Morphological Assessment and Possible Clinical Implications of the Left Ventricle Papillary Muscles. Study in a Colombian Population Sample

SUMMARY: Papillary muscles in the left ventricle present multiple anatomic expressions that are relevant for medical fields focusing on the understanding of clinical events involving these structures. Here, the aim was to perform a morphological characterization of the left ventricle papillary muscles in a sample of Colombian population. In the study were included eighty-two hearts from male individuals who underwent autopsy at the Institute of Legal Medicine and Forensic Sciences in Bucaramanga, Colombia. In each heart was carefully performed a longitudinal incision on the obtuse margin to visualize the papillary muscles. Data set was registered, and analysis of the continuous and categorical variables was carried out. Single anterior papillary muscle was observed in 74 samples (90.2 %) whereas this represented only 48 specimens (58.5 %) for the posterior papillary muscle (p = 0.3). Mean length and breadth of the anterior muscle were 29.9 ± 4.94 and 11.74 ± 2.75 mm, and those for the posterior muscle were 27.42 ± 7.08 and 10.83 ± 4.08 mm. Truncated apical shape was the most frequent type observed on the papillary muscles, anterior 41 (50 %) and posterior 37 (45.1 %), followed by flat-topped in the anterior 25 (30.5 %) and bifurcated in posterior muscle 14 (17.1 %). A mean of 9.04 ± 2.75 chordae raised from the anterior and 7.50 ± 3.3 from posterior papillary muscle. In our study we observed a higher incidence of single papillary muscles and slightly larger dimensions than information reported in the literature. The anatomic diversity of the papillary muscles should be considered for the correct image interpretation, valve implantation and performance evaluation on myocardial ischemic events.

Los músculos papilares del ventrículo izquierdo presentan múltiples expresiones anatómicas que son relevantes para las áreas médicas que se centran en la comprensión de los eventos clínicos que involucran estas estructuras. El objetivo fue realizar una caracterización morfológica de los músculos papilares del ventrículo izquierdo en una muestra de población colombiana. En el estudio se incluyeron ochenta y dos corazones de individuos masculinos a los que se les realizó autopsia en el Instituto de Medicina Legal y Ciencias Forenses de Bucaramanga, Colombia. En cada corazón se realizó cuidadosamente una incisión longitudinal en el margen obtuso para visualizar los músculos papilares. Se registró el conjunto de datos y se realizó el análisis de las variables continuas y categóricas. Se observó un solo músculo papilar anterior en 74 muestras (90,2 %), mientras que este rasgo se presentó en 48 muestras (58,5 %) para el músculo papilar posterior (p = 0,3). La longitud y anchura media del músculo anterior fueron 29,9 ± 4,94 y 11,74 ± 2,75 mm, y las del músculo posterior fueron 27,42 ± 7,08 y 10,83 ± 4,08 mm. La forma apical truncada fue el tipo más frecuente observado en los músculos papilares, anterior 41 (50 %) y posterior 37 (45,1 %), seguido de la forma plana en los 25 anteriores (30,5 %) y bifurcada en el músculo posterior 14 (17,1 %). Una media de 9,04 ± 2,75 cuerdas elevadas desde el músculo papilar anterior y 7,50 ± 3,3 desde posterior. En nuestro estudio observamos una mayor incidencia de músculos papilares únicos y dimensiones ligeramente mayores que la información reportada en la literatura. La diversidad anatómica de los músculos papilares debe ser considerada para la correcta interpretación de imágenes, implantación valvular y evaluación del desempeño en eventos isquémicos miocárdicos.

Histomorfometria do epitélio ruminal de cabritos 1/2 sangue Boer submetidos a dietas com tortas oriundas da produção do biodiesel / Histomorphometrics of the ruminal epithelium of 1/2 blood Bôer goats submitted to diets with pies from the production of biodiesel

