Locating the Human Cardiac Conduction System Using a 3D Model of Its Nutritious Arteries

Figures

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  Figure 1. The results of the histological and immunofluorescence examination of the SAN. (A) HE staining (scale bar = 1200 μm). (B) Masson staining (scale bar = 1200 μm). (C) Immunofluorescence staining with the anti-protein gene product 9.5 antibody (PGP9.5, the green region is the positive area). (D) Immunofluorescence staining with the anti-tyrosine hydroxylase antibody (TH, the green region is the positive area). (E) Immunofluorescence staining with the anti-connexin 40 antibody (Cx40, the green region is the positive area). (F) Immunofluorescence staining with the anti-hyperpolarization-activated cyclic nucleotide-gated channel 4 antibody (HCN4, the green region is the positive area). In C–F, cell nuclei are stained with DAPI, scale bar = 400 μm.

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  Figure 2. The results of the histological and immunofluorescence examination of the AVN. (A) HE staining (scale bar = 1200 μm). (B) Masson staining (scale bar = 1200 μm). (C) Immunofluorescence staining with the anti-PGP9.5 antibody. (D) Immunofluorescence staining with the anti-TH antibody. (E) Immunofluorescence staining with the anti-Cx40 antibody. (F) Immunofluorescence staining with the anti-HCN4 antibody. In C–F, the green region is the positive area, and the cell nuclei are stained with DAPI, scale bar = 400 μm.

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  Figure 3. The results of the histological and immunofluorescence examination of the HBB and RBB. (A) HE staining (scale bar = 1200 μm). (B) Masson staining (scale bar = 1200 μm). (C) Immunofluorescence staining with the anti-PGP9.5 antibody. (D) Immunofluorescence staining with the anti-TH antibody. (E) Immunofluorescence staining with the anti-Cx40 antibody. (F) Immunofluorescence staining with the anti-HCN4 antibody. In C–F, the green region is the positive area, and the cell nuclei are stained with DAPI, scale bar = 400 μm.

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  Figure 4. The results of the histological and immunofluorescence examination of the LBB. (A) HE staining (scale bar = 1200 μm). (B) Masson staining (scale bar = 1200 μm). (C) Immunofluorescence staining with the anti-PGP9.5 antibody. (D) Immunofluorescence staining with the anti-TH antibody. (E) Immunofluorescence staining with the anti-Cx40 antibody. (F) Immunofluorescence staining with the anti-HCN4 antibody. In C–F, the green region is the positive area, and the cell nuclei are stained with DAPI, scale bar = 400 μm.

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  Figure 5. Diagram and illustration. (A) Diagram of the cardiac conduction system (CCS) and its nutritious arteries. (B) The 3D model illustrates that, during some surgeries, surgeons should pay attention to the location of the LBB and its nutritious arteries. In TAVI, surgeons cannot put the aortic prosthesis over the surgery line (in blue).

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  Figure 6. The 3D model and gross specimen. A1 3D model of the 1st sample. The SANA (in red) arises from the RCA and crosses the sulcus terminalis, penetrating the SAN (green circle). The SAN is located at the junction of the superior vena cava with the right atrium. A2 Corresponds to A1 and is the gross specimen of the 1st sample. A3 and A4 Viewed from the base to display the course of the SANA (1 SANA; 2 SAN; 3 RCA; 4 aorta; 5 superior vena cava). B1 3D model of the 2nd sample. The AVNA (in red) arises from the posterior interventricular branch of the right coronary artery, penetrating the atrioventricular junction. The AVN (green circle) is at the apex of the triangle of Koch. The HBB (purple region) is situated below the atrioventricular part of the membranous part (blue circle). B2 Corresponds to B1 and is the gross specimen of the 2nd sample. B3 3D model of the 2nd sample. The RBB (yellow region) goes towards the right side of the interventricular septum at the crest, penetrating the moderator band. Its nutritious artery is the septal artery (in red). B4 Gross specimen of the 2nd sample and corresponds to B3 (1 AVNA; 2 AVN; 3 the tendon of Todaro; 4 atrioventricular part of the…