Presence of Ganglia and Telocytes in Proximity to Myocardial Sleeve Tissue in the Porcine Pulmonary Veins Wall.

Ganglia and telocytes were identified inside the porcine pulmonary veins wall near myocardial sleeve tissue at the atriopulmonary junction. These structures are reported to play a role in the initiation of pulses from outside the heart, which potentially can cause cardiac conduction disorders such as atrial fibrillation. In-depth knowledge on the fine structure of the pulmonary vein wall is a pre-requisite to better understand the underlying pathophysiology of atrial fibrillation and the origin and conduction of ectopic pulses. The importance of pulmonary vein myocardial sleeves as triggering foci for atrial fibrillation has been shown in human patients. In this context, the fine structure of the pulmonary vein wall was investigated qualitatively by light and transmission electron microscopy in the pig, which is a frequently used animal model for development of new treatment strategies. Additionally, intra and extramural ganglia, containing telocytes that create a network near the neurone cell bodies, were identified in pigs. Detailed illustration of the distribution and organization of tissues and cell types, potentially involved in the origin and propagation of ectopic stimuli originating from the pulmonary veins, might lead to a better insight on the actual composition of the tissues affected by ablation as studied in pigs.

[HISTOGENESIS AND PECULIARITIES OF STRUCTURAL ORGANIZATION OF THE CARDIAC MUSCLE TISSUE IN THE WALLS OF HUMAN CAVAL AND PULMONARY VEINS].

To study the structural organization and histogenesis of the cardiac muscle tissue in the walls of human caval and pulmonary veins, the heart was examined in 3 human embryos (at weeks 6-7 of development) and 20 fetuses (at weeks 9-10, 16, 19, 22 and 24 of development), as well as segments of caval and pulmonary veins of adult men and women (n = 50) located at various distances from the heart. The methods of light and electron microscopy were used in this work. To obtain the isolated cells from the walls of caval and pulmonary veins, the method of tissue alkaline dissociation was used. An immunohistochemical study with the monoclonal antibodies against cardiac troponin T was performed. It was found that the cardiomyocytes in humans were located in the middle and outer tunics of caval and pulmonary veins, where they formed thick layers. In the pulmonary veins of the adult humans, cardiac muscle fibers did not reach the intrapulmonary areas, in the inferior vena cava their layer did not extend beyond the pericardium, in the superior vena cava, its length was 2.5-3.0 cm. The formation of the pulmonary vein orifices occured by sequential inclusion of the wall of the common pulmonary vein, and later--of the right and left pulmonary veins into the wall of the left atrium. During the formation of the orifices of the caval veins, the gradual inclusion of the wall of the venous sinus in the wall of the right atrium was observed, resulting in caval veins opening directly into the cavity of the right atrium. The veins studied were referred to the veins of the muscular type with the strong development of muscular elements containing the myocardial component.

[Efferent innervation of pulmonary blood vessels and bronchi in rat (an immunohistochemical study)].

In this investigation the peculiarities of innervation of bronchi and blood vessels of the lung were studied in 20 rats using immunohistochemical demonstration of synaptophysin and alpha-actin. The results obtained have showen that the densest innervation is typical for bronchial walls, particularly, for the muscular lamina. Synaptophysin-immunoreactive terminals (SFIT) were detected in the bronchi in close association with both circular bundles of smooth muscle cells and microganglia. Dense network of SFIT was found in the pulmonary vein--in its middle tunic formed by cardiomyocytes. In contrast to the bronchi and pulmonary vein, large branches of the pulmonary artery contained no SFIT. We briefly discuss the problem of the origin of the nerve fibers described and their functions and suggest that SFIT are formed by efferent fibers (axons) of neurons arising from either the intrapulmonary parasympathetic ganglia.

Structure and composition of pulmonary arteries, capillaries, and veins.

The pulmonary vasculature comprises three anatomic compartments connected in series: the arterial tree, an extensive capillary bed, and the venular tree. Although, in general, this vasculature is thin-walled, structure is nonetheless complex. Contributions to structure (and thus potentially to function) from cells other than endothelial and smooth muscle cells as well as those from the extracellular matrix should be considered. This review is multifaceted, bringing together information regarding (i) classification of pulmonary vessels, (ii) branching geometry in the pulmonary vascular tree, (iii) a quantitative view of structure based on morphometry of the vascular wall, (iv) the relationship of nerves, a variety of interstitial cells, matrix proteins, and striated myocytes to smooth muscle and endothelium in the vascular wall, (v) heterogeneity within cell populations and between vascular compartments, (vi) homo- and heterotypic cell-cell junctional complexes, and (vii) the relation of the pulmonary vasculature to that of airways. These issues for pulmonary vascular structure are compared, when data is available, across species from human to mouse and shrew. Data from studies utilizing vascular casting, light and electron microscopy, as well as models developed from those data, are discussed. Finally, the need for rigorous quantitative approaches to study of vascular structure in lung is highlighted.

