How Lymph Is Drained away from the Human Papillary Muscle: Anatomical Conditions

Abstract

The lymphatic and venous bed was evaluated in 42 human heart papillary muscles. The lymphatics form networks in the superficial and deep layers of the subendocardium and in the myocardium of the papillary muscles. In the apical area, the subendocardial lymphatics gradually merge with the fine myocardial, developing arcades at the origins of chordae tendineae. Thicker myocardial lymphatics leave the area passing along the connective tissue septa, often in close vicinity to the blood vessels. The injection method failed to reveal deep lymphatics in the connective tissue of chordae tendineae. Lymphovenous anastomoses were disclosed in the papillary muscle. The possible morphological pathways for lymphatic drainage of the papillary muscle are as follows: (1) the lymphatic bed subendocardial and myocardial, joining on the ventricular wall bed at the muscle base, and (2) lymphovenous anastomoses, passing along from the myocardial and subendocardial lymphatic bed into the ventricular wall veins and the sinus coronarius system, or into the thebesian veins and further directly into the heart ventricles.

Pathology of myxomatous mitral valve disease in the dog

“…95 In human papillary muscles lymphatic networks are present in superficial and deep layers of the subendocardium and in the myocardium. 96 Lymphatic capillaries at the base of the chordae tendineae appear flattened in cross section, and from the sides project thorn-like branchlets comprised of a single endothelial cell with apposing marginal zones. Straight lymphatic capillaries terminate blindly at their end, appearing as a single endothelial cell whose ultrastructure resembles the spiny branchlets.…”

Lymphatic vasculature is increased in heart valves, ischaemic and inflamed hearts and in cholesterol-rich and calcified atherosclerotic lesions

“…Expression of VEGF receptors (VEGFRs) [1,2,3] and angiopoietin receptors Tie1 and Tie2 was studied in foetal heart by Partanen et al Epicardial lymphatics were found to express VEGFR-2, VEGFR-3, Tie1 and Tie2 [6]. Angiogenesis was observed in nonrheumatic aortic valve stenosis [7], but lymphangiogenesis has not been studied in human diseased valves.…”

“…Expression of VEGF receptors (VEGFRs) [1,2,3] and angiopoietin receptors Tie1 and Tie2 was studied in foetal heart by Partanen et al. Epicardial lymphatics were found to express VEGFR‐2, VEGFR‐3, Tie1 and Tie2 [6].…”

“…Until the generation of specific antibodies for lymphatic vessels, knowledge on mammalian cardiac and coronary lymphatics was extrapolated from animal studies conducted with ink and carbon injection techniques. However, injection techniques do not allow analysis of deeper myocardium and endocardium [3]. Human myocardial allografts and myocardial infarction during remodelling have been studied using specific antibodies [4,5].…”

Lymph vessels: the forgotten second circulation in health and disease

“…Morphologically, it is difficult to distinguish lymphatic channels from venules or capillaries. In the era before development of lymph endothelial-specific antibodies, a variety of techniques was used to visualize lymphatic vessels, which included injection techniques with India ink or Evans Blue, hydrogen peroxide techniques [ 27 , 28 ] and the enzyme histochemical detection of 5′nucleotidase [ 29 ].…”