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. 1983 Jun;38(6):408–420. doi: 10.1136/thx.38.6.408

The surgical anatomy of the conduction tissues.

R H Anderson, S Y Ho, A E Becker
PMCID: PMC459576  PMID: 6348996

Abstract

On the basis of our collective experience we have reviewed the disposition of the cardiac conduction tissues as they might be observed by the surgeon in both normal and abnormal hearts. The sinus node lies subepicardially in the terminal sulcus; because of its variable blood supply the entire superior cavoatrial junction is a potential danger area. There are no morphologically discrete tracts extending through the atrial tissues between sinus and atrioventricular nodes. The atrioventricular node, the atrial extent of the atrioventricular conduction axis, is contained exclusively within the triangle of Koch. The axis penetrates through the central fibrous body and branches on the muscular ventricular septum immediately beneath the interventricular component of the membranous septum. The landmarks to these structures are described as they might be seen through the right atrium, left atrium, and aorta. Consideration is then given to the surgical anatomy of the abnormal muscular atrioventricular connections that underscore the ventricular pre-excitation syndromes. Finally, rules are developed whereby the disposition of the conduction tissues can be predicted with accuracy in congenitally malformed hearts, in the settings of both normal and abnormal chamber connections. The most important variables in this respect are alignment between the atrial and ventricular septal structures and the pattern of ventricular architecture present.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson K. R., Ho S. Y., Anderson R. H. Location and vascular supply of sinus node in human heart. Br Heart J. 1979 Jan;41(1):28–32. doi: 10.1136/hrt.41.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Anderson R. H., Arnold R., Thapar M. K., Jones R. S., Hamilton D. I. Cardiac specialized tissue in hearts with an apparently single ventricular chamber (double inlet left ventricle). Am J Cardiol. 1974 Jan;33(1):95–106. doi: 10.1016/0002-9149(74)90744-9. [DOI] [PubMed] [Google Scholar]
  3. Anderson R. H., Becker A. E., Arnold R., Wilkinson J. L. The conducting tissues in congenitally corrected transposition. Circulation. 1974 Nov;50(5):911–923. doi: 10.1161/01.cir.50.5.911. [DOI] [PubMed] [Google Scholar]
  4. Anderson R. H., Becker A. E., Tranum-Jensen J., Janse M. J. Anatomico-electrophysiological correlations in the conduction system--a review. Br Heart J. 1981 Jan;45(1):67–82. doi: 10.1136/hrt.45.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dickinson D. F., Wilkinson J. L., Anderson K. R., Smith A., Ho S. Y., Anderson R. H. The cardiac conduction system in situs ambiguus. Circulation. 1979 May;59(5):879–885. doi: 10.1161/01.cir.59.5.879. [DOI] [PubMed] [Google Scholar]
  6. Essed C. E., Ho S. Y., Hunter S., Anderson R. H. Atrioventricular conduction system in univentricular heart of right ventricular type with right-sided rudimentary chamber. Thorax. 1980 Feb;35(2):123–127. doi: 10.1136/thx.35.2.123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Essed C. E., Ho S. Y., Shinebourne E. A., Joseph M. C., Anderson R. H. Further observations on conduction tissues in univentricular hearts--surgical implications. Eur Heart J. 1981 Feb;2(1):87–96. doi: 10.1093/oxfordjournals.eurheartj.a061168. [DOI] [PubMed] [Google Scholar]
  8. Gillette P. C., Kugler J. D., Garson A., Jr, Gutgesell H. P., Duff D. F., McNamara D. G. Mechanisms of cardiac arrhythmias after the Mustard operation for transposition of the great arteries. Am J Cardiol. 1980 Jun;45(6):1225–1230. doi: 10.1016/0002-9149(80)90482-8. [DOI] [PubMed] [Google Scholar]
  9. Harrison L., Gallagher J. J., Kasell J., Anderson R. H., Mikat E., Hackel D. B., Wallace A. G. Cryosurgical ablation of the A-V node-His bundle: a new method for producing A-V block. Circulation. 1977 Mar;55(3):463–470. doi: 10.1161/01.cir.55.3.463. [DOI] [PubMed] [Google Scholar]
  10. Ho S. Y., Monro J. L., Anderson R. H. Disposition of the sinus node in left-sided juxtaposition of the atrial appendages. Br Heart J. 1979 Feb;41(2):129–132. doi: 10.1136/hrt.41.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hudson R. E. Surgical pathology of the conducting system of the heart. Br Heart J. 1967 Sep;29(5):646–670. doi: 10.1136/hrt.29.5.646. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. JAMES T. N. THE CONNECTING PATHWAYS BETWEEN THE SINUS NODE AND A-V NODE AND BETWEEN THE RIGHT AND THE LEFT ATRIUM IN THE HUMAN HEART. Am Heart J. 1963 Oct;66:498–508. doi: 10.1016/0002-8703(63)90382-x. [DOI] [PubMed] [Google Scholar]
