Tretter Justin T, Spicer Diane E, Sánchez-Quintana Damián, Back Sternick Eduardo, Farré Jerónimo, Anderson Robert H
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Europace. 2022 Mar 2;24(3):455-463. doi: 10.1093/europace/euab285.
To take full advantage of the knowledge of cardiac anatomy, structures should be considered in their correct attitudinal orientation. Our aim was to discuss the triangle of Koch in an attitudinally appropriate fashion.
We reviewed our material prepared by histological sectioning, along with computed tomographic datasets of human hearts. The triangle of Koch is the right atrial surface of the inferior pyramidal space, being bordered by the tendon of Todaro and the hinge of the septal leaflet of the tricuspid valve, with its base at the inferior cavotricuspid isthmus. The fibro-adipose tissues of the inferior pyramidal space separate the atrial wall from the crest of the muscular interventricular septum, thus producing an atrioventricular muscular sandwich. The overall area is better approached as a pyramid rather than a triangle. The apex of the inferior pyramidal space overlaps the infero-septal recess of the subaortic outflow tract, permitting the atrioventricular conduction axis to transition directly to the crest of the muscular ventricular septum. The compact atrioventricular node is formed at the apex of the pyramid by union of its inferior extensions, which represent the slow pathway, with the septal components formed in the buttress of the atrial septum, thus providing the fast pathway.
To understand its various implications in current cardiological catheter interventions, the triangle of Koch must be considered in conjunction with the inferior pyramidal space and the infero-septal recess. It is better to consider the overall region in terms of a pyramidal area of interest.
为充分利用心脏解剖学知识，应从正确的体位方向来考量心脏结构。我们的目的是以符合体位的恰当方式探讨科赫三角。
我们回顾了通过组织切片制备的材料以及人类心脏的计算机断层扫描数据集。科赫三角是下锥体间隙的右心房表面，其边界为托达罗腱和三尖瓣隔叶的铰链，底部位于下腔静脉三尖瓣峡部。下锥体间隙的纤维脂肪组织将心房壁与肌性室间隔嵴分开，从而形成一个房室肌性夹层。从整体来看，该区域更适宜看作一个锥体而非三角形。下锥体间隙的顶点与主动脉下流出道的下间隔隐窝重叠，使房室传导轴能够直接过渡到肌性室间隔嵴。致密房室结在锥体顶点由其下部延伸（代表慢径路）与在房间隔支柱中形成的间隔成分融合而成，从而形成快径路。
为理解其在当前心脏导管介入治疗中的各种影响，必须结合下锥体间隙和下间隔隐窝来考量科赫三角。最好将整个区域视为一个感兴趣的锥体区域。