Objetivou-se determinar o melhor nível de inclusão e de substituição das tortas de dendê e amendoim, respectivamente, em dietas para cabritos 1/2 sangue Boer, por meio da avaliação histomorfométrica das papilas ruminais. Foram utilizados 40 cabritos 1/2 sangue Boer, para cada período experimental, machos, não castrados, com idade aproximada de três meses e com peso inicial de 15,01±1,76kg. Os períodos experimentais constaram de 75 dias e 72 dias. As dietas consistiram de volumoso feno de Tifton-85 e de ração em mistura completa, contendo níveis de inclusão da torta de dendê nas proporções de 0,0; 7,0; 14,0; e 21,0% com base na matéria seca; e de mistura completa, contendo níveis de substituição do farelo de soja pela torta de amendoim nas proporções de 0,0; 33,0; 66,0; e 100%, constituindo-se os tratamentos. No epitélio do rúmen, foram avaliadas altura e largura das papilas, assim como densidade papilar e espessura da parede muscular do rúmen. Entre estas, a altura das papilas, no experimento com torta de amendoim, foi a única a sofrer efeito linear decrescente (P<0,0014); as demais variáveis, tanto dos animais alimentados com torta de amendoim quanto daqueles alimentados com torta de dendê, não foram afetadas pela dieta. As médias de altura encontradas foram de 2,6 e 2,3mm para as tortas de amendoim e dendê, respectivamente. Portanto, a inclusão de até 21% de torta de dendê e a substituição de 100% de torta de amendoim no concentrado de cabritos não alteraram a morfometria das papilas ruminais.

The aim of this study was to determine the best level of pies and replacement of palm oil and peanut, respectively, in diets of 1/2 blood Bôer goats from the histomorphometry of the rumen papillae. A total of 40 1/2 blood male, unneutered, aged approximately three months and initial weight of 15.01±1.76kg Bôer goats were used in each experimental period. The experimental periods consisted of 75 days and 72 days. The diets consisted of roughage hay Tifton-85 and total mixed ration containing levels of inclusion of palm kernel cake in the proportions of 0.0, 7.0, 14.0 and 21.0% based on dry matter; and the second experiment consisted of a complete mixture containing substitution levels of soybean meal by groundnut cake in the proportions of 0.0, 33.0, 66.0 and 100%. Epithelial cells were evaluated in the rumen height and width of the papillae, and density and thickness of the papillary muscle of the rumen. Among these, the height of the papillae in the experiment with peanut butter pie was the only one to suffer a negative linear effect (P<0.0014), the other variables, both in animals fed groundnut cake and palm oil, were not affected by the diet. The average heights found were 2.6 and 2.3, for pies, peanut and palm oil, respectively. Therefore, the inclusion of up to 21% palm kernel cake and replacement of 100% peanut cake in the concentrate of kids did not alter the morphology of the rumen papillae.

Características morfológicas y biométricas del músculo papilar septal en corazones de individuos chilenos / Morphological and biometric characteristics of septal papillary muscle in hearts of chilean individuals

Se realizó un estudio descriptivo de las características anatómicas y biométricas del músculo papilar septal en 30 corazones de individuos adultos chilenos, en edades comprendidas entre 18 y 84 años de edad, de ambos sexos, sin aparente patología cardíaca, pertenecientes a la Unidad de Anatomía Humana Normal del Departamento de Ciencias Básicas de la Universidad de La Frontera. Los resultados mostraron que el músculo papilar septal, se presenta en un 83,3 por ciento de los corazones del estudio. De éstos, el 44,0 por ciento presenta un solo músculo, el 28 por ciento presenta dos músculos y el 28 por ciento tres músculos papilares septales. De los músculos papilares septales encontrados, el 71,1 por ciento correspondió a la forma cono libre, el 24,4 por ciento a la forma cono pegado y el 4,5 por ciento a la forma puente. En cuanto a la longitud de forma cono pegado y cono libre, el rango que se encuentra en mayor porcentaje está entre 4,0 mm ­ 5,99 mm; con un 45,5 por ciento y 42,4 por ciento, respectivamente. Este estudio nos demuestra la importancia de incorporar al músculo papilar septal a la nomenclatura anatómica internacional.

A descriptive research study was carried out on the anatomical and biometric characteristics of the septal papillary muscle in 30 hearts of adult Chilean subjects, between 18 and 84 years of age of both sexes and without apparent cardiac pathology, from the Normal Human Anatomy Unit, Basic Sciences Department of the Universidad de La Frontera. Results show that the septal papillary muscle was present in 83.3 percent of the hearts in the study. Of these 44.0 percent show one muscle only, 28 percent show two muscles and 28 percent show three septal papillary muscles. In the septal papillary muscles found, 71.1 percent are free cone-shaped, 24.4 percent were attached cone-shaped, and 4.5 percent were bridge-shaped. Regarding the length of attached cone and free cone shaped, the highest percentage range was between 4.0 mm and 5.99 mm, with 45.5 percent and 42.4 percent respectively. The present study shows the importance of integrating the septal papillary muscle to the International Anatomical Nomenclature.

