CN109752517A - A kind of identification method of human heart mitral annulus separation - Google Patents
A kind of identification method of human heart mitral annulus separation Download PDFInfo
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- CN109752517A CN109752517A CN201910116358.3A CN201910116358A CN109752517A CN 109752517 A CN109752517 A CN 109752517A CN 201910116358 A CN201910116358 A CN 201910116358A CN 109752517 A CN109752517 A CN 109752517A
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Abstract
The present invention relates to a kind of identification methods of human heart mitral annulus separation, belong to forensic pathology technical field.The method of the present invention cuts off atrium sinistrum, detecting bicuspid valve, whether there is or not narrow, incompetence or deformities the following steps are included: (1) takes people's corpse heart；(2) forward and backward valve is distinguished, joint after valve is positioned；(3) left ventricle is splitted, mitral annulus is expanded horizontally, observes bicuspid valve ordinary circumstance；(4) perpendicular to plane where mitral annulus, continuous section is done to bicuspid valve back lobe；(5) according to section morphological diagnosis or exclusion MAD.The method of the present invention can instruct forensic pathological scholar quickly, accurately find MAD.
Description
Technical field
The present invention relates to a kind of identification methods of human heart mitral annulus separation, belong to forensic pathology technical field.
Background technique
Sudden unexpected cardiac death (sudden unexpected death, SUD) refers to the death occurred in the short time, even if
Forensic pathology postmortem examination and histological examination, toxicological analysis by careful field investigation, system etc., can not also find
Its cause of death.SUD is always the difficult point in forensic pathology field, therefore the feature for probing into SUD related disease is cured the desease as method
The research emphasis in field of science.
It is the mitral one kind of human heart that mitral annulus, which separates (mitral annulus disjunction, MAD),
Special lesion, the pathological anatomy inspection method in relation to this lesion are rarely reported so far, and forensic pathology document also has no related
Report.Under normal circumstances, mitral valve is attached at atrioventricular junction, then claims MAD when moving to atrial wall on valve attachment point.
Carry weight document (Dejgaard LA, et al.The Mitral Annulus Disjunction Arrhythmic
Syndrome.J Am Coll Cardiol.2018；72:1600-1609.) point out that MAD is in close relations with malignant arrhythmia,
And the latter can often cause SUD, therefore one of the reason of MAD may be part SUD.
Due to lacking medicolegal examination and the determination method of heart MAD, each category of the existing related postmortem examination in China
Standard/specification, monograph, textbook (including medical jurisprudence and pathological anatomy field) are showed no the description of heart MAD.External clinical disease
Document report of science crosses the distinct methods of mitral annulus Senile Mouse: Hutchins et al. (Hutchins GM, et
al.The association of floppy mitral valve with disjunction of the mitral
annulus fibrosus.N Engl J Med.1986；314:535-40.) only (i.e. Zuo Xinyuan is cut for observation 1 section of annulus
Face), Angelini et al. (Angelini A, et al.A histological study of the
atrioventricular junction in hearts with normal and prolapsed leaflets of the
mitral valve.Br Heart J.1988；59:712-6.) then advocate to do entire mitral annulus every 3mm continuously to cut
Face, and Japan Clinic pathological research person (Sugiura M, et al. [Morphological observation of the
mitral annulus fibrosus(II)].J Cardiol Suppl.1991；25:63-73.In Japanese.) it is then right
Zuo Xinhou lateral wall annulus does 5~8 sections.It will be apparent that clinicopathologia does not form system to the inspection of MAD and judgement
Method.Although the careful inspection method of latter two avoids failing to pinpoint a disease in diagnosis for MAD, in contrast excessively cumbersome, manpower object is wasted
Power.Importantly, materials means used by clinicopathological study are more extreme, and it is more serious to the destruction of heart, it affects
The inspection and materials of heart other structures, so that can not use to the real work of forensic pathology postmortem examination.
In anatomy, mitral forward and backward valve structure is not fully consistent.In anterior mitral valve is attached to before annulus
Side is the direct extension of Heart center corpus fibrosum, and preceding valve is connected directly by fibrous trigones and aorta petal annulus, is only being leaned on
The both ends of nearly back lobe are connected with small part ventricular muscles, because there is no the anatomical basis that MAD occurs for lobe position before this.Pass through heart
The utilization of the Imaging Technologies such as ultrasound, clinical data also indicate that MAD is apt to occur in back lobe, meet the anatomy at bicuspid valve position
Feature.For this purpose, we establish a kind of medicolegal examination around bicuspid valve back lobe MAD and determination method, this is to forensic pathological
Cause of the death identification is learned to have a very important significance.
