Biomedical subjects

M Grzybiak

Publications and source records attributed to M Grzybiak.

At least 19 recordsLinked to original sources

PubMed2001

Development of the atrioventricular junctional area in the human heart.

The structure of the heart has been the subject of many observations since the beginnings of medical research. The first information regarding the existence of the conduction system of the heart was described by Purkinje and regarding the a-v node by Tawara. From the history regarding this structure it seems that this special system, so relevant to today's invasive cardiologist, is not understood in full. With regards to the interventional electrophysiology on the basis of histological study we decided to evaluate in detail the morphology and the topography of the various portions of the a-v junction. In order to confirm this hypothesis we made observations on the autopsy material of 100 normal human hearts, both sexes from 16 weeks of foetal life to 105 years of age, in which no pathological changes or inborn faults were found. Sections were done containing the heart's septum, stained using Masson's method with Goldner's modification. This research proves that the atrioventricular junction is a stable structure occurring in all hearts, undergoing involutionary changes with age, in which two main parts can be differentiated: the node and the bundle. The morphology of the node is very complex, because it is composed of three zones: the prenodal, the perinodal and the main, differing in cell structure and position. The topography of the node is generally stable, as it lies in the interatrial septum and always above the septal leaflet of the tricuspid valve. The structure of the bundle, in contrast to the node, is more stable and consists of the following parts: the penetrating, the non-branching and the branching. Its topography is also stable, as it lies in the membranous septum, mainly below the septal cusp of the tricuspid valve.

Adolescent↗

PubMed2001

Myocardial bridges in the human heart: morphological aspects.

The structures made of myocardium running most often above the coronary arteries are called the muscle bridges. However there is a large number of descriptions of that phenomenon, the data are not homogenous. Some papers affirm the occurrence of the clinical implications of their existence. The studied material contained 100 adult human hearts, both sexes, 21 to 76 years of age, preserved in formalin-ethanol solution. Standard anatomical methods were used in analysis with the help of a binocular magnifying glass. The presence of the bridges was confirmed in 41% of the researched material, most frequently above the anterior interventricular branch. The length of the bridges varies in the range of 2.3-42.8 mm, thickness 1.0-3.8 mm, angle between long axis of muscle fibres and long axis of the crossed vessel from 5 degrees to 90 degrees.

Adult↗

PubMed2001

The middle cardiac vein as a key for "posteroseptal" space--a morphological point of view.

About 25% of accessory pathways (AP) run via "posteroseptal" space (PSS). There are three approaches for ablation of these pathways: from the right atrium, from the left atrium or from the ventricle and coronary sinus (CS). However in some cases AP is too far from all of them. Catheterisation of the middle cardiac vein (MCV) seems to be the only chance for successful ablation. Our aim was to evaluate the topography of the MCV in PSS. Classical anatomical investigation was carried out on the autopsy material of 98 consecutive human hearts (42 F, 56 M; age 57 +/- 21 yrs). It was supported by transverse section performed under coronary sinus. Regions just behind the atrioventricular septum and behind the cavities were respectively classified as "septal", right (RP) and left posterior (LP). Between them right (RPS) and left posteroseptal areas (LPS) were present. At the posterior view of the heart the angle between CS and MCV ranged from 75 to 90 degrees in 62% of hearts, 60-75 degrees in 18%, 30-60 degrees in 10% and 90-130 degrees in 10%. In 16% MCV ran via the "septal" region, 59%--LPS, 10%--RPS, 10%--RP and 5%--LP. At the ostium of 58% MCV a valve was observed, however there was no trouble with insertion of the 6F catheter into it. We concluded that it is possible to insert the 6F catheter into MCV, which makes it possible to perform ablation of epicardial postero-inferior accessory pathways. The origin of MCV is usually located in the left "posteroseptal" region and runs towards the left side of the posterior wall.

Adult↗

PubMed2001

Anterior region of the atrioventricular perinodal area in relation to radiofrequency ablation procedures.

