Abstract
Introduction.
For the correct evaluation of structural differences of components of the fibrous ring of the left atrio
ventricular (AV) orifice and the differentiation of their varieties in the variational set of the usually and abnor
mally developed hearts there is needed a pattern (model) of typical structure of the left AV orifice fibrous ring.
Materials and methods.
The left AV orifice fibrous ring was studied macro- (n=382) and microscopically
(n=57) on specimens of definitive (completely developed) unchanged human hearts.
Results.
The left AV orifice fibrous ring is connected, that is, integrated, with the muscle crest of the basal
part of the left ventricle. The left AV orifice fibrous ring consists of differently transformed components: the
left and the right fibrous triangles of the heart, the fibrous strip
(lamina fibrosa)
of parabolic shape and the
fibrous coronary branch
(fila coronaria fibrosa).
The component of the compact fibrous tissue - the left and
right fibrous triangles of the heart formed in the places of fusions of the left AV orifice fibrous ring and the
fibrous ring of the aortic valve. The component of the left AV orifice fibrous ring between the fibrous trian
gles - the fibrous strip representing the
aortic-mitral-atrial fibrous connection
(AMAFC). The position of
AMAFC conditions its parabolic shape. Initially AMAFC of the parabolic shape embodies the structural
mechanism of the alternating rounding of the left ventricular outflow orifice (LVOO) and the left AV orifice
which being round have not enough room in the perimeter of the cross section of the left ventricle at the level
of AMAFC. The blood flow in the left ventricle protrudes AMAFC in the alternating manner towards the left
atrium during systole and towards the LVOO during diastole of ventricles, respectively. The fibrous coronary
branch is the fibrous base of the posterior cusp and commissures of the mitral valve.
Conclusion.
The presented construction of the left AV orifice fibrous ring is the pattern of its typical structure
in the definitive human heart.
References
1.
Бокерия Л.А., Махачев О.А., Панова М.С., Фи-
липпкина Т.Ю.
Нормативные параметры сердца
и его структур. М.: НЦССХ им. А.Н. Бакулева
РАМН; 2008: 63-9.
2.
Бокерия Л.А., Беришвили И.И.
Нормальное серд
це и физиология кровообращения. Митральный
клапан. В кн.: Бокерия Л.А., Беришвили И.И.
Хирургическая анатомия сердца. М.: НЦССХ
им. А.Н. Бакулева РАМН; 2006; 1: 220-7.
3.
Ranganathan N., Lam J.H.C., Wigle E.D.,
Silver M.D.
Morphology of the human mitral valve.
II. The valve leaflets.
Circulation.
1970; 41 (4):
459-6.
4.
Davies M.J.
Pathology of cardiac valves. London:
Butterworths; 1980.
5.
Virmani R., Atkinson J.B., Byrd B.F.
Abnormal
chordal insertion: A cause of mitral valve prolapse.
Am. Heart J.
1987; 113: 851-8.
6.
Anderson R.H., Becker A.E.
The fibrous sceleton of
the heart. In: The heart: structure in health and di
sease. Cardiac anatomy. London: Gower Medical
Publishing; 1992; 1.19.
7.
Anderson R.H., Baker E.J., Penny D.J.,
Redington A.N., Rigby M.L., Wernovsky G.
(eds.).
Paediatric cardiology. 3rd ed. London: Churchill
Livingstone; 2010: 731-2.
8.
Van Rijk-Zwikker G.L., Delemarre B.J., Hues-
mans H.A.
Mitral valve anatomy and morphology:
relevance to mitral valve replacement and valve
reconstruction.
J. Cardiol. Surg.
1994; 96 (Suppl.):
255-61.
9. Gray's anatomy. 36th ed. Ed. PL. Williams,
R. Warwick. London: Churchill Livingstone; 1980;
648-51.
10.
Бухарин В.А., Синёв А.Ф., Бондарев Ю.И., Кагра-
манов И.И.
Врожденная недостаточность мит
рального клапана.
Грудная хирургия.
1996; 2:
35-41.
11.
Синёв А.Ф.
Основы клинической анатомии
и эмбриоморфогенеза сердца человека. В кн.:
Лекции по кардиологии. Под ред. Л.А. Боке
рия, Е.З. Голуховой. М.: НЦССХ им. А.Н. Ба
кулева РАМН; 2001; II: 171-85.
12.
Синёв А.Ф., Фальковский Г.Э., Крым
ский Л.Д.
Вскрытие сердца при врожденных по
роках.
Архив патологии.
1981; 4: 77-81.
13.
Ormiston J.F., Shah P.M., Tei C.
Size and motion of
the mitral valve annulus in man. A two dimensional
echocardiographic method and findings in normal
subjects.
Circulation.
1981; 64 (1): 113-20.
14.
Timek T.A., Green G.R., Tibayan F.A.
Aorto-mitral
annular dynamics.
Ann. Thorac. Surg.
2003; 76:
1944-50.
15.
Westaby S., Karp R.B., Boackstone T.H.,
Bishop S.P.
Adult human valve dimensions and their
surgical significance.
Am. J. Cardiol.
1984; 53 (5):
552-6. 16.
Burch G.E., Giles T.D.
Angle of traction of the pap
illary muscle in normal and dilated hearts. A theo
retical analysis of its importance in mitral valve
dynamics.
Am. Heart J.
1972; 84: 141-5.
17.
Zimmerman
J.The functional and surgical anatomy of
the heart.
Ann. R. Coll. Surg. Eng.
1966; 39: 348-66.
