TOPOGRAPHY OF CARDIAC GANGLIA IN THE ADULT HUMAN HEART

Published descriptions of the topography of cardiac ganglia in the hum an heart are limited and present conflicting results, This study was c arried out to determine the distribution of cardiac ganglia in adult h uman hearts and to address these conflicts, Hearts obtained from autop sies and heart transplant procedures were sectioned, stained, and exam ined. Results indicate that the largest populations of cardiac ganglia are near the sinoatrial and atrioventricular nodes, Smaller collectio ns of ganglia exist on the superior left atrial surface, the interatri al septum, and the atrial appendage-atrial junctions, Ganglia also exi st at the base of the great vessels and the base of the ventricles. Th e right atrial free wall, atrial appendages, trunk of the great vessel s, and most of the ventricular myocardium are devoid of cardiac gangli a. These findings suggest modifications to surgical procedures involvi ng incisions through regions concentrated with ganglia to minimize arr hythmias and related complications, Repairs of septal defects, valvula r procedures, and congenital reconstructions, such as the Senning and Fontan operations, involve incisions through areas densely populated w ith cardiac ganglia. The current standard procedure for orthotopic hea rt transplantation severs cardiac ganglia and their projections to nod al and muscular tissue. One modification of the current heart transpla ntation procedure, involving bicaval anastomosis, preserves atrial ana tomy and the cardiac ganglia, Preservation of cardiac ganglia within t he donor heart may provide additional neuronal substrate for intracard iac processing and targets for regenerating nerve fibers to the donor heart.