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Introduction: The tricuspid valve complex is present between the right atrium and right ventricle which consistsof i) Tricuspid orifice and its associated annulus ii) 3 Leaflets (anterior, septal, posterior); iii) 3 Commissures(anteroposterior, posteroseptal, anteroseptal); iv) 2 Papillary muscles (anterior, posterior, occasionally septal);v)Chordae tendinae of various types. Awareness of tricuspid valve complex is of great clinical importance incardiosurgery and is considered a prerequisite for successful, uncomplicated cardiac surgeries and interventionalradiology.Materials and Methods: 45 cadaveric human hearts have been utilized in this study. Conventional dissectiontechnique was performed and the detailed morphology of the tricuspid valve complex was studied. The followingobservations were taken a)Number of commissures b) Position of commissures c) Shape of orifice d) Number &shape of leaflets e) Presence or absence of accessory leaflets f) Position of normal and accessory leaflets, ifpresent, g) No. of scallops in posterior leaflet.Observations and results: The tricuspid orifice was elliptical in 34 hearts (75.6%) and triangular in 11 hearts(24.4%).The number of leaflets or cusps in the tricuspid valve complex showed variation. There were typical 3leaflets in 41 hearts (91.1%) with anterior, posterior and septal leaflets. In 4 hearts (8.9%) 4-cuspidal form wasnoticed with an accessory cusp. Three Commissures were identified between the leaflets in the 3-cuspidal form.They are anteroposterior, posteroseptal and anteroseptal.Conclusion: This knowledge of anatomical variation in the morphology of the tricuspid valve may help cardiacsurgeons during surgical procedures conducted for correction of valve defects
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The right and left coronary artery arises from the anterior and left posterior sinus of Valsalva respectively. Aortic root is an important area for various interventional diagnostic and surgical procedures for cardiologist and radiologist which comprises of the bulbar aortic sinus and the proximal ascending aorta. 50 cadaveric human heart specimens (25 male and 25 female) were used by dissection method. It has been observed that the mean diameter of left coronary ostium is more than that of right coronary ostium. The mean diameter of left coronary ostium in male is 4.37mm ± 0.84 and in female it is 4.16mm ± 0.67. On the contrary, in case of right coronary ostium the mean diameter were 3.04mm ± 0.76 and 3.14mm ± 0.70 in male and female respectively. In 18% specimens multiple openings were observed in anterior aortic sinus. However, in 4% specimen anterior aortic sinus with no openings were also observed. Multiple openings were also seen in left posterior aortic sinus in 4% specimen. No openings were observed in the pulmonary sinuses and the right posterior aortic sinus. Knowledge of the level of ostia is very important to avoid difficulties during various diagnostic and surgical procedures, hence, to extract extra information regarding these issues, study was also extended to observe the level of ostia; and in this study right coronary ostium was found below Supravalvular Ridge (SVR) in 78% specimen, at SVR in 10% specimen and above SVR in 12% specimen. The left coronary ostium was found below SVR in 68% cases, at SVR in 16% cases and above SVR in 16% cases.
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Objective To investigate the value of high sensitive cardiac troponin T(hs-cTnT),human heart fatty acid binding protein(H-FABP),B-type natriuretic peptide(BNP),ischemia modified albumin(IMA) and creatine kinase(CK-MB) in the diagnosis of myocardial injury in preeclampsia.Methods A total of 50 women of normal pregnancy in preganancy group,and 50 healthy women without pregnacy were collected in control group,167 women in preeclampsia group (42 cases with myocardial injury,125 cases without myocardial injury).The serum IMA were detected by albumin cobalt binding test,H-FABP were detected by ELISA,hs-cTnT and BNP were detected by microparticle chemiluminescence immunoassay and CK-MB were detected by immuno-suppression.Results Five cardiac markers levels in myocardial injury group of preeclampsia group were significantly higher than those in healthy control group and normal pregnancy women and non myocardial injury group[(t=8.521,7.489,7.256;7.561,6.897,6.235;12.314,9.236,10.251;13.657,11.023,12.031;11.301,10.364,15.567),(P=0.008,0.030,0.035;0.027,0.031,0.033;0.002,0.005,0.003;0.002,0.004,0.003;0.003,0.004,0.001)].There was no significant difference in hs-cTnT among control group and normal pregnancy women and non myocardial injury group[(t=1.678,1.401;1.887,1.784),(P=0.339,0.401;0.289,0.398)].IMA、H-FABP、CK-MB and BNP in normal pregnancy women and non myocardial injury group were higher than in control group [(t=4.784,4.021;3.894,3.784;5.801,5.215),(P=0.024,0.032;0.037,0.041;0.021,0.029)].There was no significant difference in IMA,H-FABP,CK-MB and BNP between normal pregnancy women and non myocardial injury group [(t=1.325,1.257,1.241);(P=0.451,0.329,0.378)].The sensitivity of combined detection of five cardiac markers in preeclampsia myocardial injury was significantly higher than that in single marker(χ2=3.021,3.561,4.215,4.496,5.249;P=0.027,0.024,0.019,0.015,0.009).Conclusion When myocardial damage in pregnant women was determined by cardiac markers,pregnancy should be taken into account as a special physiological cycle.The combined detection of five cardiac markers is conducive to early diagnosis of ischemic myocardial injury in preeclampsia.