[Modern conceptions of the atrial fibrillation development. The role of the myocardial sleeves in the pulmonary veins].

Atrial fibrillation (AF) is the most common supraventricular cardiac arrhythmia. In this review several conceptions focused on the mechanisms of the AF initiation are discussed. At present time viewpoint that the ectopical activity in the pulmonary vien myocardial sleeves (PVs) account for AF in prevailing. PVs myocardium has been the subject of many anatomical and physiological investigations. PVs myocardium differs from left atria tissue and has many moprhological properties that make in convenient substrate for AF initiation and maintenance. PVs cardiomyocytes were shown to have great variability of electrophysiological properties (action potential duration, resting potential, upstroke velocity, etc.). Attempt to discuss afterdepolarization, triggered activity and abnormal automaticity as initiators of AF in PVs was made. It was shown that as in experimental condition, as in vivo in PVs can exist er-entry. Possibly, re-entry from PVs could be the one mechanism by which AF is initiated. In review big attention to the innervations of PVs and role of the sympathetic and the parasympathetic nerves in PVs ectopical activity is paid. Combined influence of autonomic nerves may be critical to initiating AF in PVs. Pharmacological intervention as a possible way to suppress or prevent the activity in the PVs that leads to AF is discussed.

Interstitial Cajal-like cells (ICLC) in myocardial sleeves of human pulmonary veins.

We present here evidence for the existence of a new type of interstitial cell in human myocardial sleeves of pulmonary veins: interstitial Cajal-like cell (ICLC). This cell fulfils the criteria for positive diagnosis of ICLC, including CD 117/c-kit positivity. Transmission electron microscopy revealed typical ICLC with 2 or 3 very long processes (several tens of mm) suddenly emerging from the cellular body. Also, these processes appear moniliform but extremely thin (0.1-0.4 mm) under the resolving power of the usual microscopy. Cell processes establish close spatial relationships between each other, as well as with capillaries and nerve endings. ICLC appear located among the myocardial cells and particularly at the border between the myocardial sleeve and pulmonary vein wall.

Microvascular endowment in the developing chicken embryo lung.

In the current study, the contribution of the major angiogenic mechanisms, sprouting and intussusception, to vascular development in the avian lung has been demonstrated. Sprouting guides the emerging vessels to form the primordial vascular plexus, which successively surrounds and encloses the parabronchi. Intussusceptive angiogenesis has an upsurge from embryonic day 15 (E15) and contributes to the remarkably rapid expansion of the capillary plexus. Increased blood flow stimulates formation of pillars (the archetype of intussusception) in rows, their subsequent fusion and concomitant delineation of slender, solitary vascular entities from the disorganized meshwork, thus crafting the organ-specific angioarchitecture. Morphometric investigations revealed that sprouting is preponderant in the early period of development with a peak at E15 but is subsequently supplanted by intussusceptive angiogenesis by the time of hatching. Quantitative RT-PCR revealed that moderate levels of basic FGF (bFGF) and VEGF-A were maintained during the sprouting phase while PDGF-B remained minimal. All three factors were elevated during the intussusceptive phase. Immunohistoreactivity for VEGF was mainly in the epithelial cells, whereas bFGF was confined to the stromal compartment. Temporospatial interplay between sprouting and intussusceptive angiogenesis fabricates a unique vascular angioarchitecture that contributes to the establishment of a highly efficient gas exchange system characteristic of the avian lung.

[Ultrastructural study of the pulmonary veins in pigs].

OBJECTIVE: To explore the possible relationship between the ultrastructural characteristics of pulmonary veins and the pathogenesis of atrial fibrillation originating from pulmonary veins. METHODS: The pulmonary veins from domestic pigs were serially sectioned (2 mm) transversely along the vessels. The odd number sections were fixed in 10% phosphate buffered formalin solution and the even number sections were fixed in 3% Glutaral for further electron microscopy observations. RESULTS: Two cell types were found in the pulmonary veins of pigs. One cell type was the P-like cells that had an empty-appearing cytoplasm containing only sparse myofibrils and small mitochondria, both of which were randomly distributed. Another cell type was slender transitional cells with plenty of longitudinally displayed myofibrils. CONCLUSION: P-like cells in the pig pulmonary veins were found using electron microscopy in this study and ectopic beats from P-like cells in the myocardial sleeves in the pulmonary veins might be responsible for atrial fibrillation originating from pulmonary veins.

