Duytschaever Mattias, Ho Siew Yen, Devos Dan, Tavernier Rene
Department of Cardiology, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium.
Europace. 2006 Apr;8(4):245-50. doi: 10.1093/europace/euj039. Epub 2006 Feb 21.
Knowledge of the complex three-dimensional anatomy of the right atrium is mandatory for the electrophysiologist and interventional cardiologist, but its understanding remains difficult. We hypothesized that the left hand, loosely clenched, is a good three-dimensional model to understand the position of the different anatomical and electrical regions in the right atrium. For validation, we compared the hand with an endocast that had been prepared from an adult human right atrium and with a three-dimensional electro-anatomical CT image of the right atrium.
Views of the left hand were photographed from various angles to replicate as closely as possible the standard fluoroscopic views. Using the nomenclature of the bones of the hand, we assigned the different regions of the hand to represent regions and structures of the right atrium. An endocast was prepared from an adult human right atrium. A three-dimensional electro-anatomical right atrial map with CT integration (CartoMerge) was used as the gold standard for the exact localization of electrical regions such as the sinus node (SN), bundle of His, and slow pathway region. Using the left hand, it is possible to mark the free wall, terminal crest, appendage, septal surface, oval fossa and orifices of the caval veins, tricuspid valve, and coronary sinus. We also marked the anticipated locations of the SN, His bundle, triangle of Koch, slow pathway region, inferior isthmus, and right atrial insertion of Bachmann's bundle. When compared with an endocast and a three-dimensional electro-anatomical CT image, the position and orientation of the marked regions were deemed to be anatomically correct.
Compared with an endocast and a CT-guided electro-anatomical reconstruction of the right atrium, the left hand is a reliable model to understand the position and orientation of the different anatomical and electrical regions in the right atrium. Although an oversimplification of the complex right atrial anatomy, this model is 'handy' to understand, guide, and teach electrophysiological and interventional procedures.
了解右心房复杂的三维解剖结构对电生理学家和介入心脏病学家来说是必不可少的，但对其理解仍然困难。我们假设，左手松握拳是理解右心房不同解剖和电活动区域位置的良好三维模型。为进行验证，我们将左手与由成人右心房制备的铸型以及右心房的三维电解剖CT图像进行了比较。
从不同角度拍摄左手的视图，以尽可能接近地复制标准荧光透视视图。使用手部骨骼的命名法，我们将手部的不同区域对应右心房的区域和结构。从成人右心房制备铸型。使用带有CT融合的三维电解剖右心房标测图（CartoMerge）作为电活动区域（如窦房结、希氏束和慢径区域）准确定位的金标准。使用左手，可以标记右心房的游离壁、终嵴、心耳、间隔面、卵圆窝以及腔静脉口、三尖瓣和冠状窦。我们还标记了窦房结、希氏束、科赫三角、慢径区域、下腔静脉峡部和巴赫曼束右心房插入点的预期位置。与铸型和三维电解剖CT图像相比，标记区域的位置和方向在解剖学上被认为是正确的。
与铸型和CT引导的右心房电解剖重建相比，左手是理解右心房不同解剖和电活动区域位置和方向的可靠模型。尽管该模型对复杂的右心房解剖结构有所简化，但便于理解、指导和教授电生理及介入操作。
