Cystic duct and Heister's “valves”

Abstract

The anatomy and physiology of the cystic duct have been relatively neglected by anatomists and the function of the spiral mucosal folds or "valves" of Heister, first described in 1732, remains obscure. The gross and microscopic anatomy of the cystic duct is reviewed together with results from laboratory investigations into the function of the cystic duct and its spirally arranged folds. The duct and spiral folds contain muscle fibers responsive to pharmacologic, hormonal, and neural stimuli. There is, however, no convincing evidence of a discrete muscular sphincter within the duct. Although the cystic duct is unlikely to play a major role in gallbladder filling and emptying, it appears to function as more than a passive conduit. Coordinated, graded muscular activity in the cystic duct in response to hormonal and neural stimuli may facilitate gallbladder emptying. The principal function of the internal spiral folds that are found in man and other animals may be to preserve patency of this narrow, tortuous tube rather than to regulate bile flow.

On the mechanical behavior of the human biliary system

“…During gallbladder refilling and emptying in response to hormonal and neural stimuli [45] , the bile flow passes through the cystic duct which connects the gallbladder and common bile duct, see Figure 1. Observations on the cystic duct anatomy have shown that the duct typically presents a combination of two types of structure: (1) in which the duct lumen wall may present the valve of Heister [46,47] ; (2) the duct has a smooth lumen which duodenum; (2) diverting hepatic bile into the gallbladder and (3) preventing reflux of duodenal contents from the duodenum into the biliary tree [61,62] .…”

Low Insertion of the Cystic Duct in the Common Hepatic Duct as a Coincidence with an Onset of a Pancreatic Cephalic Carcinoma

“…Toj vo prosek e dolg od 2-4 cm, so kalibar od 1-5 mm. Negovata {uplina e reducirana so spiralni mukozni nabori opi{a-ni od Haister [1,2]. Anatomijata na vlivot-insercijata na DC vo дuktus хepatikus кomunis (DHK) e prika`ana vo сlika 1.…”

“…[irokorasprostranetiot i prifaten opis na anatomijata na еkstrahepati~noto бilijarno steblo e deka DC se vliva vo DHK vo sredinata na хepatoduodenalniot ligament, vo gornata tretina na DHK [1][2][3], iako postojat pove}e anatomski modeli koi spa|aat vo normalnata anatomija vo odnos na dimenziite i na insercijata na DC vo DHK [3][4][5]. Neprepoznaenite aberantni varijacii na DC, kako i konfuzijata-neprepoznavaweto na DHK mo`at da vodat vo seriozni komplikacii koga pacientot }e bide podlo`en na interventna radiologija ili hirurgija.…”

Seldinger method for intraoperative cholangiography: a practical approach

“…Manipulation of a catheter Into the cystic duct for successful intraoperative cholangiography can be made difficult by the tortuosity of the cystic duct and the spiral valves of Heister 1 . We describe a technique to eliminate these problems and allow successful positioning of the catheter within the cystic duct.…”