HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland.
J Cardiovasc Electrophysiol. 2020 Dec;31(12):3199-3206. doi: 10.1111/jce.14767. Epub 2020 Oct 11.
The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures.
We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001).
This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
右心耳（RAA）前庭是右心房内位于 RAA 口和右房室瓣环之间的区域，可能是介入性经导管手术的目标部位。
我们检查了 200 例尸检人心。检测到三个峡部（下峡部、中峡部和上峡部）。前庭的平均长度为 67.4±10.1mm。在 15.3%的标本中观察到前庭内有裂隙和憩室。峡部的高度各不相同：上峡部 14.0±3.4mm，中峡部 11.2±3.1mm，下峡部 10.1±2.7mm（p<.001）。上峡部心房壁最厚（中水平：16.7±5.6mm），中峡部次之（13.5±4.2mm），下峡部最薄（9.3±3.0mm；p<.001）。当分析脂肪层的厚度时，也观察到相同的模式（上峡部厚度为 15.4±5.6mm，中峡部为 11.7±4.1mm，下峡部为 7.1±3.1mm；p<.001）。峡部之间的心肌厚度无差异（上峡部：1.3±0.5mm，中峡部：1.8±0.8mm，下峡部：1.6±0.5mm；p>.05）。在每个峡部内，整个心房壁和脂肪层的厚度都有变化。这些变化在靠近瓣环处最厚，在靠近 RAA 口处最薄（p<.001）。心肌层的厚度呈反向趋势（p<.001）。
本研究首次描述了 RAA 前庭及其毗邻峡部的详细局部解剖结构。RAA 峡部结构和尺寸的显著变异性可能在该解剖区域的介入计划中发挥作用。
