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Rofo 2016; 188(11): 1045-1053
DOI: 10.1055/s-0042-115569
Heart
© Georg Thieme Verlag KG Stuttgart · New York

Pneumatic Distension of Ventricular Mural Architecture Validated Histologically

Der pneumatisch gedehnte Herzmuskel im Computertomogramm und im histologischen Bild
M. C. Burg
1   Department of Clinical Radiology, University Hospital Münster, Germany
,
P. Lunkenheimer
2   Dept. of Experimental Thoraco-vascular Surgery, University Hospital Münster, Germany
,
P. Niederer
3   Institute for Biomedical Engineering, ETH and University of Zürich, Switzerland
,
C. Brune
4   Department of Applied Mathematics, University of Twente, Netherlands
,
K. Redmann
5   Center for Reproductive Medicine and Andrology, University Hospital Münster, Germany
,
M. Smerup
6   Dept of Cardiothoracic and Vascular Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
,
U. Spiegel
7   Dept. Surgical Research, Clinic of General and Visceral Surgery, University Hospital Münster, Germany
,
F. Becker
7   Dept. Surgical Research, Clinic of General and Visceral Surgery, University Hospital Münster, Germany
,
D. Maintz
1   Department of Clinical Radiology, University Hospital Münster, Germany
8   Department of Radiology, University of Cologne, Germany
,
W. Heindel
1   Department of Clinical Radiology, University Hospital Münster, Germany
,
R. H. Anderson
9   Institute of Genetic Medicine, Newcastle University, London, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History

24 June 2015

11 August 2016

Publication Date:
19 October 2016 (online)

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Abstract

Purpose: There are ongoing arguments as to how cardiomyocytes are aggregated together within the ventricular walls. We used pneumatic distension through the coronary arteries to exaggerate the gaps between the aggregated cardiomyocytes, analyzing the pattern revealed using computed tomography, and validating our findings by histology.

Methods: We distended 10 porcine hearts, arresting 4 in diastole by infusion of cardioplegic solutions, and 4 in systole by injection of barium chloride. Mural architecture was revealed by computed tomography, measuring also the angulations of the long chains of cardiomyocytes. We prepared the remaining 2 hearts for histology by perfusion with formaldehyde.

Results: Increasing pressures of pneumatic distension elongated the ventricular walls, but produced insignificant changes in mural thickness. The distension exaggerated the spaces between the aggregated cardiomyocytes, compartmenting the walls into epicardial, central, and endocardial regions, with a feathered arrangement of transitions between them. Marked variation was noted in the thicknesses of the parts in the different ventricular segments, with no visible anatomical boundaries between them. Measurements of angulations revealed intruding and extruding populations of cardiomyocytes that deviated from a surface-parallel alignment. Scrolling through the stacks of tomographic images revealed marked spiraling of the aggregated cardiomyocytes when traced from base to apex.

Conclusion: Our findings call into question the current assumption that cardiomyocytes are uniformly aggregated together in a tangential fashion. There is marked heterogeneity in the architecture of the different ventricular segments, with the aggregated units never extending in a fully transmural fashion.

Key Points:

• Pneumographic computed tomography reveals an organized structure of the ventricular walls.

• Aggregated cardiomyocytes form a structured continuum, with marked regional heterogeneity.

• Global ventricular function results from antagonistic forces generated by aggregated cardiomyocytes.

Citation Format:

• Burg MC, Lunkenheimer P, Niederer P et al. Pneumatic Distension of Ventricular Mural Architecture Validated Histologically. Fortschr Röntgenstr 2016; 188: 1045 – 1053

Zusammenfassung

Ziel: Um den Aufbau der linksventrikulären Kammerwände radiologisch zu analysieren, haben wir sie pneumatisch über die Koronararterien gedehnt, sodass Spalträume zwischen den Myokardblöcken entstehen. Das in der Computertomografie dargestellte Muster wurde anschließend histologisch validiert.

Material und Methoden: 10 Schweineherzen wurden gebläht, nachdem 4 durch Infusion kardioplegischer Lösung in Diastole fixiert und 4 durch Bariumchlorid in Systole stillgestellt worden waren. Der lamelläre Aufbau der Wände wurde computertomografisch dargestellt. Die Helixdrehung langer Myozytenketten wurde bestimmt. 2 weitere Herzen wurden histologisch aufgearbeitet.

Ergebnisse: Steigende Blähdrücke führten zu einer Verlängerung der Wände ohne signifikante Zunahme der Wanddicke. Nach Blähung des Interstitiums zwischen den lamellären Myokardblöcken trennen sich optisch eine subepikardiale, eine zentrale und eine subendokardiale Region durch ihre unterschiedlich angeordnete Fiederung. Über die Kammerwände herrscht eine ausgeprägte Variation der Dicke dieser Regionen. Es bestehen keine bindegewebigen Grenzen zwischen ihnen. Die Muskelblöcke weichen unterschiedlich stark von einer oberflächenparallelen Anordnung ab. Beim Scrollen durch den Myokardkörper von der Basis zum Apex stellt sich eine spiralige Vernetzung der Myokardblöcke dar.

Schlussfolgerung: Nach interstitieller Blähung bestätigt sich für die Struktur des Herzmuskels nicht die Annahme seiner einheitlichen tangentialen Anordnung. Es besteht regional eine ausgeprägte Heterogenität. Lamelläre Aggregate erstrecken sich niemals vollständig transmural. Ihre nicht allein tangentiale Anordnung legt das Vorherrschen eines antagonistischen Wechselspieles von entlastenden und auxotonen Kräften nahe.

Kernaussaugen:

• Die Computertomografie des pneumatisch gedehnten Myokards zeigt eine organisierte Struktur der Ventrikelwände.

• Kardiomyozyten sind zu einem hoch strukturierten Kontinuum mit ausgeprägter regionaler Heterogenität verknüpft.

• Die globale Herzfunktion ist das Ergebnis der Kräfte von Blöcken aggregierter Kardiomyozyten.

Key words

heart CT - myocardium - ventricular stucture - myocardial function - heart anatomy & histology - animal models
 

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