Atrioventricular nodal reentry tachycardia base on reentry circulation in nodal-perinodal area. The radical treatment of choice is radiofrequency ablation. Procedure approached from the anterior-superior (fast) region sufficient a few seconds of energy delivery for success, however this can result in A-V block. The possibility that arrhythmias substrate may lie very superficially (success of ablation) and damage the normal structures (complication) in the perinodal region must be considered. In order to confirm this hypothesis we examined the autopsy material of 100 normal hearts, both sexes from 18 to 105 years of age (control) and 50 hearts with A-V total block 45-95 years of age (block). We paid attention to the morphology of the nodal artery (NA), atrial inputs (AI) and transitional inputs (TI). It was observed that NA at the level of the central fibrous body was positioned in 94% in the central and in 6% in the inferior part of Koch's triangle. It was removed from the endocardium 3-6 mm in control and 2-5 mm in block group respectively (NS). In the perinodal area we distinguished AI that directly joined the A-V compact node: superficial (right part of the interatrial septum) or deep (left part). The former occurred in 100% of controls and in 80% of block groups (NS), and the latter in 80% of control group and in 34% in block respectively (p < 0.05). The real substrate of arrhythmia in anterior-superior region lies very superficially and far from the conduction tissue; NA in examined hearts was lying deep beneath the endocardium; ablation close to the node could result in A-V block.

Adolescent↗

PubMed2000

The morphological conditions of the permanent pacemaker lead extraction.

Pacemaker lead extraction is the treatment of choice in infectious complications regarding implantation procedure. The purpose of this study was to estimate the safety of the extraction in relation to the morphological changes of the pacing electrode. Research was carried out on materials consisting of 60 human hearts from 45 to 95 years of age (average 63 +/- 15 yrs), with VVI or DDD pacing (pacing duration 84 +/- 26 months) fixed in a formalin solution. Classical macroscopic anatomical methods were applied. In 44 hearts (73.3%) from the investigated group the posterior tricuspid leaflet was thickened only, and in 24 of these hearts the process regarded not only posterior leaflet but also the septal one and especially commissure between them. In 52 hearts (86.6%) inflammatory reaction spread also to the neighbouring part of the electrode. The length of the neointima-inflammatory tissue ranged from 4 to 8 mm (average 5 +/- 2 mm). On the tip of the electrode in the right ventricle cavity in 56 hearts (93.3%) we observed that endocardial leads were surrounded by fibrous thickening, and partially covered by endocardial tissue. We concluded that from the anatomical point of view the extraction of the pacing electrode seems to be questionable, especially in long-term permanent pacing. The experimental traction shows that only recently implanted electrodes were removed without any complications and in others with fraction of the tip, myocardial tissue avulsion or such removal was not successful at all.

Aged↗

PubMed2000

About variability of Vieussen valve in the adult human heart.

The Vieussen valve is situated at the ostium of the great cardiac vein to the coronary sinus. There are no details about its shape in anatomic literature. The tested material consisted of 150 adult human hearts of both sexes from 18 to 85 years of age, fixed in a formalin/ethanol solution. Classical macroscopic anatomical methods were used. The Vieussen valve was found in about 65% of the tested material. It showed a large variability in terms of morphology.

Adult↗

PubMed2000

Histologic evaluation of the atrioventricular nodal artery in healthy humans and in patients with conduction disturbances.

The anatomy of the conduction system of the heart so relevant in the contemporary invasive cardiology is not fully understood. It has turned out that ablation procedures bring new information as to its structure and function, but in some cases can result in complete a-v block. Atrioventricular nodal artery located within the nodal-perinodal tissue can probably be damaged during the ablation procedures. Therefore, we decided to explore in detail the morphology and the topography of the atrioventricular nodal artery in healthy humans and in patients with clinical traits of a-v conduction disturbances requiring permanent pacing. The microscopic study was carried out on 30 normal human hearts specimens (17 F, 3 M) from 17 to 86 years of age, and on 20 hearts with conduction disturbances (11 F, 9 M) from 39 to 85 years of age. We found that the number of the atrioventricular node arteries is different and independent of the extent that induces block causing conduction disturbances. The topography of the artery in perinodal zone was consistent in normal hearts, yet in hearts with conduction disturbances we observed about 2% of deviations in its location. It might be the reason for generation of iatrogenic complications after invasive cardiological procedures. The morphology revealed changes in 50% of the examined hearts and their vessel walls, which was declared to be connected with ageing. This correlated with certain stages of atherosclerosis as well as hypertension characteristic of elderly patients. We observed that in 33% of hearts from control group small parietal thrombi were detected and in 60% of paced group respectively. Hence, it seems that the procedures in perinodal zone should be performed in its proximal part because of a minor probability of direct and indirect (through nodal artery) damage of the atrioventricular structure of the junction.

Adolescent↗

PubMed2000

Morphology of the tendon of Todaro within the human heart in ontogenesis.

