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A modified technique of heart dissection is proposed to prevent the damage to the conducting system.

Cytoarchitectonics and ultrastructure of the node and conducting myocardiocytes of the conducting system of the heart and surrounding blood capillaries and nervous fibers are described. In diphtheria, metabolic and destructive changes were found in the node myocytes, conducting myocardiocytes and surrounding structures. The most noticeable changes were seen in the left pedicle of the atrioventricular fascicle and later others components of the conducting heart system. These changes are more pronounced in clear cells of conducting myocardiocytes as compared to the node myocytes.

Aim: Comparison of the results of clinical device investigations of the heart with morphological autopsy evidence in diphtheria., Material and Methods: Hearts of 309 patients with diphtheria aged 25 to 80 years and 60 hearts of patients who died of diphtheria were investigated using ECG, echo-CG, doppler echo-CG, Holter ECG monitoring, biochemical tests of blood. Structural study of cardiac conduction included examination of the sinus-atrial node, atrioventricular node and bundle regarding the adjacent myocardium., Results: Variants of structural-functional state of the myocardium and conduction system are explained by variability of the pathological processes which arose due to individual features of the conduction system structure and location, relationships with the myocardium. In acute diphtheria (day 1-10) dystrophic, necrobiotic and vascular disorders prevailed followed on days 11-30 by inflammation ending in myocardiosclerosis. Nodes and bundles of the conduction system are affected less frequently than the myocardium., Conclusion: A correlation exists between structural state of the cardiac conduction system and variants of clinical affection of the heart in diphtheria.

Heart conductive system (HCS) including the sinoatrial node (SAN), atrioventricular node (AVN), AV bundle (AVB) and its left and right parts was studied histologically. It is shown that different portions of HCS are damaged in diphtheria with different frequency and intensity, the frequency depending on the depth of their location. Left part of AVB is affected most frequently, followed by the right part of AVB, AVB, AVN and the least frequently SAN.

In 112 preparations of hearts from persons at the age of 18-87 years by means of the preparation method (77 hearts) and in histograms stained after Van Gieson, Mallory, Heidenhain and Masson (35 hearts), certain new data on the cardiac conduction system (CCS) have been obtained. A number of fasciculi connected with the sinuatrial and atrioventricular nodes have been revealed. The atrioventricular part of the CCS, as a more ancient one, is characterized by a more constant structure and topography. The sinuatrial part of the CCS, being phylogenetically younger, has a high degree of individual anatomical changeability.