Sinotubular junction (STJ)

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at www.nih.gov

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Details: Published: April 07, 2015

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The sinotubular junction (STJ) is a well-defined circular ridge found between the superior or tubular segment of the ascending aorta and the inferior, bulbous segment of the ascending aorta, known as the aortic root.

The STJ follows the superior contour of the three sinuses of Valsalva that form the bulbs of the aortic root and intersects the commissures of the aortic valve. In the accompanying image the STJ is depicted by a blue dotted line and the commissures are depicted by green arrows.

The ostia of the coronary arteries are usually found inferior to the STJ, although they can be on it or superior to the STJ. There seems to be a correlation with anomalous origins of the coronary ostia and sudden-death syndrome.

The image also shows the three cusps of the aortic valve: the non-coronary cusp (NCC), the right coronary cusp (RCC) and the left coronary cusp (LCC). The blue arrows indicate the location of the nodules of Arantius.

Medical terminology notes: There are many scholarly texts that hyphenate the word as [sino-tubular]. This is incorrect, as the root term is [-sin-], meaning "sinus". The addition of the [-o-] to the root term creates the combining form [-sino-] which is then used to connect to the root term [-tubul-]. Since it is a vowel and a consonant combining and they are euphonic, there is no need to add the hyphen. In fact, a word should use as a combining element either a hyphen or an [-o-], but not both. The word with the hyphen then should be [sin-tubular] which is definitely not euphonic. For more information on combining root terms, click here.

Others write [sinutubular]. The paragraph above clearly explains why this is a mistake. The root term is [-sin-] meaning "sinus" and the addition of the [-o-] creates the combining form [-sino-] and not [-sinu-].

Sources:
1. “Clinical Anatomy of the Aortic Root” Anderson, RH Heart 200; 84: 670–673
2. “The Anatomy of the Aortic Root” Loukas, E et al. Clin Anat 2014; 27:748-756
3: "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
Image property of: CAA.Inc.Photographer: D.M. Klein

Sinotubular junction (STJ)

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