Summary of the invention
A kind of human heart mitral annulus is provided it is an object of the invention to overcome above-mentioned the deficiencies in the prior art place
Isolated identification method, this method can instruct forensic pathological scholar, and quickly, accurately discovery heart mitral annulus separates.
To achieve the above object, the technical scheme adopted by the invention is as follows: a kind of identification of human heart mitral annulus separation
Method comprising following steps:
(1) people's corpse heart is taken, atrium sinistrum is cut off, detecting bicuspid valve, whether there is or not narrow, incompetence or deformities；
(2) forward and backward valve is distinguished, joint after valve is positioned；
(3) left ventricle is splitted, mitral annulus is expanded horizontally, observes bicuspid valve ordinary circumstance；
(4) perpendicular to plane where mitral annulus, continuous section is done to bicuspid valve back lobe；
(5) according to section morphological diagnosis or exclude MAD: if bicuspid valve back lobe attachment point from atrioventricular junction on move to atrium
Wall, visible connective tissue separates between annulus section bicuspid valve back lobe root and ventricular muscles upper limb, then is diagnosed as MAD, otherwise
Exclude MAD.
In the above method of the present invention, in step (5), the heart for diagnosing MAD should also record MAD happening part, MAD
Maximum separation height and MAD involve length." the MAD happening part " refers to by after the mitral valve lobed state and position characteristics institute
3 flabellums of subdivision are followed successively by preceding fan (P1), middle fan (P2) and rear fan (P3) from front to back." MAD maximum separation height " refers to
From valve attachment point to the maximum distance of ventricular muscles upper limb on any section." MAD involves length " refers to be sent out in annulus plane
The length range of raw MAD can be obtained with areal survey and then addition for discontinuous MAD and be involved length.
Due to following, forensic pathology field is there is not yet be directed to the report of the description of MAD, diagnosis and its inspection method
Road, the normative check process of MAD is also not known in relevant industries technical standard: (1) MAD clinicopathological study method does not have
Systematization often takes Different Strategies according to the needs of researcher；(2) MAD clinicopathological study purpose and forensic pathological
It is different to learn research purpose, clinicopathological study person, which does not account for, saves the complete importance of heart sample；(3) forensic pathological
Field is very few to the understanding of MAD, does not cause enough attention, and then causes to lack corresponding operation specification and guidance meaning
See.
For this purpose, the present invention provides a kind of methods of new identification human heart mitral annulus separation.Method of the invention
Take the strategy of " the continuous section of bicuspid valve back lobe " for checking MAD.Method of the invention discloses the anatomic morphological of MAD
Feature can operate with and forensic pathology worker is instructed quickly and accurately to determine MAD, while overcome existing MAD clinical disease
Pharmacological research section quantity is different, the indefinite disadvantage in section position.Importantly, utilization of this method in SUD event,
It more can reliably determine whether this kind of death incident is caused by MAD institute proarrhythmia, the forensic pathology cause of the death is identified
Play a significant role.
The method of the present invention highlight forensic pathology autopsy practicability, that is, save heart materials with check when
Between, while heart will not be damaged other important features, it is satisfied with forensic pathology postmortem examination actual needs.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(1) in, heart or the heart after formalin is fixed that people's corpse heart is fresh refrigeration.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(1) in, the method for cutting off atrium sinistrum are as follows: from left to right or right-to-left is residual by left and right pulmonary vein two along pulmonary vein direction of travel
End is cut off, and then cuts off left atrial wall along coronary sulcus horizontal annular from left pulmonary veins stump, is cut forward to left auricle of heart, cut backward to
On the left of inferior caval vein nearby (about at 1cm).