The tendon of Todaro, found in the right atrium of the heart, has considerable clinical importance in the fields of both cardiac surgery and invasive cardiology. The goal of this study was to examine the occurrence and degree of development of the tendon of Todaro in humans. Research was conducted on material consisting of 160 human hearts of both sexes from the age of 14 Hbd to 87 years of age. Classical anatomical methods were used and histological sections were prepared from 100 hearts of various age groups stained with Masson's method in Goldner's modification. The tendon of Todaro occurred in all examined hearts. In foetal hearts, in the area typical of the course of the tendon of Todaro, a very well-developed, white structure was observed, convexed into the lumen of the atrium. Histologically, this was young fibrous tissue with a characteristically large number of fibroblasts. Evenly in infants and newborns, a visible convex structure was also observed extending into the lumen of the right atrium, however, to a lesser degree than in foetuses. In the group of hearts of young adults, it was also possible to follow the course of the tendon of Todaro macroscopically. However, the older the heart was, the less the convex was visible, and in older adults it was completely invisible. In histological sections, it was observed that with ageing the number of connective tissue cells decreased, and fibres forming the lining increased. In the hearts of older adults the tendon of Todaro formed very small ribbons of connective tissue. Histologically, only small numbers of cellular elements were noticed. In the adult heart the examined tendon was located the deepest and did not connect to the endocardium. We can conclude that the tendon of Todaro is a stable structure, occurring in all examined hearts even when it is not macroscopically visible. Due to the morphological changes that affect the tendon of Todaro in human ontogenesis, for the cardiac surgeon, its relevance as an important topographical structure in the hearts of older adults is minimal.

Adolescent↗

PubMed2000

Variability of valve configuration in the lumen of the coronary sinus in the adult human hearts.

Described by many authors, valves refer to the coronary sinus. The best known among them are Thebesius and Vieussen valves. Information about valves in the lumen of the coronary sinus, though, is rarely found in anatomic literature. Frequency of occurrence of valves in the lumen of the coronary sinus and the degree of their formation was chartered in this paper. 150 adult human hearts of both sexes from 18 to 85 years of age were tested, fixed in a formalin/ethanol solution. Classical macroscopic anatomical methods were used. The valves in the sinus lumen were observed in 10% of the tested hearts, usually presented as incomplete single ones (7.3%).

Adolescent↗

PubMed2000

Right-sided aortic arch.

Congenital abnormalities of the aortic arch arise due to a defect in the unilateral disappearance of arteries of the IVth and exceptionally of the IIIrd primary branchial arches and also of the appropriate sections of paired dorsal aortas. Apart from the cases of complete "situs inversus" and a double aortic arch, the following anatomical possibilities can be distinguished: A--a left-sided aortic arch with a properly established system of branches, B--a left-sided aortic arch with an aberrant right subclavian artery, C--a left-sided aortic arch with a retro-esophageal course and right-sided descending aorta or retro-esophageal course of the brachiocephalic trunk onto the right side, D--a right-sided aortic arch of the "symmetric" type usually coexisting with cyanotic congenital heart lesions, E--a right-sided aortic arch with a retro-esophageal bulge and an aberrant left subclavian artery, and F--a right-sided aortic arch with an aorta descending left-sidedly or brachiocephalic trunk going left-sidedly behind the esophagus. At the Department of Anatomy from 1945 to 1998, 1700 adult cadavers were examined. Throughout this time, one case of each of the types E and C and two cases of the type B were noted in the material. Regardless of the rare occurrence among adults (about 0.01%), the abnormal course of the aortic arch can be the reason for atypical clinical symptoms such as esophageal compression and dysphagia or insufficient cerebral blood supply.

Adult↗

PubMed2000

The valve of the coronary sinus (Thebasian) in adult human hearts.

The observational results of the morphology of the coronary sinus valve are presented in this study. Research was conducted on material consisting of 100 adult human hearts of both sexes from 18 to 87 years of age. Basic morphological types of the examined structure are distiguished and the main traits regarding their histological nature are presented.

Adolescent↗

PubMed1999

Variations in ovarian arteries in fetuses and adults.

The present studies were carried out on 80 female fetuses and adults, aged 20 to 28 weeks and 18 to 90 years, respectively. Attention was paid to the place of origin of ovarian arteries from the aorta or renal artery, the location of these vessels in relation to the trunk of inferior vena cava, and to their courses relative to the renal veins. Four most frequently encountered types of ovarian artery courses were identified, and subsequently the discovered variations of basic types were described.

Adolescent↗

PubMed1998

Histological examination of the topography of the atrioventricular nodal artery within the triangle of Koch.

