胎儿和新生儿心脏下锥状间隙肌腱的解剖特征：实验性研究

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论证。了解胎儿和新生儿心脏下锥状间隙肌腱（Todaro tendon，TT）的解剖学特征对围产期心外科（如左心房入路）非常重要，但实际上尚未进行研究。

目的 — 评估在宏观显微镜下解剖和研究TT的可行性，并获得有关其在胎儿和新生儿心脏中的存在、形状、大小、分支和局部地形的初步数据。

材料和方法。对15个宫内发育16～40周的正常人心脏样本进行了研究。使用Olympus SZX2-ZB10显微镜（Olympus，日本）以6.3至30的放大倍数解剖10个心脏。使用分辨率为10 MP的Levenhuk M1000 PLUS相机（Levenhuk，俄罗斯）和Levenhuk lite软件，测量了TT的长度和宽度。求出算术平均值、标准差、中位数、极值、变异系数和Spearman相关系数。制备五颗心脏的组织切片，并按照Masson染色法进行染色。

结果。在所有制备样本中均检测到TT，TT总是位于心内和/或下锥状间隙的疏松结缔组织中。在所有病例中，TT都从右纤维三角开始，心房心室束和结节的前方和上方的TT最为单一。TT沿着卵圆孔下缘和冠状窦开口之间延伸，最后到达下腔静脉瓣。10例中有6例TT无分支，10例中有4例分为两个分支，覆盖冠状窦口。在一份样本中，制备了到达右冠状动脉的TT纤维。下腔静脉瓣部TT的宽度中位数 (0.35mm) 与其长度 (4.63mm; Rs=0.821; p=0.023) 和原点处的宽度 (0.24mm; Rs=0.929; p=0.0003）相关。

结论。在人发育的产前后期和围产期，心脏下锥状间隙的肌腱具有解剖结构的可变性和地形恒定的特点。结构的可变性表现为肌腱分支和宽度值变异，尤其是宽度。地形的恒定性在于肌腱的起点、连续和终点的不变性。胎儿和新生儿心脏中的这种肌腱可以通过宏观显微镜解剖来找出。

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作者简介

Andrey A. Yakimov

Ural State Medical University; Ural Federal University

编辑信件的主要联系方式.
Email: ayakimov07@mail.ru
ORCID iD: 0000-0001-8267-2895
SPIN 代码: 8618-2991

MD, Cand. Sci. (Medicine), Associate Professor

俄罗斯联邦, Ekaterinburg; Ekaterinburg

Eugenia G. Dmitrieva

Ural State Medical University; Ural Federal University

Email: anmayak@mail.ru
ORCID iD: 0000-0002-2973-3481
SPIN 代码: 7966-8133
俄罗斯联邦, Ekaterinburg; Ekaterinburg

Anton A. Gaponov

Ural State Medical University; Ural Federal University

Email: gagaponov@gmail.com
ORCID iD: 0000-0002-6681-7537
SPIN 代码: 2841-6740
俄罗斯联邦, Ekaterinburg; Ekaterinburg

参考

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2. Fig. 1. Todaro tendon (1), surrounded by the myocardium of the right atrium (2), adjacent to the coronary sinus (3) in the inferior pyramidal space. Transverse section. Specimen 275, fetus of 20-21 weeks. Trichrome Masson staining; lens ×40

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3. Fig. 2. The beginning of the inferior pyramidal space tendon from the right fibrous triangle: a — ×4; b — rectangle area from the Fig. a, ×40. Specimen 412, fetus of 16 weeks. 1 — aorta, 2 — left atrium, 3 — right atrium, 4 — bottom of the inferior pyramidal space, 5 — right fibrous triangle, 6 — bundle of His, penetrating part. Trichrome Masson staining

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4. Fig. 3. Variants of the Todaro tendon: a — trunk-line (specimen 298, fetus of 29–30 weeks); b — dichotomous (specimen 507, newborn, 40 weeks); c — trunk-line variant with the anterior elongation (specimen 517, newborn, 36 weeks); d — dichotomous (specimen 489, newborn, 39 weeks). 1 — tendon of Todaro, 2 — valve of the inferior vena cava, 3 — right fibrous triangle, 4 — right fibrous ring, right (5) and left (6) atrioventricular orifices, 7 — aortic root, left atrial (8) and the right (9) atrial wall of the inferior pyramidal space (view from this space), 10 — the coronary sinus opening. The white arrows show the tissue of the atrioventricular node (b, c). The white contour arrows show the penetrating part of the His bundle where the latter passes through the right fibrous triangle (d). The asterisk indicates the posterior branch of the tendon of Todaro (b, d); c — tendon of Todaro exhibits the anterior continuation (*) into the adventitia of the right coronary artery (**). Mesoscopic dissection by means stereoscopic microscope; zoom system: ×0,8 (c), ×1 (а, b, d). Illumination with oblique incident light from an incandescent lamp (а), a ring LED illuminator (b, c, d)

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5. Fig. 4. Posteroinferior parts of the atrial medial walls (walls of the inferior pyramidal space). Specimen 282, fetus of 19 weeks. 1 — Todaro tendon branching at the base of the inferior pyramidal space, 2 — connective tissue at the valve of the inferior vena cava, 3 — cardiac coronary sinus. Masson trichrome staining; lens ×4

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6. Fig. 5. Size distribution of the inferior pyramidal space tendon (histograms) and the relationships between them. Д marks the length of the tendon, Ш (н) means the width of the tendon at the point of origin from the right fibrous triangle, Ш (к) is the width of the tendon at the point of ending at the valve of the inferior vena cava

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