The anatomy of the tendon of the infundibulum revisited

• Autorzy: Loukas M , Tubbs R.S. , Bright J.L. , Fudalej M. , Wagner T. , Anderson R.H.
• Języki publikacji: EN

Abstrakty

EN

The heart is a muscular organ supported by collagenous tissue. The collagenous tissue is condensed in certain areas to form a supporting framework, often called the fibrous skeleton. The so-called tendon of the infundibulum has previously been described as part of this skeleton, but its structure and incidence remain ill defined. The tendon was initially described as a strip of fibrous tissue running between the aortic root and the pulmonary trunk. Since information on its structure is vague, we sought to evaluate its existence in 100 formalin-fixed adult human hearts obtained from subjects ranging in age from 22 to 86 years, in 20 hearts from infants and children aged from 2 months to 6 years at the time of their death and in 10 cattle hearts. We used classical macroscopic anatomical techniques to demonstrate all the possible connections between the sinuses of the aorta and the pulmonary trunk. We then supplemented the macroscopic techniques with serial transverse histological sections taken through the vascular roots, staining the sections with the haematoxylin-eosin, van Gieson, Masson trichrome and orcein staining methods. Fascial bands surrounded by connective tissue were observed in all hearts. In 80 adult hearts and in 16 neonatal hearts we found fascial bands or strips, which connected the aortic and pulmonary roots. Only in two hearts, however, were we able to identify tendon-like structures, and histology revealed that these were formed by tightly packed collagen fibres intermingled with fat, most likely due to advanced age. Thus in those cases where a “tendon” was present it was no more than condensed fascial bands joining together the apposing sinuses of the arterial trunks. In our opinion, therefore, accounts in the literature describing the “tendon of the infundibulum” as a tendinous structure connecting the aortic and pulmonary roots do not accurately represent this anatomical structure.

Słowa kluczowe

EN

arterial trunk; pulmonary root; anatomy; fibrous skeleton; infundibulum; heart; fascial band; aortic root; tendon

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2007
• Tom: 66
• Numer: 1
• Opis fizyczny: p.33-38,fig.,ref.

Twórcy

autor

Loukas M

• St George University, School of Medicine, Grenada, West Indies

autor

Tubbs R.S.

autor

Bright J.L.

autor

Fudalej M.

autor

Wagner T.

autor

Anderson R.H.

Bibliografia

• 1. Carmine D. Clemente (eds) (1985) Skeleton of the heart. In: Gray’s anatomy. Churchill Livingstone, New York, pp. 1494.
• 2. Hokken RB, Bartelings MM, Bogers JJ, Gittenbergerde Groot AC (1997) Morphology of the pulmonary and aortic roots with regard to the pulmonary autograft procedure. J Thor Cardiovasc Surg, 13: 453–461.
• 3. Kerr A, Goss CM (1956) Retention of embryonic relationship of aortic and pulmonary valve cusps and a suggested nomenclature. Anat Rec, 125: 77–82.
• 4. Lal M, Ho SY, Anderson RH (1997) Is there such a thing as the “tendon of the infundibulum” in the heart? Clin Anat, 10: 307–312.
• 5. Loukas M, Dimopoulos C, Bartczak A, Kordula J, Wagner T, Fudalej M (2001) The anatomy of the tendon of infundibulum. Folia Morphol, 60: 281–284.
• 6. Loukas M, Hullet J, Wagner T (2005) The clinical anatomy of the inferior phrenic artery. Clin Anat, 18: 357–362.
• 7. Mall FP (1911) On the muscular architecture of the ventricles of the human heart. Am J Anat, 11: 211–266.
• 8. McAlpine WA (1975) Heart and coronary arteries. Springer-Verlag, Berlin, Heidelberg, p. 72.
• 9. Merrick AF, Yacoub MH, Yen Ho Sy, Anderson RH (2000) Anatomy of the muscular subpulmonary infundibulum with regard to the Ross procedure. Ann Thorac Surg, 69: 556–5561.
• 10. Montes G.S. Ruggieri A, Motta PM Martinus Nijhoff (eds) (1984) Collagen distribution in tissues. In: Ultrastructure of the Connective Matrix. Springer-Verlag, Berlin, Heidelberg, pp. 35.
• 11. Netter FH (1969) The Ciba collection of medical illustrations. Heart, 5: 11.
• 12. Pomerance A, Davies MJ (1975) The pathology of the heart. Blackwell Scientific Publications, Oxford, pp.13.
• 13. Reid K (1970) The anatomy of the sinus of Valsalva. Thorax, 25: 79–85.
• 14. Walmsley T, Watson H (1978) In Clinical Anatomy of the Heart. Churchill Livingstone, Edinburgh, p. 111.
• 15. Williams PL, Warwick R, Dyson M, Bannister LH (eds) (1989) Skeleton of the heart. In: Gray’s anatomy. 37th Ed. Churchill Livingstone, New York, pp. 716–717.
• 16. Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Fergusson MWJ (eds) (1995) Skeleton of the heart. In: Gray’s anatomy. 38th Ed. Churchill Livingstone, New York, pp. 1494–1495.
• 17. Zimmerman J (1960) The functional and surgical anatomy of the aortic valve. Am Heart J, 99: 217–224.
• 18. Zimmerman J, Bailey CP (1962) The surgical significance of the fibrous skeleton of the heart. J Thor Cardiovasc Surg, 44: 701–712.