Clinical cardiac structural anatomy reconstructed within the cardiac contour using multidetector‐row computed tomography: Atrial septum and ventricular septum

Mori, Shigeo; Fukuzawa, Koji; Takaya, Tomofumi; Takamine, Sachiko; Ito, Tatsuro; Fujiwara, Sei; Nishii, Tatsuya; Kono, Atsushi K.; Yoshida, Akihiro; Hirata, Ken–ichi

doi:10.1002/ca.22546

Cited by 17 publications

(21 citation statements)

References 34 publications

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“…B). This arrangement as seen in the mouse heart close to term is comparable to the situation found in the human heart, as shown by Mori and his colleagues in their study based on multidetector computed tomographic imaging (Mori et al, ). In the mouse heart, however, there are only two pulmonary veins opening to the left atrium, which enter caudally, adjacent to the left atrioventricular junction.…”

Section: Atrial Septationsupporting

confidence: 84%

“…We show that knowledge of normal development not only provides the necessary background for understanding septal defects, but is also for appreciation of relatively subtle features of the definitive postnatal septal structures. These can now be revealed in exquisite detail in the clinical setting by multidetector computed tomography, as described elsewhere in this special issue (Mori et al, ).…”

Section: Introductionmentioning

confidence: 92%

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Insights regarding the normal and abnormal formation of the atrial and ventricular septal structures

2015

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Knowledge of cardiac development can provide the basis for understanding the morphogenesis of congenital cardiac malformations. Only recently, however, has the quality of information regarding cardiac embryology been sufficient to justify this approach. In this review, we show how such knowledge of development of the normal atrial and ventricular septal structures underscores the interpretation of the lesions that provide the basis for interatrial and interventricular shunting of blood. We show that current concepts of atrial septation, which frequently depend on a suggested formation of an extensive secondary septum, are simplistic. There are additional contributions beyond growth of the primary septum, but the new tissue is added to form the ventral buttress of the definitive atrial septum, rather than its cranial margin, as is usually depicted. We show that the ventricular septum possesses muscular and membranous components, with the entirety of the muscular septum produced concomitant with the so-called ballooning of the apical ventricular component. It is expansion of the atrioventricular canal that creates the inlet of the right ventricle, with no separate formation of an "inlet" septum. The proximal parts of the outflow cushions initially form a septal structure between the developing ventricular outlets, but this becomes converted into the free-standing muscular subpulmonary infundibulum as the aortic outlet is transferred to the left ventricle. These features of normal development are then shown to provide the basis for understanding of the channels that provide the means for interatrial and interventricular shunting.

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Section: Atrial Septationsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 92%

Insights regarding the normal and abnormal formation of the atrial and ventricular septal structures

2015

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“…As an adjunct to conventional techniques used to reveal these features,8–13 CT has now been shown to demonstrate in exquisite fashion the three-dimensional living anatomy of the atrial septum. This has shown that not all the lesions producing the potential for interatrial shunting are confined within the limits of the atrial septum 14. As we show in this review, such images now provide a much improved understanding of the relevant anatomy than can any diagrammatic schemes.…”

Section: Introductionmentioning

confidence: 91%

“…On the other side of the transverse sinus is found the non-adjacent aortic sinus of Valsalva (figures 1, 2 and 5). These anatomical alignments explain the potential risk of periprocedural complications,14 such as cardiac tamponade38 or production of fistulous communications with the non-adjacent aortic sinus 39. It is the proximity of the triangle of Koch to the anteroinferior rim of the oval fossa that determines the potential risk of injury to the atrioventricular conduction axis 14 40 41.…”

Section: Interventional Closure Of Oval Fossa Defectsmentioning

confidence: 99%

Demonstration of living anatomy clarifies the morphology of interatrial communications

Mori

Nishii

Tretter

et al. 2018

Heart

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Inferences made regarding the postnatal anatomy of the atrial septum still tend to be based on developmental evidence. Although atrial septation is a well-defined process, it is remarkably complex and remains poorly understood. It is now established, however, that the process involves the conjugation of several myocardial structures and mesenchymal tissues of both intracardiac and extracardiac origin. The resultant postnatal morphology is equally complex, evidenced by the fact that, in the normal heart, only the floor of the oval fossa, along with its anteroinferior muscular buttress, are true anatomical septums. In this regard, septums can be defined as partitions that can be removed without creating communications with the extracavitary space. The true septal components are surrounded by grooves, which themselves largely represent infolding of the atrial walls. These anatomical features can now accurately be revealed using virtual dissection of CT data sets. These images, when carefully reconstructed, demonstrated the anatomy with as much accuracy as when hearts are dissected in the autopsy room. Such virtual dissection, furthermore, shows the components as they are seen within the chest, thus facilitating understanding for those intending to undertake interventional therapeutic procedures. By preparing such images, we show the complexity of the normal atrial septum and its surrounds. We show that it is only defects within the oval fossa, or the much rarer vestibular defects, which can appropriately be illustrated in the context of a normally constructed heart.

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“…Virtual dissection also reveals the limited extent of the true atrial septum (Mori et al, ; Mori et al, ). The larger parts of the rims of the oval fossa are shown to be no more than folds between the right and left atrial walls.…”

Section: Assessing the Anatomy Of The Cardiac Componentsmentioning

confidence: 99%

What is the real cardiac anatomy?

et al. 2019

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The heart is a remarkably complex organ. Teaching its details to medical students and clinical trainees can be very difficult. Despite the complexity, accurate recognition of these details is a pre‐requisite for the subsequent understanding of clinical cardiologists and cardiac surgeons. A recent publication promoted the benefits of virtual reconstructions in facilitating the initial understanding achieved by medical students. If such teaching is to achieve its greatest value, the datasets used to provide the virtual images should themselves be anatomically accurate. They should also take note of a basic rule of human anatomy, namely that components of all organs should be described as they are normally situated within the body. It is almost universal at present for textbooks of anatomy to illustrate the heart as if removed from the body and positioned on its apex, the so‐called Valentine situation. In the years prior to the emergence of interventional techniques to treat cardiac diseases, this approach was of limited significance. Nowadays, therapeutic interventions are commonplace worldwide. Advances in three‐dimensional imaging technology, furthermore, now mean that the separate components of the heart can readily be segmented, and then shown in attitudinally appropriate fashion. In this review, we demonstrate how such virtual dissection of computed tomographic datasets in attitudinally appropriate fashion reveals the true details of cardiac anatomy. The virtual approach to teaching the arrangement of the cardiac components has much to commend it. If it is to be used, nonetheless, the anatomical details on which the reconstructions are based must be accurate. Clin. Anat. 32:288–309, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

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Clinical cardiac structural anatomy reconstructed within the cardiac contour using multidetector‐row computed tomography: Atrial septum and ventricular septum

Cited by 17 publications

References 34 publications

Insights regarding the normal and abnormal formation of the atrial and ventricular septal structures

Insights regarding the normal and abnormal formation of the atrial and ventricular septal structures

Demonstration of living anatomy clarifies the morphology of interatrial communications

What is the real cardiac anatomy?

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