Morphometric characteristics and histotopography of the left atrium walls

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Abstract

Background. Knowledge of the anatomical features of the left atrium walls will minimize complications during the “Cox-Maze” surgery.

Aim. To clarify common features and local anatomical specificities of the anterosuperior, lateral and inferior walls of the left atrial body of the heart of an adult.

Material and methods. From 60 preparations of the hearts of men and women aged 35–89 years who died from non-cardiac causes, 61 histotopograms and 180 anatomical sections of the left atrium walls were made. A stereoscopic microscope (×4.7–15 magnification), a histological microscope (×40 magnification), and an image recognition program were used. Nonparametric dispersion, correlation, one-way regression analysis were applied. The significance of differences was assessed by the Mann–Whitney U-test. The results were presented as medians.

Results. Anatomical markers of the anterosuperior wall were a compact group of transverse myocardial fibers (anterior interatrial Bachmann bundle) and a thinned section of the lower third of the medial half of the wall. A feature of the lateral wall was a group of oblique myocardial fibers (left lateral ridge). The inferior wall was characterized by well-developed subepicardial tissue. Anteroposterior wall in the medial area (5130 µm) and lateral wall (5243 µm) were thin. The epicardium with subepicardial tissue in the medial part of the inferior wall was thicker (4750 µm) than in the lateral (2651 µm) and anterosuperior (2535 µm) walls. The myocardium of the anteroposterior wall (2714 µm) was thicker than the myocardium of both the lateral (2213 µm) and inferior wall in its central (1947 µm) and lateral (1913 µm) sections. The median thickness of the endocardium of different walls varied from 335 to 426 µm. The wall thickness in the upper third mostly depended primarily on the myocardium thickness, and in the inferior third on the epicardium and subepicardial tissue thickness.

Conclusion. For the walls of the left atrium, their thickening towards the coronary sulcus was common due to the subepicardial adipose tissue. The peculiarities were the differences of the left atrium walls in thickness and their unique pattern of myocardial anatomy.

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About the authors

Anton A. Gaponov

Ural State Medical University

Email: gagaponov@gmail.com
ORCID iD: 0000-0002-6681-7537
SPIN-code: 2841-6740
ResearcherId: AAP-7575-2021

Postgrad. Stud., Assistant, Depart. of Human Anatomy

Russian Federation, Yekaterinburg, Russia

Andrei A. Iakimov

Ural State Medical University; Ural Federal University

Author for correspondence.
Email: Ayakimov07@mail.ru
ORCID iD: 0000-0001-8267-2895
SPIN-code: 8618-2991
Scopus Author ID: 35071518500
ResearcherId: E-4425-2018

M.D., Cand. Sci. (Med.), Assoc. Prof., Depart. of Human Anatomy; Assoc. Prof., Depart. of Medical Biochemistry and Biophysics

Russian Federation, Yekaterinburg, Russia; Yekaterinburg, Russia

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Supplementary files

Supplementary Files
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1. Рис. 1. Места вырезки кусочков для изготовления анатомических срезов стенок левого предсердия (схема, вид со стороны «крыши» левого предсердия). Границы иссечённой «крыши» показаны большим эллипсом, левое предсердно-желудочковое отверстие — малым эллипсом; 1, 2, 3 — соответственно медиальный, средний и латеральный участки нижней стенки; 4 — латеральная стенка; 5, 6 — латеральный и медиальный участки передневерхней стенки

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2. Рис. 2. Гистотопография передневерхней стенки левого предсердия, сагиттальный срез; 1 — эндокард; 2 — передний межпредсердный пучок (Бахмана); 3 — поверхностные группы мышечных волокон, перемежающиеся подэпикардиальной соединительной тканью. Препарат №118. Пикрофуксин по Ван-Гизону

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3. Рис. 3. Строение передневерхней стенки левого предсердия, сагиттальный анатомический срез; 1 — эндокард; 2 — миокард (пучок Бахмана); 3 — подэпикардиальная клетчатка. Чёрной стрелкой показаны глубокие продольные волокна миокарда, продолжающиеся на «крышу» левого предсердия. Препарат №133 (сердце мужчины 57 лет). Olympus SZX2-ZB10, об. ×0,75, zoom ×0,63

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4. Рис. 4. Истончённый участок передневерхней стенки левого предсердия («незащищённая пластинка» по W. McAlpine), сагиттальный срез на уровне нижней трети медиальной части стенки; 1 — эндокард; 2 — продольные волокна миокарда; 3 — эпикард. Эллипсом показан безмышечный участок. Препарат №113. Пикрофуксин по Ван-Гизону.

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5. Рис. 5. Толщина стенок левого предсердия в разных локализациях. Локализации обозначены в соответствии с рис. 1. Результаты представлены в виде медиан (точки в «ящиках»), диапазонов р25–р75 («ящики») и вариации от минимального до максимального значения («усы»)

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6. Рис. 6. Зависимость значений толщины стенок левого предсердия от толщины эпикарда (А) и миокарда (Б) в верхней, средней и нижней третях стенок

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