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Studies on the collagen system of the human myocardium are still limited compared to those on small laboratory animals. The aim of this work was to observe the collagen tissue of the myocardium of the human heart as a function of age. The types of collagen, as well as the density of collagen tissue and the diameter of collagen fibrils, were examined. Fragments of the left ventricular wall from 15 hearts, 5 from children, 5 from young adults, and 5 from elderly individuals, were analyzed by using the Picrosirius-polarization method and by transmission electron microscopy (TEM). The results showed the presence of collagen type III and collagen type I, both in the endomysium and perimysium of the 3 groups studied. Measurements of collagen content in myocardial tissue displayed that both endomysial and perimysial collagen increase in number and thickness in the adult and elderly. These histochemical results coincided with the observations obtained with the electron microscope in showing an increase in the number of collagen fibrils with a large diameter in the adult and elderly hearts. The present results on cardiac collagen may be important for assessing the pathogenesis of several cardiopathies in the hearts of children, young adults, and the elderly.
Los estudios sobre el colágeno del miocardio humano son aún escasos en comparación con los hechos en pequeños animales de laboratorio. El objetivo de este trabajo fue cuantificar el tejido colágeno del miocardio del corazón humano en función de la edad. Se estudiaron los tipos de colágeno, su densidad y el diámetro de las fibrillas de colágeno. Para esto se utilizaron fragmentos de la pared del ventrículo izquierdo de 15 corazones, cinco de niños, cinco de adultos jóvenes y 5 de personas de edad avanzada. Las muestras se analizaron mediante el método de Picrosirius-polarización y por microscopía electrónica de transmisión (MET). Los resultados mostraron la presencia de colágeno tipo III y de tipo I, tanto en el endomisio como en el perimisio de los tres grupos estudiados. Además, aumenta el colágeno tanto en el endomisio como en el perimísio, así como su número y grosor a medida que aumenta la edad. Los resultados histoquímicos coincidieron con las observaciones obtenidas con el microscopio electrónico, en las que se observa un aumento en el número de fibrillas de colágeno de gran diámetro en los corazones de los adultos y los ancianos. Estos resultados podrían ser importantes para la evaluación de la patogénesis de varias cardiopatías en los corazones de niños, jóvenes y ancianos.
