Gross and microscopic anatomy of the human intrinsic cardiac nervous system

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Abstract
The extent and locations of intrinsic cardiac ganglia on the human heart were investigated to facilitate studying their function. The locations and number of major intrinsic cardiac ganglia were determined in six human hearts by means of microdissection following methylene blue staining. Light and electron microscopic analyses were performed on right atrial and cranial medial ventricular ganglia obtained from 12 other human hearts. Gross anatomy: Collections of ganglia associated with nerves, i.e., ganglionated plexuses, were observed consistently in five atrial and five ventricular regions. Occasional ganglia were located in other atrial and ventricular regions. Atrial ganglionated plexuses were identified on 1) the superior surface of the right atrium, 2) the superior surface of the left atrium, 3) the posterior surface of the right atrium, 4) the posterior medial surface of the left atrium (the latter two fuse medially where they extend anteriorly into the interatrial septum), and 5) the inferior and lateral aspect of the posterior left atrium. Ventricular ganglionated plexuses were located in fat 1) surrounding the aortic root, 2) at the origins of the right and left coronary arteries (the latter extending to the origins of the left anterior descending and circumflex coronary arteries), 3) at the origin of the posterior descending coronary artery, 4) adjacent to the origin of the right acute marginal coronary artery, and 5) at the origin of the left obtuse marginal coronary artery. Microscopic anatomy: Ganglia ranged in size from those containing a few neurons to large ganglia measuring up to 0.5 × 1 mm. The human heart is estimated to contain more than 14,000 neurons. Neuronal somata varied in size and shape. Many axon terminals in intrinsic cardiac ganglia contained large numbers of small, clear, round vesicles that formed asymmetrical axodendritic synapses, whereas a few axons contained large, dense-cored vesicles. The human intrinsic cardiac nervous system is distributed more extensively than was considered previously, most of its ganglia being located on the posterior surfaces of the atria and superior aspect of the ventricles. Each ganglion therein contains a variety of neurons that are associated with complex synaptology. Anat. Rec. 247:289-298, 1997.

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