Músculos papilares en el corazón del avestruz (Struthio camelus) / Papillary muscles in the heart of the ostrich (Struthio camelus)

El corazón del avestruz (Struthio camelus), al igual que el corazón de las aves domésticas, tiene una valva atrioventricular derecha muscular sin cuerdas tendinosas, y una valva atrioventricular izquierda membranosa con cuerdas tendinosas que se extienden entre las cúspides y 3 músculos papilares. El objetivo del estudio fue describir los músculos papilares, número, ubicación y algunas características morfológicas. Se utilizaron 50 corazones de avestruz (Struthio camelus), que fueron disecados y fijados en formalina tamponada al 10%, y se obtuvieron cortes histológicos de 7 mieras los cuales fueron teñidos con Van Gieson y H-E. El estudio macroscópico mostró ausencia de músculos papilares en el ventrículo derecho y en el ventrículo izquierdo 3 masas musculares formadas por trabéculas carnosas longitudinales que dan inserción a las cuerdas tendinosas. En los cortes histológicos se observó que los puntos de inserción dorsal y ventral de la valva atrioventricular derecha a la pared ventricular, son prolongaciones del músculo que forma la valva y presentan fibras conductoras cardíacas. En el ventrículo izquierdo, las trabéculas carnosas longitudinales también presentan fibras conductoras cardíacas las que se extienden hasta la zona de inserción de las cuerdas tendinosas. Los resultados muestran que el corazón del avestruz (Struthio camelus) no tiene músculos papilares de forma cónica como en el corazón humano, son formaciones musculares más desarrolladas que en el corazón de las aves domésticas y funcionalmente actúan como músculos papilares al presentar fibras conductoras cardíacas.

The heart of the ostrich (Struthio camelus), just like the domestic birds's heart, has a muscular right atrioventricular valve without chordae tendinae and a membranous left atrioventricular valve with chordae tendinae than extends between the cusps and 3 papillary muscles. The aim of the study was to describe the papillary muscles, number, position and some morphologic characteristics. Fifty ostrich hearts (Struthio camelus), were dissected and fixed in 10% formalin and which got histological slices from 7 microns themselves they were stained with Van Gieson and H E. The macroscopic study evidenced absence of papillary muscles in the right ventricle and in the left ventricle 3 muscular masses formed by longitudinal trabeculae carneae that give insertion to the chordae tendinae. It was observed in the histological slices that the dorsal and ventral insertion points of the right atrioventricular valve to the ventricular wall, are prolongations of the muscle that forms the valve and shows conductive cardiac fibers. In the left ventricle, the longitudinal trabeculae carneae also show conductive cardiac fibers the ones that extend to the zone of insertion of the chordae tendinae. The results evidence that the heart of the ostrich (Struthio camelus) does not have papillary muscles of conical form like in the human heart, are more developed muscular formations than in the domestic birds's heart and functionally acts like papillary muscles to show conductive cardiac fibers.

Irrigação dos músculos papilares do ventrículo esquerdo do coração de caninos (Canis familiaris, L. 1758) / Blood supply of the papillary muscles of the left ventricle of the dog´s heart (Canis familiaris – L. 1758)

A irrigação dos músculos papilares tem informações incompletas sobre a distribuição dos vasos arteriais. Objetivando estabelecer a origem destas artérias e sua distribuição nos músculos papilares do ventrículo esquerdo, utilizamos 30 corações de cães adultos, machos e fêmeas de raça não definida e de várias idades. Após o óbito, o coração foi removido, lavado em água corrente e em seguida injetado através do óstio da artéria coronária esquerda com uma solução de acetato de vinil corado, neoprene látex 650 corado ou gelatina a 10%. Os músculos papilares em todas as técnicas utilizadas foram fixados com solução de formol a 10 %. A dissecação foi realizada de forma acelerada com o uso de solução de ácido sulfúrico a 40 %. Para realização das radiografias utilizamos injeção de mercúrio o que auxiliou a montagem dos esquemas da vascularização estudada. Utilizamos a técnica de diafanização de Spalteholz para melhor visualizar a irrigação cardíaca. Evidenciamos que os músculos papilares subauricular e subatrial são irrigados pelos ramos da artéria coronária esquerda. O subauricular pelos ramos interventricular paraconal e circunflexo e o subatrial predominantemente pelo ramo circunflexo. Os subsegmentos que suprem o subauricular do ramo interventricular paraconal são os ramos: colateral e ventriculares à esquerda; e do ramo circunflexo são os ramos: dorsais à esquerda e intermédio (marginal ventricular esquerdo) e mais raramente o ramo da borda ventricular esquerda (ramo diafragmático). Os subsegmentos do ramo circunflexo que suprem o subatrial são os ramos: intermédio (marginal ventricular esquerdo), da borda ventricular esquerda (ramo diafragmático), ramos dorsais direito e ramo interventricular subsinuoso. Em alguns casos observamos o ramo colateral e o próprio ramo interventricular paraconal atingirem a porção do vértice do subatrial.

