From the Guidelines
The Bundle of His is located near the aortic valve, specifically running inferior to the non-coronary cusp of the aortic valve, which explains the higher risk of conduction abnormalities after aortic valve surgery. This anatomical relationship is crucial in understanding the potential complications of aortic valve procedures, such as aortic valve replacement, which can damage the Bundle of His and lead to heart block, requiring pacemaker implantation 1. The Bundle of His begins at the atrioventricular node in the interatrial septum and then passes through the fibrous skeleton of the heart, traveling down the interventricular septum.
Key Points
- The Bundle of His is located near the aortic valve, which increases the risk of conduction abnormalities after aortic valve surgery 1.
- The close proximity of the Bundle of His to the aortic valve explains why aortic valve procedures sometimes result in heart block, requiring pacemaker implantation 1.
- The Bundle of His serves as a critical component of the cardiac conduction system, transmitting electrical impulses from the atria to the ventricles to coordinate proper heart contraction.
Clinical Significance
The anatomical relationship between the Bundle of His and the aortic valve has significant clinical implications. For example, patients undergoing aortic valve replacement are at a higher risk of developing conduction abnormalities, such as atrioventricular block, which may require permanent pacing 1. Therefore, it is essential to carefully evaluate patients after aortic valve surgery for signs of conduction abnormalities and to consider permanent pacing if necessary.
From the Research
Location of the Bundle of His
- The Bundle of His is located in proximity to the aortic valve, specifically between the noncoronary cusp and right coronary cusp 2.
- It traverses the membranous part of the ventricular septum as it extends from the atrioventricular node to become the bundle 3.
- The Bundle of His is situated near the membranous septum, which is a fragile area that can be prone to complications such as perimembranous ventricular septal defect following His bundle lead implantation 4.
Relationship to the Aortic Valve
- The Bundle of His is located just below the aortic valve, in the region of the membranous septum 2.
- The proximity of the Bundle of His to the aortic valve makes it a critical area for consideration during ablation procedures to avoid injury to the conduction apparatus 2, 5.
- The anatomical arrangement of the Bundle of His in relation to the aortic valve is important for understanding the development and treatment of arrhythmias, such as para-Hisian arrhythmias 3.
Anatomical Variations
- There can be variations in the anatomy of the Bundle of His, including its relationship to the interventricular septum and the origin of the bundle branches 6.
- The Bundle of His can traverse the right interventricular septal crest, and the left bundle branch origin can be a narrow stem crossing from right to left through the inferior margin of the membranous septum 6.