Anderson Robert H, Yanni Joseph, Boyett Mark R, Chandler Natalie J, Dobrzynski Halina
Cardiovascular Research Group, Faculty of Medical and Human Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, United Kingdom.
Clin Anat. 2009 Jan;22(1):99-113. doi: 10.1002/ca.20700.
All the myocytes within the heart have the capacity to conduct the cardiac impulse. A population of myocytes is specialized so as to generate the cardiac impulse and then to conduct it from the atrial to the ventricular chambers. This population has become known as the conduction system. Anatomists who seek to demonstrate the location of the components of this system must contend with the fact that the components of the system cannot be distinguished from the working myocardial elements by gross dissection. In important presentations to the German Pathological Society in 1910, rules were suggested for the histological distinction of these conducting cells. These rules proposed that the myocytes, to be considered as part of the conduction system, should be histologically discrete, traceable from section to section in serially prepared material, and if to be considered as tracts, should be insulated by fibrous tissue from the adjacent myocytes. Immunohistochemical techniques have now been developed that better demonstrate the distinction between the cells specialized to conduct from working myocytes. These new techniques, for the most part, confirm the accuracy of the initial descriptions. They also reveal additional areas with the characteristics of conduction tissues. These additional areas are located in a paranodal area adjacent to the sinus node, in the vestibules of both atrioventricular valvar orifices, and in a partial ring around the aortic root. In this review, we describe all these features, emphasizing the relationship of the newly recognized components to the established parts of the cardiac conduction system, and how the new findings need to be assessed in the light of the old criteria.
心脏内的所有心肌细胞都有传导心脏冲动的能力。有一群心肌细胞经过特化，能够产生心脏冲动，然后将其从心房传导至心室。这群细胞就被称为传导系统。试图展示该系统各组成部分位置的解剖学家必须面对这样一个事实，即通过大体解剖无法将该系统的组成部分与正常工作的心肌成分区分开来。在1910年向德国病理学会所作的重要报告中，有人提出了区分这些传导细胞的组织学规则。这些规则提出，要被视为传导系统一部分的心肌细胞，在组织学上应是离散的，在连续制备的材料中可逐节追踪，并且如果被视为束状结构，应被纤维组织与相邻的心肌细胞隔离开来。现在已经开发出免疫组织化学技术，能更好地展示专门用于传导的细胞与正常工作的心肌细胞之间的区别。这些新技术在很大程度上证实了最初描述的准确性。它们还揭示了具有传导组织特征的其他区域。这些额外区域位于与窦房结相邻的结旁区域、两个房室瓣口的前庭以及主动脉根部周围的部分环带中。在这篇综述中，我们描述了所有这些特征，强调新识别出的组成部分与心脏传导系统既定部分的关系，以及如何根据旧标准对新发现进行评估。
