Gami Apoor S, Noheria Amit, Lachman Nirusha, Edwards William D, Friedman Paul A, Talreja Deepak, Hammill Stephen C, Munger Thomas M, Packer Douglas L, Asirvatham Samuel J
Midwest Heart Specialists, Elmhurst, IL, USA.
J Interv Card Electrophysiol. 2011 Jan;30(1):5-15. doi: 10.1007/s10840-010-9523-3. Epub 2010 Dec 15.
Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications.
We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57%) had myocardial extensions above the aortic valve, and 446 of 602 (74%) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55%; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24%; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66%; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49%; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2%). Extensions were noted above the pulmonary right cusp in 360 of 602 (60%; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52%; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45%; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73%; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7%). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005).
Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.
某些流出道快速性心律失常需要在半月瓣上方进行消融。为避免并发症，需要了解这些致心律失常部位的局部解剖结构。
我们检查了1998年10月至2003年7月间603颗经福尔马林固定的尸检心脏。603颗心脏中有342颗（57%）在主动脉瓣上方有心肌延伸，602颗心脏中有446颗（74%）在肺动脉瓣上方有延伸。在603颗心脏中的332颗（55%；2.8±1.2毫米）主动脉右冠状动脉瓣叶（RCC）上方、603颗心脏中的145颗（24%；1.5±0.5毫米）左冠状动脉瓣叶（LCC）上方以及603颗心脏中的4颗（0.66%；1.3±0.5毫米；p<0.0001）非冠状动脉/后瓣叶上方、603颗心脏中的295颗（49%；2.2±1.1毫米）瓣叶间以及603颗心脏中的13颗（2.2%）瓣叶内观察到延伸。在602颗心脏中的360颗（60%；4.0±2.5毫米）肺动脉右瓣叶上方、602颗心脏中的313颗（52%；3.6±2.1毫米）后/左瓣叶上方以及602颗心脏中的268颗（45%；3.7±2.2毫米；p<0.0001）前瓣叶上方、602颗心脏中的438颗（73%；3.4±1.8毫米）瓣叶间以及602颗心脏中的10颗（1.7%）瓣叶内观察到延伸。左主冠状动脉比最靠近主动脉瓣叶（LCC）上方的心肌延伸更靠近最靠近肺动脉瓣叶（后瓣叶）上方的心肌延伸（4.8±1.7对16.3±3.3毫米，p=0.0005）。
心肌延伸常见于半月瓣上方的大动脉内及瓣叶间，很少延伸至瓣叶本身。与主动脉瓣叶上方相比，肺动脉瓣叶上方的延伸更大且更对称，主动脉最显著的延伸在RCC上方。左主冠状动脉走行靠近肺动脉后瓣叶上方的延伸。
