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(Circulation. 2008;117:2841-2843.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Accessory Atrioventricular Myocardial Connections in the Developing Human Heart: Relevance for Perinatal Supraventricular Tachycardias

 
Atrioventricular reentrant tachycardias presenting in fetal or neonatal life can be life-threatening but also tend to resolve in the majority of patients in the first year of life. The origin of accessory pathway–mediated tachycardias in the perinatal period has not been elucidated. In early embryonic development, the atrial and ventricular myocardia are continuous in the primitive atrioventricular canal. The atrioventricular conduction axis will then develop, which coincides with separation of the atrial and ventricular myocardium by formation of the annulus fibrosus. Annulus fibrosus development involves several processes in which the endocardial atrioventricular cushions that line the luminal side of the primitive atrioventricular canal, together with the inward migration of the epicardially located atrioventricular sulcus tissue, have an important role. In postseptated human hearts, we demonstrated the presence of numerous accessory atrioventricular myocardial connections around both the mitral and tricuspid annulus during normal cardiac development. At the end of the second trimester, the connections gradually decreased in number and size and were located primarily around the tricuspid annulus. The persistence of fetal atrioventricular connections may serve as substrate for atrioventricular reentrant tachycardia in the fetus and newborn. The self-limiting character of most of these tachycardias could be explained by loss of the substrate due to the ongoing development of the annulus fibrosus, a process not completely finished by the time of birth. See p 2850.

	Radial Artery Versus Saphenous Vein Patency Randomized Trial: Five-Year Angiographic Follow-Up

 
Recent publications highlight the ongoing role for and importance of coronary artery bypass surgery in the interventional management of ischemic heart disease. There is still . . . [Full Text of this Article]

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