Bharati S, Lev M
Congenital Heart and Conduction System Center, Heart Institute for Children, Palos Heights, IL 60463.
Am Heart J. 1992 Aug;124(2):486-96. doi: 10.1016/0002-8703(92)90615-3.
The conduction systems of two women who were 92 and 91 years of age, respectively, were examined by serial section. The first patient had sick sinus syndrome for more than 20 years, and the second patient had intermittent complete AV block that alternated with normal sinus rhythm for 12 years before her death. Both patients had severe coronary artery disease and had pacemakers and were doing well. The conduction systems in both revealed fatty metamorphosis in the approaches to the SA and AV nodes, the SA node, the AV node, and the atria with fibrotic changes in the ventricular septum, the AV bundle, and the bundle branches. Patient 1 had normal SA nodal artery and patient 2 had extensive vascularization of the AV node. As the heart ages, fatty replacement of the atria affect the SA and AV nodes, and fibrotic changes of the ventricular septum affect the AV bundle and the bundle branches. Adequate collateral anastomosis to the conduction system may prevent the development of permanent complete AV block in the elderly.
分别对两名92岁和91岁女性的传导系统进行了连续切片检查。第一名患者患有病态窦房结综合征20多年，第二名患者在去世前12年患有间歇性完全性房室传导阻滞，与正常窦性心律交替出现。两名患者均患有严重冠状动脉疾病，均植入了起搏器，情况良好。两人的传导系统在窦房结和房室结附近、窦房结、房室结以及心房均显示脂肪变性，室间隔、房室束和束支有纤维化改变。患者1的窦房结动脉正常，患者2的房室结有广泛血管化。随着心脏衰老，心房的脂肪替代影响窦房结和房室结，室间隔的纤维化改变影响房室束和束支。传导系统有足够的侧支吻合可能会预防老年人永久性完全性房室传导阻滞的发生。