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(2) in, the method for the differentiation forward and backward valve of bicuspid valve are as follows: dissector's face heart back side, it is flat from atrial side right-angle view annulus
Face, inside is close to aorta efferent tract before preceding valve is attached to annulus, and in single fan, back lobe is then attached to outside after annulus, because of valve
Intermediate twice incisura and in three fan.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(2) in, joint is the point of interface that forward and backward valve is located inside after annulus plane after mitral valve, around adjoins dissection mark
Will is coronary sinus.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(3) in, the method for cutting off left ventricle are as follows: the joint first after mitral valve, along about 1cm on the left of posterior interventricular groove to down toward a left side
Ventricular tip cuts off left ventricular posterior wall；Then from left ventricle tip, the left auricle of heart right side is upwardly into along (about 1cm) on the left of anterior interventricular groove
Edge cuts off left ventricle antetheca.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(3) in, the ordinary circumstance of valve include with (a) valve Zhou Jing, color, quality, smooth situation, (b) valve whether there is or not adhesion, increase
It is thick or shorten and neoplasm, (c) chordae tendineae whether there is or not attenuate, thickening or shortening, and (d) between adjacent cords whether there is or not bulge samples to change for valve
Become.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(4) in, continuous section is done to bicuspid valve back lobe method are as follows: expand horizontally bicuspid valve back lobe, from incisxal edge on the right side of at 3mm perpendicular to
Annulus cuts the first knife, then to the right every 3mm partial application, until switching to before mitral valve near joint.
The preferred embodiment of identification method as human heart mitral annulus of the present invention separation, the step
(5) further comprising the steps of after being diagnosed as MAD: to be analyzed in conjunction with forensic toxicology as a result, excluding violence nature death and Other diseases
After death, for finding the dead of MAD, consider that there are the disease of MAD institute proarrhythmia bases, and be included in analysis on cause of death
Scope；For not finding the dead of MAD, the disease basis of MAD institute proarrhythmia is excluded, considers other causes of the death.
Compared with prior art, the invention has the benefit that
(1) present invention establishes a kind of completely new forensic pathology inspection method, for diagnosing the mitral spy of human heart
Different lesion MAD.This method can instruct forensic pathological scholar quickly, accurately find MAD, for the forensic pathology cause of the death identify provide
It helps.
(2) method of present invention identification human heart mitral annulus separation can avoid destroying the complete of conducting system of heart
Property.The method of the present invention only checks bicuspid valve back lobe, avoids and destroys vital tissue structure near anterior mitral valve (such as
Atrioventricular node), meet the needs of forensic pathology real work.
(3) method of present invention identification human heart mitral annulus separation is easy to operate, is easily mastered.The method of the present invention pair
Bicuspid valve back lobe is cooked continuous section, is checked by general form, that is, be can determine whether MAD, forensic pathological is facilitated to work
Person quickly grasps and operation.
Detailed description of the invention
Fig. 1 is the flow chart of present invention identification human heart mitral annulus separation.
Specific embodiment
Purposes, technical schemes and advantages in order to better illustrate the present invention, below in conjunction with the drawings and specific embodiments pair
The present invention is described further.
In following embodiments, the process of identification human heart mitral annulus separation is as shown in Figure 1.
Embodiment 1
A kind of embodiment of the identification method of the present inventor's heart mitral annulus separation, human heart two described in the present embodiment
The identification method of cusp annulus separation are as follows:
(1) the corpse heart after formalin of learning from else's experience is fixed, from left to right along pulmonary vein direction of travel by left and right pulmonary vein
Two stumps are cut off, and then cut off left atrial wall along coronary sulcus horizontal annular from left pulmonary veins stump, are cut forward to left auricle of heart, backward
It cuts to about 1cm on the left of inferior caval vein, sufficiently cuts off atrium sinistrum, exposure bicuspid valve position；Bicuspid valve is detected, to find bicuspid valve
Other lesions such as narrow, incompetence or deformity；
(2) forward and backward valve is distinguished, in the heart back side close to coronary sinus, joint after valve is accurately positioned；Wherein, area
Divide the method for the forward and backward valve of bicuspid valve are as follows: dissector's face heart back side, from atrial side right-angle view annulus plane, preceding valve is attached
Inside is close to aorta efferent tract before annulus, in single fan, back lobe is then attached to outside after annulus, because twice are cut among valve
Mark and in three fan；
(3) joint after mitral valve cuts off the left heart along about 1cm on the left of posterior interventricular groove to down toward left ventricular apex end
Room rear wall is upwardly into left auricle of heart right border along about 1cm on the left of anterior interventricular groove, cuts off left ventricle antetheca, fill then from left ventricle tip
Left ventricle is opened in sub-cut；Expand horizontally bicuspid valve, the long 9cm of bicuspid valve, color can, quality can, smooth in appearance, no adhesion, thicken or
Shorten, chordae tendineae is without attenuating or thickening, shortening, and valve changes without bulge sample between adjacent cords；
(4) bicuspid valve back lobe is expanded horizontally, cuts the first knife perpendicular to annulus from the about 3mm of incisxal edge right side, it is then every to the right
Every about 3mm partial application, until switching to before mitral valve near joint.It can be seen that whole section (before i.e. fan P1, middle fan P2 and after
Fan P3) show themselves in that valve root is attached to atrial wall, and attachment point and ventricular muscles upper limb are separated by one section of connective tissue；
(5) it is MAD that above-mentioned anatomic morphological, which changes diagnosable, and MAD maximum separation height 7mm, MAD involves length 48mm；
(6) for the dead without other obvious pathological changes, forensic toxicology analyzes result feminine gender, eliminates violence nature death,
Therefore the cause of death of the dead is thought of as MAD institute proarrhythmia.
