Messer Simon, Moseley Ellen, Marinescu Mirela, Freeman Carol, Goddard Martin, Nair Sukumaran
Department of Cardiothoracic Surgery, Papworth Hospital NHS Trust, Cambridgeshire, UK.
J Heart Valve Dis. 2012 May;21(3):368-73.
The human tricuspid valve is conventionally thought to have a fibrous annulus in the septal region. The study aim was to conduct morphological and histological analyses of the right atrioventricular junction (RAVJ), in particular to investigate the fibrous/collagenous content of this structure in the adult human heart.
Twelve human hearts from patients who died after cardiac surgery and underwent autopsy were included in the study. Rigid exclusion criteria were practiced to ensure that the hearts studied were not subject to ventricular dilatation or hypertrophy prior to surgery, or had undergone valvular surgery. Gross examination of the RAVJ was performed and the entire circumference of the RAVJ sectioned longitudinally at 5 mm intervals; the tissues were then fixed in 10% neutral buffered formalin for 24 h. All sections were then stained with hematoxylin and eosin and elastic van Geison stains.
There were no significant amounts of fibrous or collagenous structures along the free wall segment of the RAVJ. Muscular bars, measuring about 2-4 mm in diameter, were seen to run between the wall of the right ventricle and the RAVJ on its ventricular aspect. The relationship between the base of the tricuspid valve leaflet to the right atrial and right ventricular muscle head varied significantly within, and between, hearts.
While the septal aspect of the RAVJ has scant fibrous tissue, the majority of its free wall segment is devoid of fibrous tissue. Right ventricular muscle bridges are inserted into the RAVJ, the functional significance of which, both in normal hearts and in the pathogenesis of functional tricuspid regurgitation, requires further investigation.
传统观点认为人类三尖瓣在间隔区域有一个纤维环。本研究旨在对右房室连接部（RAVJ）进行形态学和组织学分析，特别是研究该结构在成人心脏中的纤维/胶原成分。
本研究纳入了12例心脏手术后死亡并接受尸检的患者的心脏。实施严格的排除标准以确保所研究的心脏在手术前未出现心室扩张或肥厚，也未接受瓣膜手术。对RAVJ进行大体检查，并将RAVJ的整个圆周以5毫米的间隔纵向切片；然后将组织固定在10%中性缓冲福尔马林中24小时。所有切片随后用苏木精和伊红以及弹性范吉森染色。
在RAVJ的游离壁段没有大量的纤维或胶原结构。在右心室壁和RAVJ心室面之间可见直径约2 - 4毫米的肌束。三尖瓣叶基部与右心房和右心室肌头之间的关系在不同心脏之间以及同一心脏内部均有显著差异。
虽然RAVJ的间隔面纤维组织较少，但其大部分游离壁段没有纤维组织。右心室肌桥插入RAVJ，其在正常心脏和功能性三尖瓣反流发病机制中的功能意义需要进一步研究。
