Histology of vascular myocardial wall of left atrial body after pulmonary venous incorporation
Histology of vascular myocardial wall of left atrial body after pulmonary venous incorporation
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DOI：
10.1016/j.amjcard.2005.11.019
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发表时间：
2006-03-01
影响因子：
2.8
通讯作者：
DeRuiter, MC
中科院分区：
文献类型：
--
作者：
Douglas, YL;Jongbloed, MRM;DeRuiter, MC
在胚胎发育过程中，肺静脉（PV）并入左心房，形成单独的肺静脉口。我们描述的后果，这一纳入过程的组织学的左心房和可能的临床意义。本文对16例人胚胎和胎儿、1例新生儿和5例成人左心房壁组织学与肺静脉（PV）掺入的关系进行了组织化学研究。被心包外分化的心肌细胞包围的PV壁被并入LA体。合并后，肺静脉和光滑壁左心房体壁的组成在组织学上是相同的。然而，左心房附件由心内膜层和心肌层组成，没有血管壁成分。2例成人左心房后壁心肌缺失。在左心房体和左心房附件的过渡处，观察到缺乏静脉壁的壁光滑的心肌区。该区域在组织学上与右心房静脉窦相同。总之，左心房体是由肺静脉的合并和生长引起的，呈现出组织学上相同的血管壁结构，由肺静脉的心包外分化心肌覆盖。心肌的不连续性可能是心律失常的基础，并且在一些患者中心肌的缺失使得该区域可能容易受到消融策略造成的损伤。左心房体部和左心房附件之间的边界区被假设为胚胎静脉窦的左侧部分。(C)2006年爱思唯尔公司All rights reserved.
During embryonic development, the common pulmonary vein (PV) becomes incorporated into the left atrium, giving rise to separate PV ostia. We describe the consequences of this incorporation process for the histology of the left atrium and the possible clinical implications. The histology of the left atrial (LA) wall in relation to PV incorporation was studied immunohistochemically in 16 human embryos and fetuses, 1 neonate, and 5 adults. The PV wall, surrounded by extrapericardially differentiated myocardial cells, was incorporated into the LA body. After incorporation, the composition of PVs and the smooth-walled LA body wall was histologically identical. The LA appendage, however, consisted of endocardial and myocardial layers without a vessel wall component. In 2 adults, the myocardium in the LA posterior wall was absent. At the transition of the LA body and LA appendage, a smooth-walled myocardial zone lacking the venous wall was observed. This zone was histologically identical to the sinus venarum of the right atrium. In conclusion, the LA body arises by incorporation and growth of PVs, presenting with a histologically identical structure of vessel wall covered by extrapericardially differentiated myocardium of PVs. Discontinuity of myocardium may be the substrate for arrhythmias, and absence of myocardium in some patients makes this area potentially vulnerable to damage inflicted by ablation strategies. A border zone between the LA body and LA appendage is hypothesized to be the left part of the embryonic sinus venosus. (C) 2006 Elsevier Inc. All rights reserved.