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The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias

Dave T. Kim, MD^*, Angela C. Lai, BS^*, Chun Hwang, MD, FACC^*, Ling-Tao Fan^*, Hyrar S. Karagueuzian, PhD, FACC^*, Peng-Sheng Chen, MD, FACC^* and Michael C. Fishbein, MD, FACC

^* Division of Cardiology, Department of Medicine at Cedars-Sinai Medical Center/UCLA, Los Angeles, California, USA
Department of Pathology and Laboratory Medicine at UCLA School of Medicine, Los Angeles, California, USA

View larger version (105K): [in a new window]   Figure 1 Ligament of Marshall: a) Gross photo showing location on posterior surface of heart: CS = coronary sinus; LAA = left atrial appendage; LOM = ligament of Marshall; PV = left superior pulmonary vein. b) Immunohistochemical staining for tyrosine hydroxylase showing positively in nerve (brown staining—arrow). M = myocardium; F = fat. (avidin-biotin-peroxidase, x120). c to e) Subserial sections showing the ligament of Marshall (LOM), isolated from the left atrial wall (in c), with 3 tracts (arrows) emerging from it (in d) and eventually inserting into the atrial wall (in e) (hematoxylin and eosin [H&E] stain x10). f) Section from lower end of LOM showing tract inserting into the left atrial wall (arrow) and coronary sinus (CS) (H&E stain x10).