Morphometric characteristics and histotopography of the left atrium walls

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

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.

Full Text

Restricted Access

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

References

  1. Ho SY, Cabrera JA, Sanchez-Quintana D. Left atrial anatomy revisited. Circ Arrhythmia Electrophysiol. 2012;5(1):220–228. doi: 10.1161/CIRCEP.111.962720.
  2. Whiteman S, Saker E, Courant V, Salandy S, Gielecki J, Zurada A, Loukas M. An anatomical review of the left atrium. Transl Res Anat. 2019;17:100052. doi: 10.1016/j.tria.2019.100052.
  3. Mori S, Tretter JT, Spicer DE, Bolender DL, Anderson RH. What is the real cardiac anatomy? Clin Anat. 2019;32(3):288–309. doi: 10.1002/ca.23340.
  4. Ho SY, Sánchez-Quintana D. The importance of atrial structure and fibers. Clin Anat. 2009;22(1):52–63. doi: 10.1002/ca.20634.
  5. Dudkiewicz D, Słodowska K, Jasińska KA, Dobr­zynski H, Hołda MK. The clinical anatomy of the left atrial structures used as landmarks in ablation of arrhythmoge­nic substrates and cardiac invasive procedures. Transl Res Anat. 2021;23:100102. doi: 10.1016/j.tria.2020.100102.
  6. Gaponov AA, Yakimov AA. Anatomy of hypomuscular and non-muscular sites in the area of the left ear of the heart. Vestnik novykh me­ditsinskikh tekhnologiy. Elektronnoe izdanie. 2021;15(4):89–93. (In Russ.) doi: 10.24412/2075-4094-2021-4-3-3.
  7. Platonov PG, Ivanov V, Ho SY, Mitrofanova L. Left atrial posterior wall thickness in patients with and without atrial fibrillation: Data from 298 consecutive autopsies. J Cardiovasc Electrophysiol. 2008;19(7):689–692. doi: 10.1111/j.1540-8167.2008.01102.x.
  8. Beinart R, Abbara S, Blum A, Ferencik M, Heist K, Ruskin J, Mansour M. Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol. 2011;22(11):1232–1236. doi: 10.1111/j.1540-8167.2011.02100.x.
  9. Słodowska K, Hołda J, Dudkiewicz D, Malinowska K, Bolechała F, Kopacz P, Koziej M, Hołda MK. Thickness of the left atrial wall surrounding the left atrial appendage orifice. J Cardiovasc Electrophysiol. 2021;32(8):2262–2268. doi: 10.1111/jce.15157.
  10. Boussoussou M, Szilveszter B, Vattay B, Kolossváry M, Vecsey-Nagy M, Salló Z, Orbán G, Péter P, Katalin P, Vivien NK, István O, Maurovich-Horvat P, Merkely B, Gellér L, Szegedi N. The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation. Int J Cardiovasc Imaging. 2022. doi: 10.1007/s10554-022-02533-y.
  11. Sánchez-Quintana D, Cabrera JA, Climent V, Farré J, De Mendonça MC, Ho SY. Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation. Circulation. 2005;112(10):1400–1405. doi: 10.1161/CIRCULATIONAHA.105.551291.
  12. Hall B, Jeevanantham V, Simon R, Filippone J, Vorobiof G, Daubert J. Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation. J Interv Card Electrophysiol. 2006;17(2):127–132. doi: 10.1007/s10840-006-9052-2.
  13. Varela M, Morgan R, Theron A, DIllon-Murphy D, Chubb H, Whitaker J, Henningsson M, Aljabar P, Schaeff­ter T, Kolbitsch C, Aslanidi OV. Novel MRI technique enables non-invasive measurement of atrial wall thickness. IEEE Trans Med Imaging. 2017;36(8):1607–1614. doi: 10.1109/TMI.2017.2671839.
  14. Uchasova EG, Gruzdeva OV, Dyleva YuA, Akbasheva OE. Epicardial adipose tissue: pathophysiology and role in the development of cardiovascular diseases. Bulletin of Siberian Medicine. 2018;17(4):254–263. (In Russ.) doi: 10.20538/1682-0363-2018-4-254–263.
  15. Becker AE. Left atrial isthmus: Anatomic aspects relevant for linear catheter ablation procedures in humans. J Cardiovasc Electrophysiol. 2004;15(7):809–812. doi: 10.1046/j.1540-8167.2004.03651.x.
  16. Dmitrieva EG, Gaponov AA, Khatsko SL, Iakimov AA. The coronary sinus and adjacent structures in human adult hearts: morphometrical cadaveric anatomy. Eur J Anat. 2022;26(1):3–17. doi: 10.52083/BNUM8219.
  17. Miyazaki S, Hasegawa K, Yamao K, Mukai M, Ao­yama D, Sekihara T, Nodera M, Eguchi T, Iesaka Y, Tada H. High‐resolution mapping and ablation of atrial tachycardias involving the lateral left atrium. J Am Heart Assoc. 2021;10(20):1–12. doi: 10.1161/jaha.121.022384.
  18. Cabrera JA, Ho SY, Climent V, Sánchez-Quintana D. The architecture of the left lateral atrial wall: A particular anatomic region with implications for ablation of atrial fibrillation. Eur Heart J. 2008;29(3):356–362. doi: 10.1093/eurheartj/ehm606.
  19. Piątek-Koziej K, Hołda J, Tyrak K, Bolechała F, Strona M, Koziej M, Lis M, Jasińska KA, Hołda MK. Anatomy of the left atrial ridge (coumadin ridge) and possible clinical implications for cardiovascular ima­ging and invasive procedures. J Cardiovasc Electrophysiol. 2020;31(1):220–226. doi: 10.1111/jce.14307.
  20. Nakamura T, Kiuchi K, Fukuzawa K, Takami M, Watanabe Y, Izawa Y, Takemoto M, Sakai J, Yatomi A, Sonoda Y, Takahara H, Nakasone K, Yamamoto K, Suzuki Y, Kono A, Tani K, Ashihara T, Negi N, Hirata KI. The impact of the atrial wall thickness in normal/mild late-gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients. J Arrhythmia. 2022;00:1–11. doi: 10.1002/joa3.12676.
  21. Hołda MK, Hołda J, Strona M, Koziej M, Klimek-Piot­rowska W. Blood vessels and myocardial thickness within the left atrial appendage isthmus line. Clin Anat. 2018;31(7):1024–1030. doi: 10.1002/ca.23242.
  22. Dydykin SS, Zadnipryanyi IV, Tretyakova OS. AQUA (anatomical quality assurance): A review of the experience of foreign colleagues. Russian journal of operative surgery and clinical anatomy. 2017;1(1):14–19. (In Russ.) doi: 10.17116/operhirurg20171114-19.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. 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

Download (20KB)
Indexing metadata
3. 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

Download (67KB)
Indexing metadata
4. 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

Download (35KB)
Indexing metadata
5. 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.

Download (37KB)
Indexing metadata
6. 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»)

Download (31KB)
Indexing metadata
7. Рис. 6. Зависимость значений толщины стенок левого предсердия от толщины эпикарда (А) и миокарда (Б) в верхней, средней и нижней третях стенок

Download (65KB)
Indexing metadata

© 2022 Eco-Vector




This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies