Morphology of the tendon of Todaro within the human heart in ontogenesis

Abstract

The tendon of Todaro, found in the right atrium of the heart, has considerable clinical importance in the fields of both cardiac surgery and invasive cardiology. The goal of this study is to examine the occurrence and degree of development of the tendon of Todaro in humans. Research was conducted on material consisting of 160 human hearts of both sexes from the age of 14 Hbd to 87 years of age. Classical anatomical methods were used and histological sections were prepared from 100 hearts of various age groups stained in Masson’s method with Goldner’s modification. The tendon of Todaro occurred in all examined hearts. In foetal hearts, in the area typical of the course of the tendon of Todaro, a very well-developed, “white-like” structure was observed, convexed into the lumen of the atrium. Histologically, this was young fibrous tissue with a characteristically large number of fibroblasts. Evenly in infants and newborns, a visible convex structure was also observed extending into the lumen of the right ventricle, however, to a lesser degree than in foetuses. In the group of hearts of young adults, it was also possible to follow the course of the tendon of Todaro macroscopically. However, the older the heart was, the less the convex was visible, and in older adults it was completely invisible. In histological sections, it was observed that with ageing the number of connective tissue cells decreased, and fibres forming the lining increased. In the hearts of older adults the tendon of Todaro formed very small ribbons of connective tissue. Histologically, only small numbers of cellular elements were noticed. In the adult heart the examined tendon was located the deepest and did not connect to the endocardium. We can conclude that tendon of Todaro is a stable structure, occurring in all examined hearts even when it is not macroscopically visible. Due to the morphological changes that affect the tendon of Todaro in human ontogenesis, for the cardiac surgeon, its relevance as an important topographical structure in the hearts of older adults is minimal.