A histopathologic study of the conduction system in a case of complete heart block of 42 years' duration

Lev, Maurice; White, Paul D.

doi:10.1016/0002-8703(58)90119-4

Cited by 32 publications

(5 citation statements)

References 42 publications

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“…The histopathological findings would, at first sight, also favour a congenital origin. As Lev et al (1958) indicated, only one case of acquired atrionodal discontinuity has been recorded (Oppenheimer and Oppenheimer, I914). Furthermore, in 352 Gerlis, Anderson, and Becker superficial nodal segment, FO foramen ovale, SS sinus septum, CS coronary sinus, TV tricuspid valve, MV mitral valve, TT tendon of Todaro, S2°septum secundum, Si' septum primum, VS ventricular septum, TO tricuspid orifice, MO mitral orifice, pb penetrating bundle, lbb left bundlebranch, rbb right bundle-branch.…”

Section: Discussionmentioning

confidence: 99%

“…According to the recent review of congenital heart block by Carter, Blieden, and Edwards (I974), 4 cases of this variety of block were of congenital origin. To these cases should be added the case of Lev, Benjamin, and White (1958). However, in the opinion of the latter authors, a similar arrangement could have resulted from acquired disease, as illustrated in the case reported by Oppenheimer and Oppenheimer (I914).…”

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confidence: 83%

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Complete heart block as a consequence of atriondal discontinuity.

Gerlis¹,

Anderson²,

Becker³

1975

Heart

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We have recently studied a case of complete heart block in which there was considerable difficulty in deciding whether it was of congenital or acquired origin. This was because the heart block wasfirst discovered at the age of 2 years in the course of acute diphtheria. Though diphtheritic infections are known to affect the cardiac conduction system, authenticated cases of post-diphtheritic block persisting after the infection are rare, and, furthermore, histopathological study in this case revealed discontinuity between the atrial tissues and the more peripheral parts of the atrioventricular conduction tissues. This has been more commonly observed in congenital cases of complete heart block and it has been postulated on theoretical grounds that this could be the basis for congenital heart block; on the other hand, it has been noted in a single case thought to be of acquired origin. Review of the evidence availablefailed to allow accurate classification of the case into either congenital or acquired categories. The normal, segmental development of the atrioventricular node, each segment being of different embryological origin, is discussed and the case presented is understandable in the light of this.The distinction between congenital and acquired heart block, while of considerable clinical importance (Ayers, Boineau, and Spach, I966), is often difficult to make. This difficulty is illustrated by a recent case we have studied, in which heart block was first observed at the age of 2 (I972). Indeed, such block had been predicted on theoretical grounds by Kung and Mobitz (I930) and Mahaim (I93i). None the less, it is less readily comprehensible on the basis of nodal structure and formation as propounded by James (i96i, I970). In view of these considerations, we are reviewing the possible morphogenesis of this case and other varieties of heart block in terms of presently demonstrated architecture of the normal atrioventricular node. Case reportThe patient was a girl, bom in I932 after an uneventful pregnancy and normal delivery. No hospital records were available, but she was apparently normal until she contracted scarlet fever at the age of 2 years followed by diphtheria at the age of 2j years. She was said to have been very ill, and was found to have heart block at the time. In her recovery period she had temporary paralysis of one arm and the face on the same side. A detailed cardiological investigation was not made at this time. She subsequently made a complete recovery and remained well during the rest of her childhood. There was no restriction of her physical activities. At the age of IS years she complained of episodes of tiredness, vertigo, and breathlessness. She was noted to have a slow pulse and complete heart block was again diagnosed.

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Section: Discussionmentioning

confidence: 99%

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confidence: 83%

Complete heart block as a consequence of atriondal discontinuity.

Gerlis¹,

Anderson²,

Becker³

1975

Heart

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“…[19][20][21] Thus, it seems likely that in the present patient these fat-related lesions led to the supra-Hisian 2nd Wenckebach-type AV block during lower atrial pacing of 130 beats/min or less, which suggests that patients showing such a Wenckebach block point should be considered to have marked fatty infiltration in both the approaches to the AVN and the node itself and an accompanying atrophic AV node, and be at risk for a supra-Hisian AV block. In contrast, only 2 of the remaining 11 cases with normal Wenckebach block points at rapid atrial pacing showed the fat-related lesions described.…”

Section: A B Cmentioning

confidence: 76%

Implications of Marked Fatty Infiltration Around and In the Atrophic Atrioventricular Node in Elderly Patients With Permanent Pacemaker Implantation for Symptomatic Sick Sinus Syndrome

et al. 1999

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“…Congenital absence of the AV node in a position of the bundle of His has also been found [18,19,37], Lesions higher in the conducting sys tem may also exist. L ev et al [20] reported markedly defective atrial musculature with a complete lack of connection between this and the bundle of His, with absence of the AV node. An isolated tumour involv ing the bundle of His has also been recorded [25].…”

Section: Discussionmentioning

confidence: 99%