Francalanci P, Drago F, Agostino D A, Di Liso G, Di Ciommo V, Boldrini R, Ragonese P, Bosman C
Department of Pathology, Bambino Gesù Hospital, Rome, Italy.
Pacing Clin Electrophysiol. 1998 Aug;21(8):1576-9. doi: 10.1111/j.1540-8159.1998.tb00245.x.
The atrioventricular node is situated in the lower atrial septum, at the apex of the Koch's triangle. The dimensions of the Koch's triangle are studied in adult humans, while no data exist about them in pediatric age. The knowledge of the dimensions of Koch's triangle in childhood is very important for safe and correct application of radiofrequency energy during transcatheter ablation. The dimensions of Koch's triangle were determined in 69 human pediatric hearts. The median age of the children was 3 months, with a range from 1 day to 14 years, 30 were female and 39 were male. Relations between body weight (extracardiac parameter) and tricuspid valve diameter (intracardiac parameter) were determined in all hearts to show morphometric modifications with growth. The distribution of body weight was not Gaussian and no correlation could be obtained between Koch's triangle dimensions and body weight. However, it was possible to identify that the mean ratio between the cathetus of the Koch's triangle corresponding to the annulus of the tricuspid valve and the tricuspid valve diameter was 0.45 +/- 0.16, with a highly significant correlation coefficient (r = 0.653, P < 0.001). Therefore, by knowing: (1) the diameter of the tricuspid valve, and (2) the constant ratio between the cathetus of the Koch's triangle and the tricuspid valve diameter, it is possible to calculate the length of the segment of the tricuspid annulus along which the transcatheter application of radiofrequency current can be applied to ablate the slow-pathway, thus reducing the risks of damage of the atrioventricular node.
房室结位于房间隔下部、科赫三角的顶点。科赫三角的尺寸在成年人体内进行了研究，但儿科年龄段尚无相关数据。了解儿童时期科赫三角的尺寸对于经导管消融术中安全正确地应用射频能量非常重要。对69例儿童心脏的科赫三角尺寸进行了测定。儿童的中位年龄为3个月，范围从1天至14岁，其中30例为女性，39例为男性。在所有心脏中测定体重（心外参数）与三尖瓣直径（心内参数）之间的关系，以显示随生长的形态学改变。体重分布不呈高斯分布，科赫三角尺寸与体重之间未获得相关性。然而，可以确定，对应于三尖瓣环的科赫三角边与三尖瓣直径的平均比值为0.45±0.16，相关系数高度显著（r = 0.653，P < 0.001）。因此，通过了解：（1）三尖瓣直径，以及（2）科赫三角边与三尖瓣直径之间的恒定比值，就可以计算出三尖瓣环上可经导管施加射频电流以消融慢径路的节段长度，从而降低房室结损伤的风险。
