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Is there such a thing as the "tendon of the infundibulum" in the heart?
1Department of Paediatrics, Imperial College of Science, Technology and Medicine, London, United Kingdom.
Insights
This study investigated the fibrous tendon between the aortic and pulmonary roots. Researchers found no distinct fibrous or elastic structure, questioning its anatomical significance in cardiac surgery.
Area of Science:
- Cardiac Anatomy
- Surgical Anatomy
- Morphology
Background:
- The fibrous skeleton of the heart is crucial in anatomical and surgical contexts.
- Descriptions frequently mention a tendon or ligament between aortic and pulmonary roots.
- This structure is seldom discussed in relation to ventricular outflow tract surgeries.
Purpose of the Study:
- To investigate the existence and nature of the purported tendon/ligament between the aortic and pulmonary roots.
- To clarify its role, if any, in cardiac anatomy and surgery.
Main Methods:
- Serial transverse sections of an intact fetal heart.
- Dissection of ten normal adult human hearts to examine the fibrous skeleton.
- Histological examination of the tissue plane between aortic sinuses and subpulmonary infundibulum.
Main Results:
- No discrete fibrous or elastic structure identified between the aortic sinuses and subpulmonary infundibulum.
- A fascial strand was observed in only one adult heart specimen.
- The space was predominantly occupied by loose fibroareolar tissue.
Conclusions:
- The existence of a distinct tendon or ligament between the aortic and pulmonary roots is not supported by this investigation.
- Previous descriptions may stem from historical accounts without reconfirmation.
- This finding has implications for understanding cardiac morphology and surgical approaches.
Abstract:
The fibrous skeleton of the heart has featured prominently in anatomical and surgical descriptions, although all its purported components are difficult to demonstrate. In descriptions of the skeleton, there have been repeated references to the presence of a tendon (or ligament) between the aortic and pulmonary roots. Such a tendon is rarely, if ever, discussed in the context of surgical procedures being carried out on the ventricular outflow tracts. Our study was undertaken, therefore, to investigate the existence and nature of such a tendon or ligament. Serial transverse sections were made through roots of aorta and pulmonary trunk in an intact fetal heart. In addition, ten normal adult hearts were dissected to display the components of the fibrous skeleton of the heart. No discrete fibrous or elastic structure could be detected in the tissue plane between the aortic sinuses and the subpulmonary muscular infundibulum, although a fascial strand was observed in one heart. Apart from this specimen, the space between the free-standing muscular subpulmonary infundibulum and the sinuses of aorta hearing the coronary arteries was occupied only by loose fibroareolar tissue. The initial presence of the ligament was described following studies of animal and macerated human hearts. Subsequently, it would seem its existence has been passed down through generations of morphologists and surgeons without its presence being reconfirmed. We have been unable to demonstrate any structure approximating to the initial illustrations.