  13. James T. N. The sinus node. Am J Cardiol. 1977 Dec;40(6):965–986. doi: 10.1016/0002-9149(77)90048-0. [DOI] [PubMed] [Google Scholar]
  14. Latham R. A., Anderson R. H. Anatomical variations in atrioventricular conduction system with reference to ventricular septal defects. Br Heart J. 1972 Feb;34(2):185–190. doi: 10.1136/hrt.34.2.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Massing G. K., James T. N. Anatomical configuration of the His bundle and bundle branches in the human heart. Circulation. 1976 Apr;53(4):609–621. doi: 10.1161/01.cir.53.4.609. [DOI] [PubMed] [Google Scholar]
  16. Milo S., Ho S. Y., Macartney F. J., Wilkinson J. L., Becker A. E., Wenink A. C., Gittenberger de Groot A. C., Anderson R. H. Straddling and overriding atrioventricular valves: morphology and classification. Am J Cardiol. 1979 Nov;44(6):1122–1134. doi: 10.1016/0002-9149(79)90178-4. [DOI] [PubMed] [Google Scholar]
  17. Milo S., Ho S. Y., Wilkinson J. L., Anderson R. H. Surgical anatomy and atrioventricular conduction tissues of hearts with isolated ventricular septal defects. J Thorac Cardiovasc Surg. 1980 Feb;79(2):244–255. [PubMed] [Google Scholar]
  18. Sealy W. C., Gallagher J. J. The surgical approach to the septal area of the heart based on experiences with 45 patients with Kent bundles. J Thorac Cardiovasc Surg. 1980 Apr;79(4):542–551. [PubMed] [Google Scholar]
  19. Sealy W. C., Gallagher J. J., Wallace A. G. The surgical treatment of Wolff-Parkinson-White Syndrome: evolution of improved methods for identification and interruption of the Kent Bundle. Ann Thorac Surg. 1976 Nov;22(5):443–457. doi: 10.1016/s0003-4975(10)64453-0. [DOI] [PubMed] [Google Scholar]
  20. Soto B., Becker A. E., Moulaert A. J., Lie J. T., Anderson R. H. Classification of ventricular septal defects. Br Heart J. 1980 Mar;43(3):332–343. doi: 10.1136/hrt.43.3.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Spach M. S., King T. D., Barr R. C., Boaz D. E., Morrow M. N., Herman-Giddens S. Electrical potential distribution surrounding the atria during depolarization and repolarization in the dog. Circ Res. 1969 Jun;24(6):857–873. doi: 10.1161/01.res.24.6.857. [DOI] [PubMed] [Google Scholar]
  22. Spach M. S., Lieberman M., Scott J. G., Barr R. C., Johnson E. A., Kootsey J. M. Excitation sequences of the atrial septum and the AV node in isolated hearts of the dog and rabbit. Circ Res. 1971 Aug;29(2):156–172. doi: 10.1161/01.res.29.2.156. [DOI] [PubMed] [Google Scholar]
  23. TITUS J. L., DAUGHERTY G. W., EDWARDS J. E. Anatomy of the atrioventricular conduction system in ventricular septal defect. Circulation. 1963 Jul;28:72–81. doi: 10.1161/01.cir.28.1.72. [DOI] [PubMed] [Google Scholar]
  24. Thiene G., Nava A., Rossi L. The conduction system in corrected transposition with situs inversus. Eur J Cardiol. 1977 Sep-Oct;6(1):57–70. [PubMed] [Google Scholar]
  25. Ullal R. R., Anderson R. H., Lincoln C. Mustard's operation modified to avoid dysrhythmias and pulmonary and systemic venous obstruction. J Thorac Cardiovasc Surg. 1979 Sep;78(3):431–439. [PubMed] [Google Scholar]
  26. Wenink A. C. Congenitally complete heart block with an interrupted Mönckeberg sling. Eur J Cardiol. 1979 Feb;9(2):89–99. [PubMed] [Google Scholar]
  27. Wenink A. C. The conducting tissues in primitive ventricle with outlet chamber. Two different possibilities. J Thorac Cardiovasc Surg. 1978 May;75(5):747–753. [PubMed] [Google Scholar]
  28. Wilkinson J. L., Anderson R. H., Arnold R., Hamilton D. I., Smith A. The conducting tissues in primitive ventricular hearts without an outlet chamber. Circulation. 1976 Jun;53(6):930–938. doi: 10.1161/01.cir.53.6.930. [DOI] [PubMed] [Google Scholar]
  29. Wilkinson J. L., Smith A., Lincoln C., Anderson R. H. Conducting tissues in congenitally corrected transposition with situs inversus. Br Heart J. 1978 Jan;40(1):41–48. doi: 10.1136/hrt.40.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wittig J. H., Stark J. Intraoperative mapping of atrial activation before, during, and after the Mustard operation. J Thorac Cardiovasc Surg. 1977 Jan;73(1):1–13. [PubMed] [Google Scholar]

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