[A new view of anatomic substrate, electrophysiological mechanisms of atrial fibrillation, and results of interventional treatment].

Literature data on anatomic and electrophysiological properties of pulmonary veins (PVs) are very scarce. The study included an investigation of 20 human autopsy hearts with and without cardiovascular pathology. In addition, biopsy samples from the right superior PV were taken from 5 patients with atrial fibrillation (AF) for ultrastructural study. The investigation found myocardial sleeves (MS) in 86.3% of cases, an additional PV between right PVs--in 15%, a collector type of superior and inferior PV--in 25% of cases. MS were situated on the adventitial side of PVs; along the whole length of the PVs the MS myocyte fascicles ran in different directions. Local changes, such as productive myocarditis, fibrosis and fibro-lipomatosis, were observed in MS of PV of patients with AF. 106 patients (80 of whom were male; middle age 42.9 +/- 12.5 years) with symptomatic AF underwent clinical examination. Electrophysiological features of the PVs were evaluated in 30 patients. Effective and functional refractory periods of PVs were found to be shorter than those of the left atrium and non-arrhythmogenic PVs. Radiofrequency ablation (RA) with application of electrophysiological criteria proved to be effective in all patients with frequent ectopy from PVs. The use of electroanatomical mapping allowed successful RA in 82% of patients with persistent and chronic AF. The study demonstrates that the changes in MS of PV, discovered by means of light and electron microscopy, as well as their complex three-dimensional morphological structure may cause and maintain AF. Very distinct electrophysiological features, found in AF patients, probably play a major role in arrhythmogenicity.

Immunohistochemical study of the innervation of pulmonary vessels and smooth muscles in the respiratory tract of two frog species.

The innervation of the respiratory tract of amphibians is still poorly understood. Therefore, the respiratory tracts of the frogs Rana esculenta and Discoglossus pictus have been investigated in order to describe non-adrenergic non-cholinergic (NANC) and adrenergic innervation, and the localization of neuromediators that are possibly involved. Immunohistochemical staining of many bioactive substances was found in neuroepithelial cells of the buccopharynx, larynx, lung septa, nerves and neurons throughout the airway system. The findings indicate the occurrence of vasoactive intestinal peptide (VIP)-immunopositive nerve fibers in fibromuscular septa and the vasculature, nitrergic innervation of the large pulmonary veins showing a plexus of nNOS-immunopositive nerve fibers that also innervate the lung wall and the localization of neuronal nitric oxide synthase (nNOS) in neurons in the lung wall. In addition, laryngeal blood vessels and small arteries in the wall of septa that form capillary networks are supplied by enkephalin-immunopositive nerve terminals. We conclude that the airway system of the two frog species studied is innervated by a parasympathetic NANC system. Adrenergic innervation was also found that was immunostained for tyrosine hydroxylase. Adrenergic fibers were mainly present in muscles in septal edges, arteries present in septa and the wall of the lung. It is suggested that nNOS-positive and leu-enkephalin-positive neurons mediate vasodilation via the release of NO, but the nature of the NANC innervation remains obscure. Despite the many pharmacological studies of the lungs of amphibians, the physiological role of pulmonary autonomic innervation remains poorly understood.

Dynamics of the pulmonary venous flow in the fetus and its association with vascular diameter.

