Is there such a thing as the "tendon of the infundibulum" in the heart?
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.
Lal
M
M
Department of Paediatrics, Imperial College of Science, Technology and Medicine, London, United Kingdom.
Ho
S Y
SY
Anderson
R H
RH
D001021:Aortic Valve / Q000033:anatomy & histology / Q000196:embryology*; D002102:Cadaver; D005318:Fetal Heart / Q000033:anatomy & histology*; D005865:Gestational Age; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008022:Ligaments / Q000196:embryology; D011664:Pulmonary Valve / Q000033:anatomy & histology / Q000196:embryology*; D012016:Reference Values; D012680:Sensitivity and Specificity; D013710:Tendons / Q000033:anatomy & histology / Q000196:embryology* / Q000502:physiology