Анализ топографоанатомических соотношений сердца

Abstract

Проведено морфологічний аналіз формоутворення серця людини, взаємовідношень між різними структурними компонентами міокарда на етапах пренатального онтогенезу. Описана синтопія серця і його відділів на зрізах, використовуваних у клінічному ультразвуковому дослідженні; проведено анатомо-клінічне зіставлення даних клінічного та анатомічного вивчення розвитку серця і різних його компонентів в пренатальному онтогенезі людини.

Проведен морфологический анализ формообразования сердца человека, взаимоотношений между различными структурными компонентами миокарда на этапах пренатального онтогенеза. Описана синтопия сердца и его отделов на срезах, используемых в клиническом ультразвуковом исследовании; проведено анатомо-клиническое сопоставление данных клинического и анатомического изучения развития сердца и различных его компонентов в пренатальном онтогенезе человека.

In our study, we examined the sintopy of the heart in three different planes: sagittal, frontal and horizontal. In connection with the fact that in clinical practice echocardiography of the fetus is carried out in the cross section, less often in the sagittal one, we found it necessary to pay more attention to the analysis of the topographic and anatomical correlations of the heart with respect to the indicated positions. At an early age, the description was carried out in early fetuses (9-16 weeks), fruits 24-26 weeks, and late fruits (36-40 weeks). It is during these periods that an echocardiographic study can diagnose possible disorders in the development of the heart and large vessels of the fetus. On the sagittal sections of early fetuses, carried out along the anterior median and left ocircumbrine lines, the chambers of the heart were clearly defined; the shape of the organ approached the round, the apex did not have a characteristic expression, the diaphragm surface had a considerable length. In the early fetal period (9-16 weeks), the heart of the fruit has a rounded shape, occupies the third part of the thoracic cavity, the apex of the heart is weakly expressed, the diaphragmatic heart surface has a considerable length, the long axis of the heart is directed approximately at right angles to the sagittal axis through the thoracic cage. The volumes of the atrial cavities slightly exceed the volumes of the ventricular cavities, the thickness of the walls of the right and left ventricles are approximately equal, the interatrial and interstitial baffles do not have a characteristic expression in comparison with the hearts of the middle and late fetuses. Beginning with the 20th week, there is a pronounced transformation of interorganic relationships, which involves a change in the sintopy of the heart in the thoracic cavity, expressed in the rotation of the heart around the vertical axis and in the change in the angle between the long axis of the heart and the sagittal axis drawn through the chest to an acute angle , open anteriorly and equal to approximately 76-80°. There is also a dynamics of increased ventricular growth and a predominance of left ventricular growth in thickness above the right ventricle. In the late fetal period (from the 32nd-40th week), definitive syntopic relationships are established between the organ structures of the thoracic cavity and heart. The sternum-rib surface of the heart has a characteristic bulge, facing the anterior wall of the thoracic cavity. Most of the sternum-rib surface is occupied by the right parts of the heart and only a small one by the left ventricle. If we assume that the linear dimensions obtained at the anatomical sections are more objective, then the analogous data obtained in clinical studies are not always correct and are associated with the error of the technique. Important in determining the size of the heart in the clinic is “you-keeping” the heart in a plane in which the given size is the maximum. The error in obtaining linear dimensions of the heart in the clinic may, apparently, be associated with diasporic relaxation and systolic contraction of the heart. Looking at what phase of the cardiac activity is measured by the parameter, it will have a maximum or minimum value. Therefore, when you “deduce” the heart of the fetuses in the clinic, you need to strive to obtain a section of the heart in which this size will be most reliable and the cross section will be similar to the anatomical section on which a particular heart parameter was obtained. Thus, the use in the clinic of data obtained in the study of anatomical sections, their comparison with the scans and nomograms obtained in the echocardiogram of fruits, broadens the possibility of obtaining real data, increases the informativeness and objectivity of research. Promising is not only a comparison of the linear dimensions of the heart of fruits, but also the acquisition of integrated, volumetric indicators and the construction of mathematical models of the fetal heart and the dynamics of its development.