ABSTRACT
BACKGROUND: For the last 90 years, several authors have focused on studying the blood supply to the conduction system in the human heart. However, an important gap has been maintained between this topic and cardiac surgical procedures when they should have been closely matched. This paper is aimed at clarifying the morphology of the conduction system and its blood supply and assessing its role in cardiac surgical procedures. METHODS: Twenty human hearts were dissected after antegrade and retrograde injection. After dissection, different surgical procedures were simulated. Finally, we assessed the damage that these procedures might have caused either to the conduction system or to the vessels supplying it. RESULTS: Kügel's artery, the right superior descending artery, and the sinoatrial node artery were found to be harmed by the surgical procedures performed. In all these cases, these vessels were supplying part of the conduction system. CONCLUSIONS: All the vascular structures described in the paper play a very important role in the blood supply to the conduction system, and they become vulnerable during aortic root and mitral valve surgical procedures.
Subject(s)
Aorta, Thoracic/surgery , Coronary Vessels/surgery , Heart Atria/surgery , Mitral Valve/surgery , Adolescent , Adult , Aged , Aorta, Thoracic/pathology , Coronary Vessels/pathology , Female , Heart Atria/pathology , Heart Conduction System/pathology , Heart Conduction System/surgery , Humans , Male , Middle Aged , Mitral Valve/pathology , Reference ValuesABSTRACT
The anatomy of the heart's conduction system and of its blood supply have been research topics for many years. However, several proposals have never been demonstrated. In this paper, we describe 2 vascular conduits that have never before been objectively shown to supply the conduction system. Twenty human hearts from subjects aged between 15 and 65 years--with and without coronary disease--were dissected after anterograde and retrograde injection with latex butaclor E-650 by means of a technique developed by the authors. In 40% of these hearts, Kugel's artery was found to supply the atrioventricular node. The right descending superior artery supplied the atrioventricular node in 70% of the hearts dissected. These findings may be of major significance both in clinical cardiology and in cardiovascular surgery.