Kim D T, Lai A C, Hwang C, Fan L T, Karagueuzian H S, Chen P S, Fishbein M C
Department of Medicine at Cedars-Sinai Medical Center/UCLA, Los Angeles, California, USA.
J Am Coll Cardiol. 2000 Oct;36(4):1324-7. doi: 10.1016/s0735-1097(00)00819-6.
We sought to study the anatomy of human ligament of Marshall (LOM).
Although the LOM has been implicated in the genesis of focal atrial tachyarrhythmias, its gross anatomic and microscopic features in humans hearts have not been completely defined.
We studied seven postmortem human hearts from five men and two women with a mean age of 52 +/- 26 years. Four did not have any heart disease. One woman had dilated cardiomyopathy, and two men had chronic atrial fibrillation. A block of tissue encompassing the LOM from the coronary sinus (CS) cephalad, between the atrial appendage and left pulmonary veins, was dissected. Serial sections from this tissue were then stained with hematoxylin and eosin, trichrome, and/or tyrosine hydroxylase.
The LOM consists of multiple sympathetic nerve fibers, ganglia, blood vessels and multiple myocardial tracts (Marshall Bundles) insulated by fibrofatty tissue. One or more myocardial tracts was inserted directly into the left atrial free wall and CS. The distance between insertion sites was 7.8 +/- 2.5 mm. Nerve fibers, some tyrosine hydroxylase positive, were present within the fibrofatty matrix and within the myocardial tracts.
Human LOM 1) is innervated by sympathetic nerve fibers; 2) is more complex than the LOM in canine hearts; and 3) has multiple myocardial tract insertions into the left atrial free wall and CS, forming a substrate of reentry. Radiofrequency catheter ablation from the CS may fail to reach the free wall insertion.
我们试图研究马歇尔韧带（LOM）的人体解剖结构。
尽管LOM被认为与局灶性房性快速心律失常的发生有关，但其在人类心脏中的大体解剖和微观特征尚未完全明确。
我们研究了7例尸检的人类心脏，来自5名男性和2名女性，平均年龄为52±26岁。其中4例无任何心脏病。1名女性患有扩张型心肌病，2名男性患有慢性心房颤动。从冠状窦（CS）头端至心耳与左肺静脉之间，切取包含LOM的组织块。然后将该组织的连续切片用苏木精和伊红、三色染色法和/或酪氨酸羟化酶染色。
LOM由多条交感神经纤维、神经节、血管和多条被纤维脂肪组织隔离的心肌束（马歇尔束）组成。一条或多条心肌束直接插入左心房游离壁和CS。插入部位之间的距离为7.8±2.5mm。在纤维脂肪基质和心肌束内存在神经纤维，部分神经纤维酪氨酸羟化酶呈阳性。
人类LOM 1）由交感神经纤维支配；2）比犬类心脏中的LOM更复杂；3）有多个心肌束插入左心房游离壁和CS，形成折返基质。从CS进行射频导管消融可能无法到达游离壁插入部位。
