The Right Ventricular Moderator Band: From Leonardo da Vinci's Drawings to Current Cardiac Imaging

David González-Casal; Damián Sánchez-Quintana; Alejandro Jiménez Restrepo; Tomás Datino; Vicente Martínez de Vega; Silvia Bayona Horta; Adolfo Fontela; Belén Terol Espinosa de Los Monteros; Sergio Hernández Jiménez; José-Ángel Cabrera

doi:10.1016/j.jaccas.2024.102647

The Right Ventricular Moderator Band: From Leonardo da Vinci's Drawings to Current Cardiac Imaging

JACC Case Rep. 2024 Nov 6;29(21):102647. doi: 10.1016/j.jaccas.2024.102647.

Affiliations

¹ Cardiology Department, Hospital Universitario QuirónSalud, European University of Madrid, Madrid, Spain.
² Department of Human Anatomy, Faculty of Medicine, Badajoz, Spain.
³ University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁴ Florida Electrophysiology Associates, Atlantis, Florida, USA.
⁵ Radiology Department, Hospital Universitario QuirónSalud, European University of Madrid, Madrid, Spain.

Abstract

Anatomy: We aim to review the anatomy of the moderator band (MB) and the trabeculated right ventricle (RV).

Pathology: We thoroughly describe the morphological variations of the MB and its spatial relationship with the right ventricular anterior papillary muscle, its muscular trabeculations, and the free wall.

Imaging correlation: We provide echocardiography, computed tomography, and magnetic resonance imaging to better understand histologic specimens of the MB, the trabeculated RV, and the right ventricular papillary muscles.

Treatment: We provide examples of intracardiac echocardiography and transesophageal echocardiogram to guide safe and effective structural interventions in the RV, and mapping and ablation of ventricular arrhythmias arising from the MB.

Keywords: MR sequences; computed tomography; echocardiography; electroanatomical mapping; imaging; right ventricle; three-dimensional imaging; tricuspid valve.