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Adulto , Anciano de 80 o más Años , Preescolar , Femenino , Humanos , Masculino , Colágeno Tipo I/análisis , Colágeno Tipo III/análisis , Ventrículos Cardíacos/química , Miocardio/química , Factores de Edad , Análisis de Varianza , Compuestos Azo/análisisRESUMEN
Objective To evaluate the early diagnostic value of human heart-type fatty acid- binding protein (H-FABP) of acute coronary syndrome (ACS) and compare the diagnostic accuracy of different combination regimens of cardiac markers. Methods A total of 103 consecutive patients with chest pain (within 6 h after admission to Peking University Third Hospital,emergency department) suggestive of ACS were recruited for the analysis from April,2010 to June,2011.The blood levels of H-FABP,cardiac troponin-T (cTnT) and creatine kinase-myocardial band (CK-MB) were obtained at admission. The sensitivity,specificity,positive predictive value and negative predictive value together with the sensitivity and specificity in different phases of illness at admission were analyzed and compared among H-FABP,cTnT,CK-MB and different combinations by using SPSS version 17.0 software.Results Within 6 h of onset of symptom,the overall sensitivities of H-FABP,cTnT and CK-MB were 62.5％,30.6％ and 33.3％ respectively for patients with ACS.The sensitivity of H-FABP was significantly higher than that of cTnT and CK-MB (P ＜0.01 ).There were no differences in specificity and positive predictive value.The combination of H-FABP with cTnT had the greatest negative predictive value (53.8％ ).The sensitivity of H-FABP was higher during 3 - 6 h (77.8％ ) than during 0 - 3 h (53.3 ％ ) after chest pain onset (P =0.038).Within 0 - 3 h of onset of AMI,the overall sensitivities of the combination of H-FABP with cTnT and H-FABP with CK-MB (55.6％) were significantly higher than the combinaton of cTnT with CK-MB ( 24.4％ ) ( P =0.003 ).The sensitivity of the combination of H-FABP with cTnT was higher than that of single H-FABP during 0- 3 h and 3 -6 h after onset of AMI with increment in 3.3％ and 7.4％ respectively.The combination of H-FABP with cTnT had the greatest sensitivity ( 85.2％ ) during 3 - 6 h after onset.Conclusions H-FABP is the most sensitive cardiac marker in diagnosing of ACS in the early phase within 6 h,especially during 3 -6 h after onset.The sensitivity of the combination of H-FABP with cTnT is higher than that of H-FABP alone.The combination of H-FABP with cTnT has the best diagnostic value during 3 -6 h after onset of ACS.
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Objective To investigate the differences of connexin 43(Cx43)expression between adult and infant heart. Methods By using immunohistochemistry to observe the expression of Cx43. Results 1.The expression of Cx43 had a punclate distribution in cytoplasm and over the entire surface of the cardiocyte,and a few located at intercalated disk of atrial and ventricular myocardium in the infant heart.2.Cx43 positive granules distributed irregularly in cell side surface and cytoplasm as well as intercalated disk in adult atrium.Cx43 immunolabelling of adult ventricular myocardium was typically confined to the site of intercalated disk.3.The results of image analyzer showed that the amount of connexin43 expression was lower in the atrium than that of the ventricle in infant heart and atrium bigger than ventricle in adult heart.The expression of Cx43 was less in adult heart than that of infant heart.Conclusion The expression of Cx43 was mainly over the entire surface of the myocardium in infant heart.There were expression differences of Cx43 in human ventricular and atrial myocytes.The amount of Cx43 expression was higher in ventricle than that of atrium in infant heart and atrium bigger than ventricle in adult heart.It was less in adult heart than that of infant.It showed that the expression of Cx43 in human heart existed a developmental differences.
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The morphology and position of the AV node and AV bundle were observed in 13 human hearts with serial sections. 1.the AV node is a long sagittal flatt ened structure, its transverse section is triangular in shape with a right convex surface, sometimes the cross section is fusiform or half oval in shape. Its size is 3.5x3.3x1.1 mm in adult. In 5 cases the endocardium lying on the right surface of the AV node is elevated.2.The AV node is situated in the upper border of the atrioventricular septum (between the levels of the attachment lines of the mitral and tricuspid valves). The adult AV node is 1.8-5.8 mm anterior to the coronary sinus orifice, 0.3-0.7 mm from the endocardium of the right atrium, 3.3-7.5 mm above the upper border of the septal leaflet of the tricuspid valve. The left surface of the AV node contacts with the central fibrous body.3.The AV node can be divided in 2 parts: superficial and deep, the fibers of the super ficial part are longitudinal in sections and end in the lower border of the AV node. In one case, the deep part is subdivided in an upper part and a lower part. In the specimens in which the right atrial endocardium lying on the right surface of the AV node is elevated, the overlaying fibers end in the endocardium. At the upper border, right surface, and posterior margin of the AV node, there are atrial fibers ending to the AV node. 4. The adult AV bundle is 5.7-7.9 mm long, 1.1-1.5 mm in diameter. Its anterior part is on top of the muscular interventricular septum in 7 specimens, on its left surface in 3 specimens, and in the substance of the muscular interventricular septum in 2 specimens. In one case its course is very special, at first on the top of muscular interventricular septum, then at its left surface, finally in the substance of the right part of the muscular interventricular septum.