Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK.
Congenital Heart Center, All Children's Hospital, St Petersberg, Florida, USA.
J Anat. 2024 Aug;245(2):201-216. doi: 10.1111/joa.14048. Epub 2024 Apr 17.
Despite centuries of investigation, certain aspects of left ventricular anatomy remain either controversial or uncertain. We make no claims to have resolved these issues, but our review, based on our current knowledge of development, hopefully identifies the issues requiring further investigation. When first formed, the left ventricle had only inlet and apical components. With the expansion of the atrioventricular canal, the developing ventricle cedes part of its inlet to the right ventricle whilst retaining the larger parts of the cushions dividing the atrioventricular canal. Further remodelling of the interventricular communication provides the ventricle with its outlet, with the aortic root being transferred to the left ventricle along with the newly formed myocardium supporting its leaflets. The definitive ventricle possesses inlet, apical and outlet parts. The inlet component is guarded by the mitral valve, with its leaflets, in the normal heart, supported by papillary muscles located infero-septally and supero-laterally. There is but a solitary zone of apposition between the leaflets, which we suggest are best described as being aortic and mural. The trabeculated component extends beyond the inlet to the apex and is confluent with the outlet part, which supports the aortic root. The leaflets of the aortic valve are supported in semilunar fashion within the root, with the ventricular cavity extending to the sinutubular junction. The myocardial-arterial junction, however, stops well short of the sinutubular junction, with myocardium found only at the bases of the sinuses, giving rise to the coronary arteries. We argue that the relationships between the various components should now be described using attitudinally appropriate terms rather than describing them as if the heart is removed from the body and positioned on its apex.
尽管经过了数个世纪的研究，左心室解剖学的某些方面仍然存在争议或不确定。我们并不声称已经解决了这些问题，但我们的综述基于我们目前对发育的了解，希望能够确定需要进一步研究的问题。最初形成时，左心室只有入口和心尖部分。随着房室管的扩张，发育中的心室将其入口的一部分让给右心室，同时保留分隔房室管的更大部分的垫。进一步重塑室间隔沟通为心室提供了出口，主动脉根部随着新形成的心肌瓣叶一起转移到左心室。最终的心室具有入口、心尖和出口部分。入口部分由二尖瓣保护，在正常心脏中，二尖瓣瓣叶由位于下隔和上外侧的乳头肌支撑。瓣叶之间只有一个单一的贴合区，我们建议最好将其描述为主动脉和壁。小梁部分从入口延伸到心尖，并与出口部分融合，出口部分支撑主动脉根部。主动脉瓣的瓣叶以半月形的方式支撑在根部内，心室腔延伸至窦管交界处。然而，心肌-动脉交界处远未达到窦管交界处，只有窦底部有心肌，产生冠状动脉。我们认为，现在应该使用适当的态度术语来描述各个部分之间的关系，而不是将其描述为将心脏从体内取出并放置在其心尖上。
