婴幼儿和法洛氏四联症房室结和房室束的外科解剖及计算机三维重建Ⅰ.位置与毗邻

SURGICAL ANATOMY AND 3- DECONSTRUCTION OF THE AV NODES AND HIS BUNDLES IN INFANT HEARTS AND THOSE WITH TETRALOGY OF FALLOT I. THE LOCATION AND RELATIONSHIP

通过对15例人心(成人5例,婴幼儿5例,法四5例)房室结和房室束的连续切片观察和图像分析,表明:15例房室结均位于Koch三角内.与成人相比,婴幼儿房室结位置相对较高,法四房室结位置偏低,其结前部紧靠三尖瓣隔瓣根部.婴幼儿房室束多位子三尖瓣隔瓣附着缘以上的房室肌隔内或室嵴顶部,而法四房室束起始部紧邻三尖瓣隔瓣根部的深面,其余部份可位:室嵴左侧,室缺的后下缘;房室束可直接位于室缺游离缘的心内膜下,或距室缺游离缘(可为肌性或腱性)1.88-2.14mm处.为临床小儿心外科手术提供了直接的形态学依据.

The Av nodes (AVN) and His bundles (AVB) in 10 normal hearts (5 infants,5 adults) and 5 with Tetralogy of Fallot (TOF) were studied with serial sections and Image Analysis.(1) The AVN in all 15 hearts are in the triangle of koch.While infant AVN are higher in the triangle in comparison with the adult's.Those in TOF,however,are in the lowest part of the Koch,closed to the attachment of the septal leaflet of the tricuspid.(2) The infant AVB are usually situated in the atrioventricular septum,above the attachment of the tricuspid,and the top of the septal crest.While those in TOF are below the attachment,mostly at the left side of the septal crest,and the posterionferior corner of the ventricular septal defect (VSD).(3) The AVB in TOF may be just under the endocardium of the free margin of VSD,or have a distance of 1.88-4.30mm (tendonous or musculous) from the free margin.The morphologic basis is directly offered for the paediatric thoracic surgery.