在心脏静脉的心肌袖中,存在呈浦肯野型形态及显著的连接蛋白45免疫反应的心肌细胞

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Presence of cardiomyocytes exhibiting Purkinje-type morphology and prominent connexin45 immunoreactivity in the myocardial sleeves of cardiac veins.

背景

肺静脉(PV)心肌是心房颤动的一个已知来源,一个有争议的问题是,向腔静脉和冠状窦(Cs)延伸的心肌是否具有相似的特性。目前还没有研究发现心脏外心脏的特定起搏器和/或传导特性。本研究的目的是观察心脏静脉壁心肌袖的组织学和免疫组织化学特征。

方  法

本文对32例心脏标本进行了研究,取肺静脉 (PVs),、上腔静脉(Svc)、冠状窦(CS)、窦房结、房室结及左心室标本,用BEST's红霉素进行细胞内糖原的选择性染色,用抗连接蛋白45(Cx 45)和Cx 43特异性抗体检测心外心肌的传导特性。

结  果

16例心脏pvs壁可见心肌袖,22例svc中有21例,8例有8例心肌细胞呈糖原阳性,静脉袖内可见糖原阳性心肌细胞束,胞浆苍白,周围肌原纤维较多。心外心肌可见强Cx 45和Cx 43弱标记,起搏器和传导系统有类似的染色模式,而心室心肌表现出明显的Cx 43和无Cx 45免疫反应。

结  论

肺静脉 (PVs)、上腔静脉(Svc)、冠状窦(CS) 心肌纤维形态与Purkinje纤维相似,且富含糖原。我们首次提供了心脏外心肌Cx 45显著阳性染色的数据,显示了其潜在的起搏器和/或传导性质。

原始文献摘要

BACKGROUND:

Pulmonary vein (PV) myocardium is a known source of atrial fibrillation. A debated question is whether myocardial extensions into caval veins and coronary sinus (CS) have similar properties. No studies have documented specific pacemaker and/or conducting properties of human extracardiac myocardium.

OBJECTIVE:

The purpose of this study was to characterize the histology and immunohistochemical features of myocardial sleeves in the wall of cardiac veins.

METHODS:

Sections of 32 human hearts were investigated. Specimens of PVs, superior caval vein (SVC), CS, sinoatrial and atrioventricular nodes, and left ventricle were stained with Best's Carmine for selective staining of intracellular glycogen. Anti-connexin45 (Cx45)- and Cx43-specific antibodies were used to determine the conduction properties of extracardiac myocardium.

RESULTS:

Myocardial sleeve was found in the wall of PVs of 15 of 16 hearts, 21 of 22 SVCs, and 8 of 8 CSs. Bundles of glycogen-positive cardiomyocytes exhibiting pale cytoplasm and peripheral myofibrils were observed in the venous sleeves. Strong Cx45 and weak Cx43 labeling was detected in the extracardiac myocardium. Similar staining pattern was observed for the pacemaker and conduction system, whereas ventricular myocardium exhibited prominent Cx43 and no Cx45 immunoreactivity.

CONCLUSION:

Myocardial fibers of PVs, SVC, and CS exhibit morphology similar to that of Purkinje fibers and are enriched in glycogen. We provide data for the first time on prominent positive staining for Cx45 in the extracardiac myocardium, indicating its potential pacemaker and/or conducting nature.

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