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(Circulation. 1998;97:934-935.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Connective Tissue Skeleton of the Human Heart

A Demonstration by Cell-Maceration Scanning Electron Microscope Method

Marcos A. Rossi, MD; Monica A. Abreu, BS; ; Lígia B. Santoro, BS

From the Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.

Correspondence to Professor Marcos A. Rossi, Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 140049-900 Ribeirão Preto, SP, Brazil. E-mail marossi@fmrp.usp.br

The stroma of the heart maintains the structure of the myocardium, determining tissue tensile strength and stiffness.¹ In addition, it contributes to ventricular function through the transmission of myocyte-generated force to the atrial and ventricular chambers and to the relengthening of myocytes in diastole.² The three-dimensional configuration of cardiac collagen has been determined by scanning electron microscopy^{3 4 5} : the epimysium envelops the entire cardiac muscle; the perimysium, which is an extension of the epimysium, serves to enwrap groups of myocytes; and the endomysium, as final arborization of the perimysium, supports and connects individual cells. The endomysial weave envelops each individual myocyte and is connected to adjacent myocytes by lateral struts.

Because this knowledge was obtained through studies on whole fixed myocardial tissue without removal of its nonfibrous elements, we attempted to dissolve the cellular elements and leave behind a noncollapsed matrix, aiming for a better three-dimensional view. For this, we used a modification of the NaOH maceration technique reported by Ohtani.⁶ This method was reported to be able to remove cellular elements much more effectively than any other method. Small fragments, 10x5x3 mm in size, of the anterior wall at the midventricular region were obtained from three human hearts, weighing between 300 and 350 g, without any pathological changes. All samples were fixed in 10% neutral formalin. After being rinsed in distilled water, the specimens were immersed in a 10% NaOH solution for 4 to 6 days at room temperature and then rinsed in distilled water until they became transparent. . . . [Full Text of this Article]

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