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(Circulation. 1996;94:1642-1646.)
© 1996 American Heart Association, Inc.

Articles

Fibrous Matrix of Ventricular Myocardium in Tricuspid Atresia Compared With Normal Heart

A Quantitative Analysis

Siew Yen Ho, PhD, FRCPath; Mark Jackson, PhD; Lucienne Kilpatrick, BS; Audrey Smith, PhD; Leon M. Gerlis, MBBS, FRCPath

the Department of Paediatrics (S.Y.H., L.K., L.M.G.), National Heart and Lung Institute, Imperial College School of Medicine, London, UK; and Department of Anatomy (M.J., A.S.), Institute of Child Health, Alder Hey Children's Hospital, Liverpool, UK.

Correspondence to Dr S.Y. Ho, Department of Paediatrics, National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, UK.

Background The collagen matrix is a small component of the myocardium, but it provides a supportive framework. An increase in collagen in the pressure-overloaded ventricle is known to cause myocardial stiffness. However, little is known about the collagen matrix in the volume-overloaded ventricle, particularly in relation to congenital heart disease.

Methods and Results We examined a total of 53 hearts with tricuspid atresia and 58 normal hearts matched for age. Using a microscopic-morphometric method, we analyzed the percentage per field area occupied by interstitial fibrous tissue in four sites in the ventricular mass for each specimen. A comparison of sampling sites showed no significant variations between normal and malformed hearts. Results from a homogeneity of regression coefficients analysis suggested that the two groups shared the same basic relation of proportion of fibrosis with age. The use of ANCOVA, however, revealed a clear separation between the extents of fibrous tissue in the two groups of hearts.

Conclusions The myocardium of hearts with tricuspid atresia is consistently more fibrotic than normal heart and is probably an inherent part of the malformation. This difference could explain, at least in part, the clinical observation that the left ventricle is frequently abnormal, even at an early age.

Key Words: heart defects, congenital • myocardium • pathology • ventricles

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