血管構築からみた虚血性心疾患の病理学的研究 : 心筋硬塞巣の経時的変化と対応した血管構築の改変像を中心として
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The present study was designed for morphologic-al investigation of the vascular abnormalities or vascular reconstruction in areas of myocardial infarction, compared with the normal vascular patterns. The vascular changes along with the time course changes of infarcts were emphasized. Studies were performed on 62 hearts obtained at random at necropsy in Tokyo Medical Examiners' Office. The age of patients including 15 cases of myocardial infarction range from 5 to 85 years. At necropsy, the heart was removed and canulae were inserted into the right and left coronary arteries at their origin. A radiopaque medium (60 wt/vol% barium sulfate) with addition of 5% gelatin was injected into the coronary arteries under hand operated pressure, at about 40℃ at first into the left coronary artery followed by the right as a rule. After injection, stereo-arteriography of each intact heart, unrolled heart and transverse section of heart was carried out. Serial observation of 2mm thick sections of coronary arteries was then carried out, before clearing the heart tissue. Histological investigation of myocardium stained by Hematoxylin and Eosin, Elastica Van Gieson and Mallory-Azan staining was also carried out. Results: 1) Three fundamental intramural intramural vascular patterns were distinguished in the left ventricular free wall of the normal heart. The vessels of type I leave the extramural subepicardial artery at right angles into myocardium and quickly branch like a bamboo-broom or like an arbor with delicate fine branching, gradually losing its lumen diameter. Although smaller vessels of this type terminate themselves in middle layer of the myocardium, larger vessels penetrate deeper up to the inner one thirds or one fourths of myocardium or even to the traveculae. The vessels of type II also leave at right angles into myocardium like the vessels of type I, but are less numerous, branch infrequently and arrive directly at papillary muscles and traveculae, where they subdivide, forming large looping arcades bending upwards and downwards like a hook or a rake. The vessels of type III are rela-tively smaller ones seen in the subepicardial layer. Various intermediate or transitional vessels between typical patterns of type I and type II are recognized. Except the subendocardial layer and septum, intramural interarterial anastomoses are not found in the normal myocardium as a rule.
- 社団法人日本循環器学会の論文
- 1972-09-20