Truong Ba Luu, Jouk Pierre-Simon, Auriau Johanne, Michalowicz Gabrielle, Usson Yves
Centre National de la Recherche Scientifique (CNRS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques, Applications, Grenoble (TIMC-IMAG), Grenoble, France.
Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital, Paris, France.
Front Pediatr. 2020 Sep 22;8:503054. doi: 10.3389/fped.2020.503054. eCollection 2020.
The pathognomonic feature of tetralogy of Fallot (ToF) is the antero-cephalad deviation of the outlet septum in combination with an abnormal arrangement of the septoparietal trabeculations. The aim of this article was to study perinatal hearts using Polarized Light Imaging (PLI) in order to investigate the deep alignment of cardiomyocytes that bond the different components of the ventricular outflow tracts both together and to the rest of the ventricular mass, thus furthering the classic description of ToF. 10 perinatal hearts with ToF and 10 perinatal hearts with no detectable cardiac anomalies (control) were studied using PLI. The orientation of the myocardial cells was extracted and studied at high resolution. Virtual dissections in multiple section planes were used to explore each ventricular structure. Contrary to the specimens of the control group, for all ToF specimens studied, the deep latitudinal alignment of the cardiomyocytes bonds together the left part of the Outlet septum (OS) S to the anterior wall of the left ventricle. In addition, the right end of the muscular OS bonds directly on the right ventricular wall (RVW) superior to the attachment of the ventriculo infundibular fold (VIF). Thus, the OS is a bridge between the lateral RVW and the anterior left ventricular wall. The VIF, RVW, and OS define an "inverted U" that roofs the cone between the interventricular communication and the overriding aorta. The opening angle and the length of the branches of this "inverted U" depend however on three components: the size of the OS, the size of the VIF, and the distance between the points of insertion of the OS and VIF into the RVW. The variation of these three components accounts for a significant part of the diversity observed in the anatomical presentations of ToF in the perinatal period.
法洛四联症（ToF）的特征性表现是流出道间隔向前头侧偏移，并伴有隔顶小梁排列异常。本文旨在使用偏振光成像（PLI）研究围产期心脏，以探究连接心室流出道不同组成部分以及与心室其余部分的心肌细胞深度排列，从而完善对ToF的经典描述。使用PLI研究了10例患有ToF的围产期心脏和10例未检测到心脏异常的围产期心脏（对照组）。以高分辨率提取并研究心肌细胞的方向。使用多个截面平面的虚拟解剖来探索每个心室结构。与对照组标本相反，对于所有研究的ToF标本，心肌细胞的深度横向排列将流出道间隔（OS）S的左部分与左心室前壁连接在一起。此外，肌性OS的右端直接附着于室漏斗皱襞（VIF）附着点上方的右心室壁（RVW）。因此，OS是右心室外侧壁和左心室前壁之间的桥梁。VIF、RVW和OS形成一个“倒U形”，覆盖心室间交通和骑跨主动脉之间的圆锥。然而，这个“倒U形”的开口角度和分支长度取决于三个因素：OS的大小、VIF的大小以及OS和VIF插入RVW的点之间的距离。这三个因素的变化在很大程度上解释了围产期ToF解剖表现中观察到的多样性。
