Demonstration of living anatomy clarifies the morphology of interatrial communications

Abstract

Inferences made regarding the postnatal anatomy of the atrial septum still tend to be based on developmental evidence. Although atrial septation is a well-defined process, it is remarkably complex and remains poorly understood. It is now established, however, that the process involves the conjugation of several myocardial structures and mesenchymal tissues of both intracardiac and extracardiac origin. The resultant postnatal morphology is equally complex, evidenced by the fact that, in the normal heart, only the floor of the oval fossa, along with its anteroinferior muscular buttress, are true anatomical septums. In this regard, septums can be defined as partitions that can be removed without creating communications with the extracavitary space. The true septal components are surrounded by grooves, which themselves largely represent infolding of the atrial walls. These anatomical features can now accurately be revealed using virtual dissection of CT data sets. These images, when carefully reconstructed, demonstrated the anatomy with as much accuracy as when hearts are dissected in the autopsy room. Such virtual dissection, furthermore, shows the components as they are seen within the chest, thus facilitating understanding for those intending to undertake interventional therapeutic procedures. By preparing such images, we show the complexity of the normal atrial septum and its surrounds. We show that it is only defects within the oval fossa, or the much rarer vestibular defects, which can appropriately be illustrated in the context of a normally constructed heart.

Pacemaker and conduction disturbances in patients with atrial septal defect

“…1 The defect can be located at different locations in the interatrial septum or as an interatrial communication, with secundum defects being the most frequent. 2 Most children with an isolated atrial septal defect are asymptomatic; however, signs of the adverse effects of an atrial septal defect increase with advancing age. Indeed, patients with an atrial septal defect have increased risk of developing heart failure, a higher risk of stroke, atrial fibrillation, 3,4 pneumonia, 5 and a reduced life expectancy regardless of closure in childhood or adulthood.…”

Un caso de CIA compleja: ¿dónde están los bordes del septum interauricular?

“…El más frecuente es el defecto a nivel del septo interauricular, es decir la CIA tipo foramen oval o también llamada ostium secundum. Las otras CIA son los defectos tipo seno venoso (superior e inferior), los defectos tipo seno coronario y los defectos tipo ostium primum, que tienen una unión auriculoventricular común como los demás defectos del septo atrioventricular (5,6,7) . En el paciente de este caso, el defecto es tan grande que podría considerarse que se ha extendido al seno venoso inferior (8) .…”

Unsolvable Relationship Between Anatomy and Human Cadaver: A Burden or a Boon in Disguise to Teach Compentencies in Medical Curriculum

“…As this concept developed, several medical universities have replaced traditional anatomy labs with computer labs and some broke down again. This discussion highlights the important changes in the medical education and the teaching anatomy (13) .…”