Three-dimensional histologic reconstruction of remnant functional accessory atrioventricular myocardial connections in a case of Wolff-Parkinson-White syndrome

• Published in: Cardiovascular pathology 2018-11, Vol.37, p.1-4
• Main Authors: Matsuyama, Taka-aki, Haraguchi, Ryo, Nakashima, Junko, Kusano, Kengo, Ishibashi-Ueda, Hatsue
• Format: Article
• Language: English
• Subjects: Accessory Atrioventricular Bundle - pathology; Accessory Atrioventricular Bundle - physiopathology; Accessory Atrioventricular Bundle - surgery; Accessory pathway; Action Potentials; Aged, 80 and over; Atrioventricular junction; Autopsy; Biopsy; Bundle of Kent; Cryosurgery; Electrocardiography; Heart Rate; Histologic reconstruction; Humans; Imaging, Three-Dimensional - methods; Male; Myocardium - pathology; Patient-Specific Modeling; Predictive Value of Tests; Surgical ablation; Wolff-Parkinson-White Syndrome - pathology; Wolff-Parkinson-White Syndrome - physiopathology; Wolff-Parkinson-White Syndrome - surgery; WPW syndrome
• ISSN: 1054-8807; 1879-1336
• DOI: 10.1016/j.carpath.2018.07.003

Myocardial bundles working as accessory pathways in Wolff-Parkinson-White (WPW) syndrome are generally tiny tissues, so elucidating the culprit histology of atrioventricular (AV) myocardial connections requires careful serial sectioning of the AV junction. We performed a postmortem examination of accessory AV myocardial connections in an 84-year-old man who died from pneumonia 20 years after surgical cryoablation for WPW syndrome. Three-dimensional reconstruction images of serial histologic sections revealed accessory AV connections between the atrial and ventricular myocardium in the vicinity of the cryoablation scar. The remnant myocardial bridge was 4 mm wide and made up of multiple discontinuous fibers. This case was informative in that it provided for visualization of the histologic morphology of a remnant bundle of Kent. •A post-mortem three-dimensional reconstruction image of serial histologic sections allowed detection of accessory muscular connections between the atrial and ventricular myocardium associated with Wolff-Parkinson-White syndrome.•Accessory atrioventricular (AV) connections working as a bundle of Kent consisted of ordinary non-specialized cardiomyocytes.•The reconstruction image revealed anomalous connections anchored to the ventricular myocardium like the roots of a tree.