Ultrastructure of sarcoplasmic reticulum in atrial myocardium of patients with mitral valvular disease.

Alterations observed in the sarcoplasmic reticulum of muscle cells in left and right atrial myocardium from 10 patients with mitral valvular disease consisted of: a) proliferation of rough-surfaced endoplasmic reticulum, which formed large cisterns in perinuclear areas of hypertrophied cells and was considered indicative of increased protein synthesis; b) proliferation of free sarcoplasmic reticulum, a change that occurred in degenerated cells and appeared to be related to loss of contractile elements; c) two types of aggregates of tubules of free SR--one type was associated wtih abnormal Z-band material and was found only in cells showing loss of myofibrils and proliferation of free SR, whereas the other was not associated with either of these changes and occurred in less severely altered cells; and d) proliferation and enlargement of cisterns of extended junctional sarcoplasmic reticulum, which formed two distinct types of complexes: the first of these consisted of large, convoluted (Type A) cisterns that were wide (550 to 650 A in thickness) and did not have a central dense lamina; the second was composed of stacks of concentric or parallel (Type B) cisterns that were narrower (220 to 300 A in thickness), had a central dense lamina, and were separated from one another by layers of glycogen granules. The formation of these complexes of cisterns was regarded as an extreme form of overdevelopment of extended junctional sarcoplasmic reticulum in atrial muscle cells.