Oh Il Young, Cha Myung Jin, Lee Tae Hui, Seo Jeong Wook, Oh Seil
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Korean Circ J. 2018 Dec;48(12):1081-1096. doi: 10.4070/kcj.2018.0335.
We reviewed the anatomical characteristics of the conduction system in the ventricles of human and ungulate hearts and then raised some questions to be answered by clinical and anatomical studies in the future. The ventricular conduction system is a 3-dimensional structure as compared to the 2-dimensional character of the atrial conduction system. The proximal part consisting of the atrioventricular node, the bundle of His and fascicles are groups of conducting cells surrounded by fibrous connective tissue so as to insulate from the underlying myocardium. Their location and morphological characters are well established. The bundle of His is a cord like structure but the left and right fascicles are broad at the proximal and branching at the distal part. The more distal part of fascicles and Purkinje system are linear networks of conducting cells at the immediate subendocardium but the intra-mural network is detected at the inner half of the ventricular wall. The papillary muscle also harbors Purkinje system not in the deeper part. It is hard to recognize histologically in human hearts but conducting cells as well as Purkinje cells are easily recognized in ungulate hearts. Further observation on human and ungulate hearts with myocardial infarct, we could find preserved Purkinje system at the subendocardium in contrast to the damaged system at the deeper myocardium. Further studies are necessary on the anatomical characteristics of this peripheral conduction system so as to correlate the clinical data on hearts with ventricular arrhythmias.
我们回顾了人类和有蹄类动物心室传导系统的解剖学特征，随后提出了一些问题，以待未来的临床和解剖学研究解答。与心房传导系统的二维特性相比，心室传导系统是三维结构。由房室结、希氏束和束支组成的近端部分是一群被纤维结缔组织包围的传导细胞，以便与下方的心肌绝缘。它们的位置和形态特征已得到充分确定。希氏束是条索状结构，但左、右束支在近端较宽，在远端分支。束支和浦肯野系统的更远端部分是紧邻心内膜下的传导细胞线性网络，但在心室壁内半部可检测到壁内网络。乳头肌也含有浦肯野系统，但不在更深层。在人类心脏中，从组织学上很难识别，但在有蹄类动物心脏中，传导细胞和浦肯野细胞很容易识别。通过对有心肌梗死的人类和有蹄类动物心脏的进一步观察，我们发现在心内膜下浦肯野系统得以保留，而更深层心肌中的系统则受损。有必要对这个外周传导系统的解剖学特征进行进一步研究，以便将有关心室心律失常心脏的临床数据联系起来。