BACKGROUND: The usual positioning of the Doppler sample volume to assess fetal pulmonary vein flow is in the distal portion of the vein, where the vessel diameter is maximal. This study was performed to test the association of the pulmonary vein pulsatility index (PVPI) with the vessel diameter. METHODS AND RESULTS: Twenty-three normal fetuses (mean gestational age, 28.6+/-5.3 weeks) were studied by Doppler echocardiography. Pulmonary right upper vein flow was assessed adjacent to the venoatrial junction ("distal" position) and in the middle of the vein ("proximal" position). The vessel diameter was measured by 2D echocardiography with power Doppler, and the PVPI was obtained by the ratio (maximal velocity [systolic or diastolic peak]-minimal velocity [presystolic peak])/mean velocity. The statistical analysis used t test and exponential correlation studies. Mean distal diameter was 0.33+/-0.10 cm (0.11 to 0.57 cm), and mean proximal diameter was 0.16+/-0.08 cm (0.11 to 0.25 cm) (P<0.0001). Mean distal PVPI was 0.84+/-0.21 (0.59 to 1.38), and mean proximal PVPI was 2.09+/-0.59 (1.23 to 3.11) (P<0.0001). Exponential inverse correlation between pulmonary vein diameter and pulsatility index was highly significant (P<0.0001), with a determination coefficient of 0.439. CONCLUSIONS: In the normal fetus, the pulmonary venous flow pulsatility decreases from the lung to the heart, and this parameter is inversely correlated to the diameter of the pulmonary vein, which increases from its proximal to its distal portion. This study emphasizes the importance of the correct positioning of the Doppler sample volume, adjacent to the venoatrial junction, to assess pulmonary venous flow dynamics.

Evidence of specialized conduction cells in human pulmonary veins of patients with atrial fibrillation.

UNLABELLED: Specialized Conducting Cells in Human PV. INTRODUCTION: Depolarizations similar to those from the sinus node have been documented from the pulmonary veins after isolation procedures. We assessed the hypothesis that sinus node-like tissue is present in the pulmonary veins of humans. METHODS AND RESULTS: Pulmonary vein tissue was obtained from five autopsies (four individuals with a history of atrial fibrillation and one without a history of atrial arrhythmias) and five transplant heart donors. Autopsy veins were fixed in formaldehyde and processed for light microscopy to identify areas having possible conductive-like tissue. Areas requiring additional study were extracted from paraffin blocks and reprocessed for electron microscopy. Donor specimens were fixed in formaldehyde for histologic sections and glutaraldehyde for electron microscopy. Myocardial cells with pale cytoplasm were identified by light microscopy in 4 of the 5 autopsy subjects. Electron microscopy confirmed the presence of P cells, transitional cells, and Purkinje cells in the pulmonary veins of these cases. CONCLUSION: Our report is the first to show the presence of P cells, transitional cells, and Purkinje cells in human pulmonary veins. Whether these cells are relevant in the genesis of atrial fibrillation requires further study.

Pulmonary lymphatics and edema accumulation after brief lung injury.

In a past study of hyperoxia-induced lung injury, the extensive lymphatic filling could have resulted from lymphatic proliferation or simple lymphatic recruitment. This study sought to determine whether brief lung injury could produce similar changes, to show which lymphatic compartments fill with edema, and to compare their three-dimensional structure. Tracheostomized rats were ventilated at high tidal volume (12-16 ml) or low tidal volume (3-5 ml) or allowed to breathe spontaneously for 25 min. Light microscopy showed more perivascular, interlobular septal, and alveolar edema in the animals ventilated at high tidal volume (P < 0.0001). Scanning electron microscopy of lymphatic casts showed extensive filling of the perivascular lymphatics in the group ventilated at high tidal volume (P < 0.01), but lymphatic filling was greater in the nonventilated group than in the group that was ventilated at low tidal volume (P < 0.01). The three-dimensional structures of the cast interlobular and perivascular lymphatics were similar. There was little filling and no difference in pleural lymphatic casts among the three groups. More edema accumulated in the surrounding lymphatics of larger blood vessels than smaller blood vessels. Brief high-tidal-volume lung injury caused pulmonary edema similar to that caused by chronic hyperoxic lung injury, except it was largely restricted to perivascular and septal lymphatics and prelymphatic spaces.

Differential expression of connexin43 gap junctions in cardiomyocytes isolated from canine thoracic veins.

We investigated the phenotypic features of cardiomyocytes, including the gap junctions, in the myocardial sleeve of thoracic veins. Single cardiomyocytes, isolated from the canine pulmonary veins (PV) and superior vena cava (SVC) using digestive enzymes, were examined by immunoconfocal microscopy using antisera against connexin43 (Cx43), Cx40, and other cell markers. The results showed that isolated cardiomyocytes displayed rod shapes of various sizes, ranging from <50 microm to >200 microm in length, and all the cells expressed alpha-actinin and vinculin. Gap junctions made of various amounts of Cx43 and Cx40 were found at the cell borders. These two connexins were extensively co-localized. Comparison between the thoracic veins showed that cells of the SVC contained more Cx43 gap junctions (total Cx43 gap junctions area per cell surface area, 4.0 +/- 0.2% vs 1.5 +/- 0.2%; p<0.01). In addition, for single-nucleus cells, those from the PV were longer (103.7 +/- 3.6 vs 85.0 +/- 3.1 microm; p<0.01) but narrower (14.4 +/- 0.5 vs 16.9 +/- 0.9 microm; p<0.01). In conclusion, canine thoracic veins contain cardiomyocytes with differences in shape and gap junctions, suggesting that the electrical conduction properties may be different between the thoracic veins.

