The left ventricular outflow tract in atrioventricular septal defect revisited: Surgical considerations regarding preservation of aortic valve integrity.

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Presentation transcript:

The left ventricular outflow tract in atrioventricular septal defect revisited: Surgical considerations regarding preservation of aortic valve integrity in the perspective of anatomic observations Yuichi Shiokawa, MD, Anton E. Becker, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 114, Issue 4, Pages 586-593 (October 1997) DOI: 10.1016/S0022-5223(97)70048-5 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 Diagram of the LVOT in hearts with AV septal defect. Shown are the three levels (LVOT-1, LVOT-2, and LVOT-3) at which measurements were taken, together with those of the width of the interventricular septum (IS), the width of the anterior left ventricular (LV) free wall, that of the superior bridging leaflet (SBL), and the length of the tendinous cords. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 AV septal defect of the partial type with separate AV orifices. A, Right ventricular view showing a connecting tongue between the superior (SL) and inferior leaflet (IL). B, Left ventricular view showing direct insertion of the superior leaflet (SL) into the interventricular septum (IS). The “borderline” is only slightly concave. Asterisk shows left ventricular free wall. Ao, Aorta; LV, left ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 AV septal defect of the partial type with separate AV orifices. A, Right ventricular view showing a connecting tongue between the superior (SL) and inferior leaflet (IL). B, Left ventricular view showing direct insertion of the superior leaflet (SL) into the interventricular septum (IS). The “borderline” is only slightly concave. Asterisk shows left ventricular free wall. Ao, Aorta; LV, left ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 AV septal defect of the complete type with a common AV orifice. A, Right ventricular view showing no connecting tongue between the superior bridging leaflet (SBL) and inferior bridging leaflet (IBL). B, Left ventricular view showing attachment between the superior bridging leaflet and ventricular septum by tendinous cords. Subaortic extension of the interventricular septum (IS) is deficient, which creates an almost straight line. Asterisk shows left ventricular free wall. Ao, Aorta; LV, left ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 AV septal defect of the complete type with a common AV orifice. A, Right ventricular view showing no connecting tongue between the superior bridging leaflet (SBL) and inferior bridging leaflet (IBL). B, Left ventricular view showing attachment between the superior bridging leaflet and ventricular septum by tendinous cords. Subaortic extension of the interventricular septum (IS) is deficient, which creates an almost straight line. Asterisk shows left ventricular free wall. Ao, Aorta; LV, left ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 LVOT/ascending aorta ratio in 29 heart specimens, showing the overall results and the subcategorization into those with a common (complete type) and those with two separate AV orifices (partial type). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 AV septal defect of the complete type with a common AV orifice. A, Right ventricular view showing the Rastelli type A arrangement. Left ventricular view (B) shows a reasonably wide LVOT. The concave outline of the interventricular septum (IS) is apparent. Asterisk shows left ventricular free wall. Ao, Aorta; IBL, inferior bridging leaflet; LV, left ventricle; RV, right ventricle; PA, pulmonary artery; SBL, superior bridging leaflet. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 AV septal defect of the complete type with a common AV orifice. A, Right ventricular view showing the Rastelli type A arrangement. Left ventricular view (B) shows a reasonably wide LVOT. The concave outline of the interventricular septum (IS) is apparent. Asterisk shows left ventricular free wall. Ao, Aorta; IBL, inferior bridging leaflet; LV, left ventricle; RV, right ventricle; PA, pulmonary artery; SBL, superior bridging leaflet. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Graphs showing the ratios of the measurements of the interventricular septum (IS), the tendinous cords, the left ventricular (LV) free wall, and the valve leaflet related to the circumference of the ascending aorta. The overall ratios are shown as well as those of hearts with a common (complete type) and separate AV orifice (partial type). AV, Atrioventricular. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Graphs showing the ratios of the measurements of the interventricular septum (IS), the tendinous cords, the left ventricular (LV) free wall, and the valve leaflet related to the circumference of the ascending aorta. The overall ratios are shown as well as those of hearts with a common (complete type) and separate AV orifice (partial type). AV, Atrioventricular. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Graphs showing the ratios of the measurements of the interventricular septum (IS), the tendinous cords, the left ventricular (LV) free wall, and the valve leaflet related to the circumference of the ascending aorta. The overall ratios are shown as well as those of hearts with a common (complete type) and separate AV orifice (partial type). AV, Atrioventricular. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Graphs showing the ratios of the measurements of the interventricular septum (IS), the tendinous cords, the left ventricular (LV) free wall, and the valve leaflet related to the circumference of the ascending aorta. The overall ratios are shown as well as those of hearts with a common (complete type) and separate AV orifice (partial type). AV, Atrioventricular. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Graph showing the proportion of the ratio of the interventricular septum (IS), the tendinous cords, the superior (bridging) leaflet (SBL), and the anterior free wall (FW) compared with the total circumference at the three levels (LVOT-1, LVOT-2, and LVOT-3). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 586-593DOI: (10.1016/S0022-5223(97)70048-5) Copyright © 1997 Mosby, Inc. Terms and Conditions