Randall W C, Ardell J L, Wurster R D, Milosavljevic M
Department of Physiology, Stritch School of Medicine of Loyola University of Chicago, Maywood, IL 60153.
J Auton Nerv Syst. 1987 Jul;20(1):13-23. doi: 10.1016/0165-1838(87)90077-4.
Differential, selective distribution of parasympathetic, postganglionic innervation to the atrioventricular nodal (AVN) region of the canine heart was recently described. Ablation of parasympathetic pathways to the AVN by disruption of the epicardial fat pad at the junction of the inferior vena cava and inferior left atrium did not interfere with normal vagal control of the sinoatrial node (SAN) function. In sharp contrast, surgical dissection of the fat pad overlying the right pulmonary vein-left atrial junction interrupted the major right and left vagal inputs to the SAN region. The pulmonary vein fat pad (PVFP) in the dog heart is triangular in shape with roughly equilateral dimensions of approximately 1 cm, its base extending from superior to inferior veins, and its apex extending nearly to the sinus nodal artery as it courses rostrally in the sulcus terminalis. Careful dissection of smaller fat pads around the circumference of the pulmonary veins and particularly over the rostral-dorsal surfaces of the right superior pulmonary vein and adjacent right atrium, completed SAN parasympathetic denervation. Care in making these dissections left the vagal supply to the AVN region essentially intact, and preserved the sympathetic supplies to both SAN and AVN regions. Autonomic ganglia, varying in size from 1 or 2 cells to 80-100 cells, were found scattered throughout the ventral PVFP (overlying and surrounding the right pulmonary vein-left atrial junction). The ganglia were generally imbedded in fatty connective tissue, although they commonly rested very close to, or were loosely surrounded by epicardial muscle. Ganglia were also found in smaller fat pads on the dorsal surfaces of the atrium between the azygos and the right superior pulmonary vein.
最近有人描述了犬心房室结（AVN）区域副交感节后神经支配的差异性、选择性分布。通过破坏下腔静脉与左心房交界处的心外膜脂肪垫来消融通往AVN的副交感神经通路，并不干扰对窦房结（SAN）功能的正常迷走神经控制。与之形成鲜明对比的是，手术剥离右肺静脉-左心房交界处上方的脂肪垫，中断了通往SAN区域的主要左右迷走神经输入。犬心的肺静脉脂肪垫（PVFP）呈三角形，大致等边，尺寸约为1厘米，其底部从上静脉延伸至下静脉，其尖端在终沟内向前走行时几乎延伸至窦房结动脉。仔细剥离肺静脉周围较小的脂肪垫，特别是右上肺静脉和相邻右心房的头背表面上的脂肪垫，完成了对SAN的副交感神经去神经支配。在进行这些剥离时小心操作，使通往AVN区域的迷走神经供应基本保持完整，并保留了对SAN和AVN区域的交感神经供应。在腹侧PVFP（覆盖并围绕右肺静脉-左心房交界处）中发现了大小不一的自主神经节，从1或2个细胞到80 - 100个细胞不等。这些神经节通常嵌入脂肪结缔组织中，尽管它们通常非常靠近心外膜肌肉或被心外膜肌肉松散地包围。在奇静脉和右上肺静脉之间心房背表面的较小脂肪垫中也发现了神经节。
