Observations on the development of the human atrioventricular node and bundle.

This light microscopic study of the cardiac junctional tissues was based on 27 human embryos, fetuses and postnatal hearts. Evidence was presented that superficial and deep portions of the postnatal AV node were derived from two cellular primordia in the posterior wall of the common atrium at the 6-mm stage. The small right primordia was associated with the right venous valve and give rise to the loosely organized superficial AV node that extended posteriorly to the coronary sinus ostium. A larger left primordia formed the more compact deep subdivision of the AV node located against the anulus fibrosus. In most postnatal hearts the two subdivisions are partially or completely fused to form the adult AV node. Failure of the nodal primordia to fuse during cardiogenesis may result in two separate nodal cell aggregates above the anulus. The present observations provide a rational explanation for the two AV nodal masses described in the literature and an additional specimen that is illustrated in this communication. An AV bundle was first identified in a 13-mm embryo and appeared to be derived from large clear cells of the posterior AV canal. At 25 mm the bundle formed a broad band across the top of the IV septum and continued into both ventricles. At this stage multiple cell strands penetrated the endocardial cushion to connect the AV bundle to the two nodal primordia. Failure of normal fusion between the AV node primordia and AV bundle can result in a variety of junctional anomalies including congenital heart block.