Anat Cell Biol.  2018 Dec;51(4):266-273. 10.5115/acb.2018.51.4.266.

Ganglion cardiacum or juxtaductal body of human fetuses

  • 1Department of Anatomy and Institute of Medical Science, Chonbuk National University Medical School, Jeonju, Korea.
  • 2Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan, Korea.
  • 3Department of Anatomy, Wuxi Medical School, Jiangnan University, Wuxi, China.
  • 4Division of Internal Medicine, Asuka Hospital, Sapporo, Japan.
  • 5Department of Anatomy, Akita University School of Medicine, Akita, Japan.


The ganglion cardiacum or juxtaductal body is situated along the left recurrent laryngeal nerve in the aortic window and is an extremely large component of the cardiac nerve plexus. This study was performed to describe the morphologies of the ganglion cardiacum or juxtaductal body in human fetuses and to compare characteristics with intracardiac ganglion. Ganglia were immunostained in specimens from five fetuses of gestational age 12-16 weeks and seven fetuses of gestational age 28-34 weeks. Many ganglion cells in the ganglia were positive for tyrosine hydroxylase (TH; sympathetic nerve marker) and chromogranin A, while a few neurons were positive for neuronal nitric oxide synthase (NOS; parasympathetic nerve marker) or calretinin. Another ganglion at the base of the ascending aorta carried almost the same neuronal populations, whereas a ganglion along the left common cardinal vein contained neurons positive for chromogranin A and NOS but no or few TH-positive neurons, suggesting a site-dependent difference in composite neurons. Mixtures of sympathetic and parasympathetic neurons within a single ganglion are consistent with the morphology of the cranial base and pelvic ganglia. Most of the intracardiac neurons are likely to have a non-adrenergic non-cholinergic phenotype, whereas fewer neurons have a dual cholinergic/noradrenergic phenotype. However, there was no evidence showing that chromogranin A- and/or calretinin-positive cardiac neurons corresponded to these specific phenotypes. The present study suggested that the ganglion cardiacum was composed of a mixture of sympathetic and parasympathetic neurons, which were characterized the site-dependent differences in and near the heart.


Ganglion cardiacum; Juxtaductal body; Chromogranin A; Neuronal nitric oxide synthase; Human fetuses

MeSH Terms

Calbindin 2
Chromogranin A
Ganglion Cysts*
Gestational Age
Nitric Oxide Synthase Type I
Recurrent Laryngeal Nerve
Skull Base
Tyrosine 3-Monooxygenase
Chromogranin A
Nitric Oxide Synthase Type I
Tyrosine 3-Monooxygenase


  • Fig. 1 Schematic representation of the cardiac nerve plexus and ganglion cardiacum. Ventral view of the heart in adults. The ganglion cardiacum is located near the ligamentum arteriosum (ligament) and along the left laryngeal recurrent nerve (LRN). AO, ascending aorta; PA, pulmonary arterial trunk; SVC, superior vena cava.

  • Fig. 2 The ganglion cardiacum at gestational age 10 weeks (crown-rump length 50 mm). Sagittal sections. Panels A and B are stained with hematoxylin and eosin, and panels C, D, and E with antibodies to S100, chromogranin A (chrA), and smooth muscle action (SMA), respectively. Panel A is 50 microns anterior to panel B; panel C corresponds to a square in panel A; and panels D and E correspond to the ganglion cardiacum (ggl) in a square in panel C. The ggl contains a large number of chrA-positive cells, but it does not express SMA. AO, aorta, BO, Botallo's duct (ductus arteriosus); BR, left main bronchus; LA, left atrium; LCCV, left common cardinal vein; PA, pulmonary artery; RAU, right auricle; RV, right ventricle; X, vagus nerve. Scale bars=1 mm (A–C), 0.1 mm (D, E).

  • Fig. 3 The ganglion cardiacum (ggl) at gestational age 14 weeks (crown-rump length 106 mm). Sagittal sections stained with antibodies to S100 protein (A), chromogranin A (chrA) (B, F), tyrosine hydroxylase (TH) (C, D), and neuronal nitric oxide synthase (NOS) (E). Panels B and C show sections near panel A. Panel D (or F) is a higher magnification view of a square in panel C (or B). Panels D and E display adjacent sections. The ggl contains abundant neurons expressing chrA (F) or TH (arrows in D), but few NOS-positive cells (arrows in E). A cell mass near the ganglion (star in panels A–C) contains nerves positive for S100 and chrA (A, B). The other ganglion near the aortic valve (AOV) is shown in Fig. 5. AO, aorta, BO, Botallo's duct (ductus arteriosus); BR, left main bronchus; ES, esophagus; LA, left atrium; LCCV, left common cardinal vein; PA, pulmonary artery; THY, thymus. Scale bars=1 mm (A–C), 0.1 mm (D–F).

  • Fig. 4 The ganglion cardiacum (ggl) at gestational age 28 weeks (crown-rump length 235 mm). Sagittal sections stained with antibodies to S100 protein (B), smooth muscle actin (SMA) (C) and calretinin (CAL) (D, E). Panels B–E represent nearly sections, with panel E showing a plane 0.1 mm posterior to panel D. In panel B, the ggl surrounds the left laryngeal recurrent nerve (LRN). The ggl is negative for SMA (C) and contains few neurons positive for calretinin (D, E). AO, aorta, BO, Botallo's duct (ductus arteriosus); BR, left main bronchus; LY, lymph nodes; X, vagus nerve. Scale bars=1 mm (A–C), 0.1 mm (D, E).

  • Fig. 5 Ganglion cell clusters other than the ganglion cardiacum. Sagittal sections stained with antibodies to tyrosine hydroxylase (TH) (A, C, F), neuronal nitric oxide synthase (NOS) (B, D, G) and chromogranin A (chrA) (E, H). Panels A and B display a ganglion adjacent to the aortic valve (AOV; topographical anatomy, see the upper circle in Fig. 3A), while panels C–E display a small ganglion (arrow) near the left common cardinal vein (LCCV; topographical anatomy, see the lower circle in Fig. 3A). The former ganglion contains abundant TH-positive neurons (A), whereas the latter ganglion is negative for neurons expressing TH (C). Panels F–H show intramural neurons of the esophagus (ES). TH-positive nerves are present near (arrows in panel F), but not in the ES. All panels were prepared at the same magnification. Scale bar=0.1 mm (A).


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