Anderson Robert H, Sánchez-Quintana Damián, Nevado-Medina Jorge, Spicer Diane E, Tretter Justin T, Lamers Wouter H, Hu Zihan, Cook Andrew C, Sternick Eduardo Back, Katritsis Demosthenes G
Biosciences Division, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK.
Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain.
J Cardiovasc Dev Dis. 2025 Jun 26;12(7):245. doi: 10.3390/jcdd12070245.
The anatomical arrangement of the atrioventricular node has been likened to a riddle wrapped up in an enigma. There are several reasons for this alleged mystery, not least the marked variability in structure between different species. Lack of detailed knowledge of the location of the node relative to the atrial and ventricular septal structures has also contributed to previous misunderstandings. Recent studies comparing the findings of gross dissection with virtual dissection of living datasets, combined with access to a large number of serially sectioned human and animal hearts, have served to provide the evidence to solve the riddle. We summarise these findings in this review. We explain how the node is located within the atrial walls of the inferior pyramidal space. It becomes the non-branching component of the atrioventricular conduction axis as the axis extends through the plane of atrioventricular insulation to enter the infero-septal recess of the left ventricular outflow tract. The node itself is formed by contributions from the tricuspid and mitral vestibules, with extensive additional inputs from the base of the atrial septum. We show how knowledge of development enhances the appreciation of the arrangements and offers an explanation as to why, on occasion, there can be persisting nodoventricular connections. We discuss the findings relative to the circuits producing atrioventricular re-entry tachycardia. We conclude by emphasising the significance of the variation of the anatomical arrangements within different mammalian species.
房室结的解剖结构一直被比作一个谜团中的谜题。造成这种所谓谜团的原因有几个，尤其是不同物种之间结构的显著差异。对该结相对于心房和心室间隔结构位置的详细了解不足，也导致了之前的误解。最近的研究将大体解剖结果与活体数据集的虚拟解剖结果进行比较，并结合大量连续切片的人类和动物心脏，为解开这个谜题提供了证据。我们在这篇综述中总结了这些发现。我们解释了该结是如何位于下锥体空间的心房壁内的。当房室传导轴穿过房室绝缘平面进入左心室流出道的下间隔隐窝时，它成为房室传导轴的非分支部分。结本身由三尖瓣和二尖瓣前庭的贡献形成，并从房间隔底部获得广泛的额外输入。我们展示了发育知识如何增强对这些结构的理解，并解释了为什么有时会存在持续的结室连接。我们讨论了与产生房室折返性心动过速的电路相关的发现。我们强调不同哺乳动物物种解剖结构变化的重要性作为结论。
