatomy & histology</subject><subject>Atrioventricular Node - injuries</subject><subject>Atrioventricular Node - surgery</subject><subject>Atrioventricular node extensions</subject><subject>Bundle of His - anatomy & histology</subject><subject>Bundle of His - injuries</subject><subject>Bundle of His - surgery</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - methods</subject><subject>Female</subject><subject>Heart Valve Diseases - surgery</subject><subject>Humans</subject><subject>Intraoperative Complications - prevention & control</subject><subject>Koch's triangle</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve - anatomy & histology</subject><subject>Mitral Valve - surgery</subject><subject>Mitral valve leaflet</subject><subject>Models, Anatomic</subject><subject>Models, Cardiovascular</subject><subject>Safety</subject><subject>Tricuspid septal leaflet</subject><subject>Tricuspid Valve - anatomy & histology</subject><subject>Tricuspid Valve - surgery</subject><issn>1054-8807</issn><issn>1879-1336</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFu1TAQRS0EoqXwCSAv2STYsR3bK4QqoJUqsYG15TiTxo_EDrZT0e_gh3H7Hmy7Gnt079wZHYTeUtJSQvsPh9bZtNkytx2hsiV9S4h4hs6pkrqhjPXP65sI3ihF5Bl6lfOBEKI45y_RWaek0Iqqc_TnyucSl3jrnV1wiVu8TXab73GccJkB25J8vINQi9sXm3CIY-2GEfuSMfwuELKPIWMfcILFlvqpYx69dcHRxzLHZJ13OO_pmLJU-2rTz0dTiGmtvXlfbcAz2FTya_RiskuGN6d6gX58-fz98qq5-fb1-vLTTeM4o6VhQnQDG5RVsrMcpk5L7agcmSYUnFQT6fmkhLUjI9wN0lk6cKnFIPmknVbsAr0_zt1S_LVDLmb12cFS94O4Z0N1JzpFNJNVKo5Sl2LOCSazJV9vuDeUmAce5mBOPMwDD0N6U3lU37tTxD6sMP53_QNQBR-PAqiH3nlIJjsPwcHoE7hixuifiPgLHvui1A</recordid><startdate>201709</startdate><enddate>201709</enddate><creator>Randhawa, Arpandeep</creator><creator>Gupta, Tulika</creator><creator>Aggarwal, Anjali</creator><creator>Sahni, Daisy</creator><creator>Singh, Rana Sandip</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201709</creationdate><title>Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts</title><author>Randhawa, Arpandeep ; Gupta, Tulika ; Aggarwal, Anjali ; Sahni, Daisy ; Singh, Rana Sandip</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-3552b3b8a872a4ef2979c17d3901ec78f064f85aad304cb7ca1b4795b74f9c983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrioventricular node</topic><topic>Atrioventricular Node - anatomy & histology</topic><topic>Atrioventricular Node - injuries</topic><topic>Atrioventricular Node - surgery</topic><topic>Atrioventricular node extensions</topic><topic>Bundle of His - anatomy & histology</topic><topic>Bundle of His - injuries</topic><topic>Bundle of His - surgery</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - methods</topic><topic>Female</topic><topic>Heart Valve Diseases - surgery</topic><topic>Humans</topic><topic>Intraoperative Complications - prevention & control</topic><topic>Koch's triangle</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve - anatomy & histology</topic><topic>Mitral Valve - surgery</topic><topic>Mitral valve leaflet</topic><topic>Models, Anatomic</topic><topic>Models, Cardiovascular</topic><topic>Safety</topic><topic>Tricuspid septal leaflet</topic><topic>Tricuspid Valve - anatomy & histology</topic><topic>Tricuspid Valve - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Randhawa, Arpandeep</creatorcontrib><creatorcontrib>Gupta, Tulika</creatorcontrib><creatorcontrib>Aggarwal, Anjali</creatorcontrib><creatorcontrib>Sahni, Daisy</creatorcontrib><creatorcontrib>Singh, Rana Sandip</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cardiovascular pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Randhawa, Arpandeep</au><au>Gupta, Tulika</au><au>Aggarwal, Anjali</au><au>Sahni, Daisy</au><au>Singh, Rana Sandip</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts</atitle><jtitle>Cardiovascular pathology</jtitle><addtitle>Cardiovasc Pathol</addtitle><date>2017-09</date><risdate>2017</risdate><volume>30</volume><spage>38</spage><epage>44</epage><pages>38-44</pages><issn>1054-8807</issn><eissn>1879-1336</eissn><abstract>Atrioventricular (AV) nodal injury which results in cardiac conduction disorders is one of the potential complications of heart valve surgeries and radiofrequency catheter ablations. Understanding the topography of the AV conduction system in relation to the tricuspid and mitral valves will help in reducing these complications.
A tissue block of 3cmx4cm, which contain the AV node, bundle of His and the AV nodal extensions, was excised at the AV septal junction in 20 apparently normal human hearts. The block was divided into three equal segments through vertical incisions perpendicular to the insertion of the septal leaflet of the tricuspid valve. Each segment was processed and stained with H&E and Gomori to study the different parts of the AV conduction system.
The lower pole of the AV node was located vertically above the tricuspid septal leaflet (TSL) in 100% (20/20) of cases and at the level of the muscular interventricular septum in 65% (13/20) of cases. The upper pole of the compact AV node was located at the level of the mitral valve leaflet (MVL) in 50% (10/20) of cases. The penetrating bundle of His was seen at the level of the TSL, while the branching bundle of His was situated 1.9±1.5 mm inferior to the TSL. The right and left posterior extensions of the AV node spanned from the MVL to 2.9±1.3 mm above the TSL.
A rectangular area (2.5 mm × 12 mm) in the Koch's triangle was devoid of AV nodal tissue and could be labeled as a safe area with no risk of conduction defects during valve surgeries. Information on the separation of AV nodal extensions from the TSL, MVL and muscular interventricular septum may play a crucial role in guiding and improving the safety of radiofrequency ablations.
•Compact atrioventricular (AV) node-mitral valve leaflet (MVL) distance <2.5 mm in 50%.•Compact AV node and its extensions were at level of MVL in 50% and 100% cases.•Compact and right posterior extension was 2–3 mm above Tricuspid septal leaflet (TSL).•Distance AV extension – TSL, MVL, MIVS (muscular interventricular septum) – 3 mm, 0 mm, 2 mm.•A rectangular area (2.5×12mm) in Koch's triangle was devoid of AV nodal tissue.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28759818</pmid><doi>10.1016/j.carpath.2017.06.005</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Atrioventricular node Atrioventricular Node - anatomy & histology Atrioventricular Node - injuries Atrioventricular Node - surgery Atrioventricular node extensions Bundle of His - anatomy & histology Bundle of His - injuries Bundle of His - surgery Catheter Ablation - adverse effects Catheter Ablation - methods Female Heart Valve Diseases - surgery Humans Intraoperative Complications - prevention & control Koch's triangle Male Middle Aged Mitral Valve - anatomy & histology Mitral Valve - surgery Mitral valve leaflet Models, Anatomic Models, Cardiovascular Safety Tricuspid septal leaflet Tricuspid Valve - anatomy & histology Tricuspid Valve - surgery |
| title | Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts |
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