Tissue structure and connexin expression of canine pulmonary veins.

OBJECTIVE: Rapid electrical activity in pulmonary veins (PVs) has been proposed as a mechanism for focal atrial fibrillation. The way in which the myocardial sleeve inside PVs can form a substrate for focal activity is not well understood. Therefore, we have studied tissue structure and connexin distribution at the veno-atrial transition in the dog. METHODS: In adult mongrel dogs, the anatomy of the PV area was studied. Tissue structure in individual veins was assessed in formalin fixed sections using Masson's Trichrome staining. Gap junction protein distribution was examined using antibodies against connexin40 (Cx40) and connexin43 (Cx43). The ultrastructure of myocytes in myocardial sleeves was studied using electron microscopy. RESULTS: Individual PVs in the dog had a gross morphology similar to that observed in the human, with myocardial sleeves extending into the veins for 4-20 mm. In all veins examined, myocytes in myocardial sleeves had a normal atrial morphology and anti-desmin staining pattern. Cx43 was expressed throughout the sleeve at levels comparable to normal atrial myocardium. By contrast, Cx40 expression was lower in myocardial sleeves than in the rest of the left atrium. Myocytes in the sleeve, which were ultrastructurally similar to normal atrial myocytes, were predominantly organized in a circumferential pattern. CONCLUSIONS: PVs in the dog and various canine models of heart disease will be a suitable model for (patho)physiology of the veno-atrial transition. Myocytes in myocardial sleeves are similar to normal atrial myocytes. The circumferential orientation of these myocytes may provide a substrate for rapid circular reentry.

Morphometric characterization of the airway and vascular systems of the lung of the domestic pig, Sus scrofa: comparison of the airway, arterial and venous systems.

The bronchial system (BS), the pulmonary artery (PA) and the pulmonary vein (PV) of the lung of the domestic pig, Sus scrofa were simultaneously cast with silicone rubber and studied. Asymmetrical dichotomous bifurcation preponderated in the tree-like arrangement of the three conducting systems. Lengths and diameters of the various generations were measured. At the extremities of the BS and the PA, alveoli and blood capillaries related very closely. In the cranial and middle lobes of the right and left lungs, topographically, the PA and the PV closely followed the BS, but in the accessory and the caudal (diaphragmatic) lobes, only the PA accompanied the BS: the PV run intersegmentally. Certain similarities and differences were observed between the diameters and lengths of the various generations of the three conducting systems. The strong correlations between some of the structural parameters indicated a high level of structural optimization. While morphometric variations suggest that the air and the blood flow dynamics may somewhat differ between the three conducting systems, they may also register structural features unique to the lung of the domestic pig, an animal that has been highly genetically exploited for fast growth and now leads an indolent lifestyle in captivity.

Potassium channels regulate tone in rat pulmonary veins.

Intrapulmonary veins (PVs) contribute to pulmonary vascular resistance, but the mechanisms controlling PV tone are poorly understood. Although smooth muscle cell (SMC) K(+) channels regulate tone in most vascular beds, their role in PV tone is unknown. We show that voltage-gated (K(V)) and inward rectifier (K(ir)) K(+) channels control resting PV tone in the rat. PVs have a coaxial structure, with layers of cardiomyocytes (CMs) arrayed externally around a subendothelial layer of typical SMCs, thus forming spinchterlike structures. PVCMs have both an inward current, inhibited by low-dose Ba(2+), and an outward current, inhibited by 4-aminopyridine. In contrast, PVSMCs lack inward currents, and their outward current is inhibited by tetraethylammonium (5 mM) and 4-aminopyridine. Several K(V), K(ir), and large-conductance Ca(2+)-sensitive K(+) channels are present in PVs. Immunohistochemistry showed that K(ir) channels are present in PVCMs and PV endothelial cells but not in PVSMCs. We conclude that K(+) channels are present and functionally important in rat PVs. PVCMs form sphincters rich in K(ir) channels, which may modulate venous return both physiologically and in disease states including pulmonary edema.