不同胎龄胎心二尖瓣复合体的形态学观测

Morphological changes in the mitral complex of fetal hearts in different months

目的:二尖瓣复合体在结构和功能上是一个整体,它构成了左心室流入道主体。其任何一部分异常,均可导致二尖瓣功能障碍,引起先天性心脏病。观测各月龄胎儿心脏二尖瓣复合体的形态特征,分析其变化规律,为解剖学及临床诊治先天性心脏病积累资料。方法:①实验材料:选择2004-02/2005-12新乡地区非正常分娩的正常胎儿心脏40例,医院死亡鉴定小组确认胎儿已死亡,经死者家属同意捐献给医院处理,其中男21例,女19例,按胎儿发育特征及临床资料确定月龄,研究方案获伦理委员会批准。②实验方法:将40例心脏按不同月龄平均分为≤20周组,21～24周组,25～36周组,>36周组,每组10例,并记录胎儿的基本情况。③实验评估:解剖观测其二尖瓣复合体的形态特征。结果:纳入非正常分娩的正常胎儿心脏40例,均进入结果分析。①胎儿心脏二尖瓣复合体由二尖瓣瓣环、瓣膜、腱索和乳头肌组成。②由小到大4组的二尖瓣瓣环周长分别为(1.48±0.51)、(1.55±0.35)、(2.38±0.48)、(3.05±0.45)cm。前尖、后尖的高度分别为(0.33±0.13)、(0.20±0.03)cm;(0.34±0.10)、(0.21±0.04)cm;(0.51±0.15)、(0.28±0.01)cm;(0.62±0.01)、(0.39±0.10)cm。前、后乳头肌的最大高度分别为(0.46±1.13)、(0.44±0.19)cm;(0.52±0.10)、(0.50±0.11)cm;(0.65±0.17)、(0.70±0.12)cm;(0.73±0.10)、(0.74±0.13)cm。前、后乳头肌发出腱索的数目分别为(11.15±0.71)、(12.00±2.83)cm;(8.50±1.29)、(8.67±3.63)cm;(13.00±2.83)、(0.00±9.90)cm;(21.00±3.61)、(21.67±0.58)cm。结论:①乳头肌的增长变化与胎儿心脏整体增长变化是一致的,胎心部分结构随着胎龄增长可能发生重吸收。②胎儿心脏二尖瓣复合体的形态变化总体上与月龄变化呈正相关趋势。

AIM： Mitral complex is the whole structure and composed of inflow tract bulk of left ventncle. Any abnormal part should result in functional disturbance of mitral complex, then congenital cardiopathy. This article is designed to observe the morphologic charactenstics of mitral complex in different phases of fetus and analyze its regularity to accumulate information for zootomy and clinical diagnosis and therapy of congenital cardiopathy. METHODS： （1）Totally 40 samples of fetus hearts donated with abnormal parturition were obtained at Xinxiang area from February 2004 to December 2005, of which 21 was originated from male fetuses and 19 female fetuses. Fetal death was identified by hospital death identification team and the dead fetuses were intervened by hospital after the agreement of family members of the dead. Month age was defined according to fetal development and clinical data. Research schema was approved by ethics committee. （2）They were divided into 4 groups according to month age, ≤20 weeks group, 21-24 weeks group, 25-36 weeks group and 〉36 weeks group with 10 in each group. Fetal condition was recorded. （3）The mitral complex were dissected, observed and measured with anatomical method. RESULTS： The 40 fetal hearts were all involved in the result analysis. （1）The complex was made of mitral annulus, valve, tandineae and columna papillares. （2）The average perimeter of valves ellipse of the mitral complex according to their order was （1.48±0.51）, （1.55±0.35）,（2.38±0.48）, （3.05±0.45） cm respectively. The average height of paracone and metacone was （0.33±0.13）,（0.20±0.03） cm; （0.34±0.10）,（0.21±0.04） cm; （0.51±0.15）,（0.28±0.01） cm; （0.62±0.01 ）,（0.39±0.10） cm respectively. The average maximal heights of the anterior, posterior papillary muscle were （0.46±1.13）,（0.44±0.19） cm; （0.52±0.10）,（0.50±0.11） cm; （0.65±0.17）,（0.70±0.12） cm; （0.73±0.10）,（0.74±0.13） cm respectively. The average numbers of tandineae coming from the anterior, posterior papillary muscle were （11.15±0.71 ）, （12.00±2.83） cm; （8.50±1.29）,（8.67±3.63） cm; （13.00±2.83）,（0.00±9.90） cm; （21.00±3.61）,（21.67±0.58） cm respectively. CONCLUSION： （1）The growth of papillary muscle is consistent with the growth of fetal heart, and reabsorption appears in fetal heart with the increase of fetal age. （2）The morphologic changes of mitral complex in fetal hearts have positive correlation with the changes of fetal month age.