The irrigation of the papillary muscles, has incomplete information on the distribution of the arterial vessels. Objectifying to establish the origin of these arteries and their distribution in the left ventricle papillary muscles, we used 30 hearts of adult, male and female mongrel dogs. After the death, the heart was removed, washed and injected through the left coronary artery opening with an acetate solution of stained vinyl, neoprene latex 650 colored or 10% gelatin. The papillary muscles in all the applied techniques had been fixed with 10% formaldehyde solution. The dissection was carried out with the aid of a 40% sulfuric acid solution. For accomplishment of the radiography, we used mercury injection what assisted the assembly of the studied vascularization projects. Clearing technique of Spalteholz was applied for better visualization of the cardiac irrigation. We evidenced that the subauricular and subatrial papillary muscles are irrigated by the left coronary artery branches. The subauricular papillary muscle was blood-supplied by the interventricular paraconal and circumflex branches and the subatrial papillary muscle mainly by the circumflex branch. The sub-segments that supply the subauricular papillary muscle from the interventricular paraconal branch are the left collateral and ventricular branches and from the circumflex branch: left dorsal branches and intermedial (left ventricular marginal) and rarely from the left ventricular ridge (diaphragmatic branch). The subsegments of the circumflex branch that supply the subatrial papillary muscle are: intermedial (left ventricular marginal), from the left ventricular ridge (diaphragmatic branch), right dorsal branches and subsinuous interventricular branch. In some cases we observed the collateral branch and the proper interventricular paraconal branch reaching the portion of the vertex of the subatrial papillary muscle.

A morphological and morphometric study of the right ventricular papillary muscles of autopsied heart of Bangladeshi people.

Fifty formalin-fixed hearts from thirty nine male and eleven female Bangladeshis aged 20 to 70 years and without any known cardiac disorder were used in the present study. In right ventricle, there was a single anterior papillary muscle in 92% cases. The posterior papillary muscle was double in 32% and single in 28% cases. The septal papillary muscle was single in 46% cases while in 30% cases it was absent. The different between males and females in the total number of papillary muscles was statistically non significant. In the right ventricle, the anterior papillary muscles were the longest and the septal papillary muscles were the shortest.

Chordae tendineae architecture in the papillary muscle insertion

La arquitectura de las cuerdas tendinosas y su unión con el músculo papilar fueron estudiados a través de microscopía electrónica de barrido, comparando corazones humanos y de cerdos. Músculos papilares con sus correspondientes cuerdas tendinosas fueron obtenidos de corazones humanos y de cerdos (Sus scrofa) , después de la exposición de la cavidad ventricular izquierda, y fijados con formaldehido al 4 por ciento. Los especímenes fueron seccionados en pequeñas muestras y divididas en cuatro grupos, una control y las otras sometidas a la hidrólisis en una solución de hipoclorito de sodio al 2.5 por ciento en solución salina durante 5, 10 y 15 minutos, respectivamente. Los especímenes fueron lavados y fijados en tetróxido de osmio al 1 por ciento en buffer cacodylate, por ciento mantenidos al 1 por ciento en ácido tánico por 30 minutos, deshidratados y secadas en punto crítico, montados y impregnadas con oro. Los especímenes fueron examinados y documentados en un microscopio electrónico de barrido JEOL 5200. Las cuerdas tendinosas humanas y de cerdos tienen una arquitectura similar: ambas están cubiertas por un endotelio, el cual está en continuidad con los músculos papilares, las capas interiores están compuestas por haces de fibras colágenas longitudinales y oblicuas entremezcladas con fibras elásticas. Diferencias entre corazones humanos y de cerdos fueron encontradas en la unión de las cuerdas tendinosas y el músculo papilar. En el corazón humano los haces de colágenos se mostraron más organizados, formando una malla con las fibras dispuestas en ángulos aproximadamente octogonales, en cambio, en el corazón de cerdo estaban dispuestas al azar.

