The Vestigial Fold in Humans: Characterization of a Potential Novel Target for Selective Cardiac Sympathetic Denervation.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-03-17 DOI:10.1016/j.hrthm.2025.03.1957

Takanori Sato, Micheal C Fishbein, Peter Hanna, Olujimi A Ajijola, Kalyanam Shivkumar, Shumpei Mori

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Abstract

Background: The vestigial fold is an epicardial structure related to the posterior hilum of the heart, containing the remnant of the left superior vena cava. It is the superior continuation of the ligament/vein of Marshall. While neural structures along the human ligament/vein of Marshall have been characterized, those within the human vestigial fold remain unexplored.

Objective: This study aimed to characterize the neural structures within the human vestigial fold.

Methods: Twelve human vestigial fold samples (67% men, 50.0 ± 12.7 years) were analyzed. Nerve fascicles ≥50 μm in diameter were counted and characterized by immunohistochemistry staining. Percentage area of sympathetic, parasympathetic, and sensory nerve fibers (axons) within individual nerve fascicles was measured.

Results: A total of 87 nerve fascicles were analyzed. The size of the vestigial fold averaged 12.7 ± 5.1 mm in length and 3.6 ± 1.7 mm in width. Each vestigial fold contained 7.3 ± 4.2 nerve fascicles (102.0 ± 51.8 μm in diameter). The minimum distance from the epicardium to nerve fascicles was 487.1 ± 440.2 μm. Immunohistochemistry showed sympathetic predominance (Percentage area within each fascicle; sympathetic 16.9 ± 12.7%, parasympathetic 1.6 ± 1.0%, and sensory 1.2 ± 1.0%, p<0.001). Representative whole-mount staining of the tissue-cleared sample also confirmed three-dimensional distribution of the predominant sympathetic nerve fascicles within the vestigial fold.

Conclusion: The vestigial fold predominantly contains sympathetic nerve fascicles. This epicardial structure is a potential novel target for selective human cardiac sympathetic denervation, especially in cases with uncontrollable ventricular arrhythmia arising from the inferior left ventricle.

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.

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