UNLABELLED: The treatment of choice in patients with drug-resistant atrioventricular nodal reentry tachycardia is radiofrequency fast or slow pathway ablation. Ablation of the reentrant circuit in the region of the His bundle, when approached from the anterior-superior region (fast pathway); can result in complete AV block. This is less likely if the posterior-inferior (in the region of coronary sinus ostium) approach is used (slow pathway ablation). The possibility that radiofrequency energy may damage the vascular supply to the AV node must be considered. In order to confirm this hypothesis observation was conducted on the autopsy material of 50 human hearts (20 F, 30 M) from 18 to 81 years of age. Specimens were taken containing the triangle of Koch (the apex- right fibrous trigone, the base- coronary sinus ostium). These histological blocks were sectioned in the frontal plane and stained using Masson's method. Koch's triangle was divided in the sagittal plane into 3 parts: inferior (between the base and the attachment of the tricuspid valve), central (between the base and the apex of the right fibrous trigone) and superior (between this trigone and the tendon of Todaro). It was observed that the AVN artery at the coronary sinus ostium level (the base of the triangle of Koch) was positioned in 68% in the central and in 32% in the inferior part of Koch's triangle. The AVN artery in the central part was removed from the endocardium 1 mm (18%), 2 mm (42%), 3 mm (22%), 4 mm (18%). In the inferior part 1 mm (26%), 2 mm (37%), 3 mm (37%). No statistically significant relationship was observed between those groups. CONCLUSIONS: 1) in 20% of examined hearts the AVN artery lay just beneath the endocardium near the coronary sinus ostium 2) there is a risk of the AVN artery coagulation during radiofrequency ablation in the slow pathway region.

Adult↗

PubMed1998

Main tributaries of the coronary sinus in the adult human heart.

The coronary sinus collects blood from the heart walls. It is a structure which presently plays a very important clinical role in invasive cardology. In this study, the occurrence of the main tributaries of the coronary sinus was examined as wall as the topography of their outlet portions. Material consistied of 150 adult human hearts of both sexes from aged 18 to 85 years. In the examined material, the graet and middle cardiac veins as well as the posterior vein of the left ventricle were always obserwed. The remaining tributaries of the coronary sinus were less stable. The outlet portions of the main veins of the heart were characterized by significant variability.

Adolescent↗

PubMed1997

A microscopic view of false tendons in the left ventricle of the human heart.

Research was conducted on material consisting of 45 fetal, newborn, infant and adult human hearts. False tendons in fetal, newborn and infant hearts were made up of mainly heart muscle tissue. False tendons of the tendon attachment to the interventricular septum. These false composed of muscle tissue and connective tissue in various proportions. Most of the connective tissue was observed in this age group in the area of the tendin attachment to the interventricular septum. These false tendons turned out to be very richly vascularized. In some of them, elements of the conductive system was confirmed, being an extension of the left branch of the bundle of His. This may confirm the role of false tendons in heart arrhythmias.

Adolescent↗

PubMed1997

Selected cases of atypical course of renal and gonadal arteries and veins.

In studies conducted on material comprising 209 individuals of both sexes at the age of 20 weeks to 90 years, five cases were found with atypical course of renal and gonadal vessels along with developmental anomalies of the kidneys and ureters. In three individuals with these anomalies of vessels and ureters some accompanying complicated organic heart diseases were also detected.

Adolescent↗

PubMed1997

Variations in testicular arteries in fetuses and adults.

An investigation was carried out of 100 human male individuals at the age of 20 hbd to 28 hbd and of 18 to 90 years. Attention was paid to the fact whether these blood vessels commenced in the aorta or renal artery, to the relation of testicular arteries to the trunk of vena cava inverior, and to their course vis a vis that of the renal veins. Four most common variations in the course of these vessels were identified, and variations in their basic types seen in our material were described.

Adolescent↗

PubMed1996

False tendons in the left ventricle of the heart in humans during pre- and postnatal periods.

Research was conducted on material consisting of 180 fetal, newborn, infant, and adult hearts of various ages. Upon opening of the left ventricle the frequency of occurrence as well as the morphology of the false tendons were examined in this heart chamber. Special attention was paid to false tendons running through the ventricular lumen. It was determined that these elements occur with similar frequency, accounting for about 40% of hearts, in all examined age groups. In fetal hearts, the greatest number of false tendons in the ventricular lumen ran between the interventricular septum and the exterior ventricular wall, finding its attachment generally just below the base of the papillary muscle. In newborn, infant and adult hearts the greatest number of false tendons connected the interventricular septum with the posterior papillary muscle.

Adolescent↗