Finally, it should be noted that the above embodiments are merely illustrative of the technical solutions of the present invention rather than protects to the present invention
The limitation of range is protected, although the invention is described in detail with reference to the preferred embodiments, those skilled in the art should
Understand, it can be with modification or equivalent replacement of the technical solution of the present invention are made, without departing from the essence of technical solution of the present invention
And range.
Claims (10)
1. a kind of identification method of human heart mitral annulus separation, which comprises the following steps:
(1) people's corpse heart is taken, atrium sinistrum is cut off, detecting bicuspid valve, whether there is or not narrow, incompetence or deformities；
(2) forward and backward valve is distinguished, joint after valve is positioned；
(3) left ventricle is splitted, mitral annulus is expanded horizontally, observes bicuspid valve ordinary circumstance；
(4) perpendicular to plane where mitral annulus, continuous section is done to bicuspid valve back lobe；
(5) according to section morphological diagnosis or exclude MAD: if bicuspid valve back lobe attachment point from atrioventricular junction on move to atrial wall,
Visible connective tissue separates between annulus section bicuspid valve back lobe root and ventricular muscles upper limb, then is diagnosed as MAD, otherwise excludes
MAD。
2. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (1)
In, heart or the heart after formalin is fixed that people's corpse heart is fresh refrigeration.
3. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (1)
In, the method for cutting off atrium sinistrum are as follows: from left to right or right-to-left cuts left and right two stump of pulmonary vein along pulmonary vein direction of travel
It opens, then cuts off left atrial wall along coronary sulcus horizontal annular from left pulmonary veins stump, cut forward to left auricle of heart, cut backward to cavity of resorption
Near on the left of vein.
4. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (2)
In, the method for the differentiation forward and backward valve of bicuspid valve are as follows: dissector's face heart back side, it is preceding from atrial side right-angle view annulus plane
Inside is close to aorta efferent tract before valve is attached to annulus, and in single fan, back lobe is then attached to outside after annulus, because two among valve
Road incisura and in three fan.
5. the identification method of human heart mitral annulus separation as claimed in claim 2, which is characterized in that the step (2)
In, joint is the point of interface that forward and backward valve is located inside after annulus plane after mitral valve, and around adjoining anatomic landmark is
Coronary sinus.
6. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (3)
In, the method for cutting off left ventricle are as follows: the joint first after mitral valve, to down toward left ventricular apex on the left of posterior interventricular groove
End, cuts off left ventricular posterior wall；Then from left ventricle tip, it is upwardly into left auricle of heart right border on the left of anterior interventricular groove, cuts off left ventricle
Antetheca.
7. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (3)
In, the ordinary circumstance of valve includes: (a) valve Zhou Jing, color, quality, smooth situation, (b) valve whether there is or not adhesion, thicken or contract
Short and neoplasm, (c) chordae tendineae whether there is or not attenuate, thickening or shortening, and (d) between adjacent cords whether there is or not the changes of bulge sample for valve.
8. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (4)
In, continuous section is done to bicuspid valve back lobe method are as follows: expand horizontally bicuspid valve back lobe, from incisxal edge on the right side of at 3mm perpendicular to valve
The first knife of ring cutting, then to the right every 3mm partial application, until switching to before mitral valve near joint.
9. the identification method of human heart mitral annulus separation as described in claim 1, which is characterized in that the step (5)
In, heart record MAD happening part, MAD maximum separation height and MAD for diagnosing MAD involve length.
10. the identification method of human heart mitral annulus separation as described in any one of claims 1 to 9, which is characterized in that institute
State after step (5) is diagnosed as MAD, it is further comprising the steps of: analyzed in conjunction with forensic toxicology as a result, exclude violence nature it is dead and its
After its disease death, for finding the dead of MAD, consider that there are the disease of MAD institute proarrhythmia bases, and be included in dead
Because analyzing scope；For not finding the dead of MAD, the disease basis of MAD institute proarrhythmia is excluded, considers other causes of the death.
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