Variations in the papillary muscles of normal tricuspid valve and their clinical relevance in medicolegal autopsies

In our study, tricuspid valves in cases of sudden death secondary to congenital differences of the tricuspid valve with significant papillary muscle anatomy were investigated. No studies of papillary muscle anatomy of the tricuspid valve have been found in medicolegal autopsies in literature. The purpose of our study is to investigate the relationship of papillary muscle in tricuspid valve in cases of sudden deaths, especially those resulting from cardiac disease, with the muscle structure, as well as the number of the muscle leading congenital changes. The study was carried out in the Department of Anatomy, Faculty of Medicine, Ege, University, Izmir, Turkey and comprised of 400 human hearts obtained between 2000 and 2002 from 400 autopsy cases during a medicolegal autopsy with permission from the Council of Forensic Medicine, Izmir. Quantitative and morphological aspects of the papillary muscles of the right ventricle were evaluated. The criteria such as number, incidence, length and shape of the anterior, [APM] septal [SPM] and posterior papillary muscles [PPM] have been observed. Although the papillary muscle presented great variability in numbers, with a minimum of 2 and a maximum of 9 papillary muscles in the right ventricle, there were usually 3 papillary muscles in the right ventricle; APM, PPM and SPM. The one headed APM was found to be more often in cardiac deaths. However, observing more frequent conical and flat topped configurations in all PPM was striking. The absence or lower ratio, or both of attachment bridges of SPM and APM/PPM in deaths of cardiac origin is also significant. We have found that the presence of this attachment is higher in deaths of noncardiac origin. This anatomical study may explain the increased in incidence wide variations of papillary muscle tricuspid valve in deaths of cardiac origin. The verdict in legal affairs may change with this. The knowledge regarding wide variations and minor anatomical abnormalities of papillary muscle helps forensic examiners not to get confused at unexpected deaths

Morphology and blood supply of papillary muscle in the arterial conus

The morphology and position of the papillary muscle of the arterial conus were studied in 50 human hearts of both sexes. In 40 hearts, the interventricular anterior and posterior arteries were filled with vinyl acetate to study the blood supply. the muscle lenght varied from 4 mm to 18 mm and the base of implantation was located between the anterobasal and posterobasal limbs of the septomarginal trabecula. The most frequent forms of muscle presentation were an attached conus (68 porcento of cases(, a free conus (10 porcento) and a double conus (6 porcento). the blood supply was derived from the first, second and third septal interventricular branches of the anterior interventricular artery in 75 porcento, 22.5 porcento and 2.5 porcento of the cases, respectively. Since the term "papillary muscle of the arterial conus"is not a standard anatomical term, and since "septal papillary muscle"does not clearly define the muscle position in the septal wall of the right ventricle, new terminology is required to accurately describe the septal papillary muscles of the right ventricle.

The blood supply of the papillary muscles of the right ventricle

Because of the functional importance of the Papillary Muscles (PM) we conducted this study on the blood supply of these structures in the right ventricle. The main vessels of the musculli papillares parvi are the ramus septalis of the ramus interventricularis subsinuosus (RSSS), helped by the ramus septalis of the arteria coronaria dextra (RSCD) and the first ramus septalis of theramus interventricularis paraconalis (RSPC). Themusculi papillares magnus receives vessels mainly from theramus ventricularis of the a. coronaria dextra (RVCD) associated with the RSPC, or RSSS. Themmusculus papillaris subarteriosus receives vessels only from the RSCD. In each papillary muscle there is an arterial circle (a double blood supply), which is an anatomical arrangement protecting these structures against vascular problems.

The relationship between the papillary muscles and the anatomicosurgical segments of the left ventricle of the human heart

A relaçäo entre irrigaçäo sanguínea dos músculos papilares do ventrículo esquerdo de 90 coraçöes humanos (adultos Caucasianos) e as artérias dos segmentos anatomo-cirúrgicos cardíacos foi estudada após injeçäo arterial de acetato de vinila e corrosäo parcial ou total. O músculo papilar anterior integra, na maioria dos casos, o I SV segmento enquanto que o posterior pertence ao III DV segmento, o primeiro depende da artéria coronária esquerda, e o segundo da artéria direita