Closure of muscular ventricular septal defects guided by en face reconstruction and pictorial representation Kothandam Sivakumar, DM, Sivadasan Radha.

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Closure of muscular ventricular septal defects guided by en face reconstruction and pictorial representation Kothandam Sivakumar, DM, Sivadasan Radha Anil, DNB, Suresh G Rao, MCh, Krishnanaik Shivaprakash, MCh, Raman Krishna Kumar, DM The Annals of Thoracic Surgery Volume 76, Issue 1, Pages 158-166 (July 2003) DOI: 10.1016/S0003-4975(03)00336-9

Fig 1 Right ventricular septal landmarks: 1 = tricuspid annulus at septal leaflet attachment; 2 = posterior margin of ventricular septum; 3 = apex of right ventricular sinus; 4 = septal band; 5 = moderator band; 6 = apex of right ventricular infundibulum; 7 = anterior margin of ventricular septum; 8 = outflow septum; and 9 = membranous septum. The Annals of Thoracic Surgery 2003 76, 158-166DOI: (10.1016/S0003-4975(03)00336-9)

Fig 2 Subxiphoid short axis sweeps from basal to apical septum. Frame 1 illustrates the inflow septum in close vicinity to the base of MV and TV and frame 2 cuts through the belly of the AV valves (arrows = a large posterior muscular VSD). Frame 3 cuts through the septum immediately below the tips of the AV valve leaflets. Here the dimension of the VSD has reduced, giving a clue of the shape of the VSD, reconstructed in the diagram (frame 5). Frame 4 is at the level of the papillary muscles and the septal band in trabecular septum. The VSD is not imaged in this plane. The arrows in the drawing of the right ventricular surface are numbered and indicate the planes of section for the corresponding frames. The shaded area in the diagram (frame 5) represents the VSD. (AV = atrioventricular; LV = left ventricle; MV = mitral valve; RV = right ventricle; TV = tricuspid valve; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2003 76, 158-166DOI: (10.1016/S0003-4975(03)00336-9)

Fig 3 Apical sweep from posterior to anterior plane (same patient as illustrated in Fig 2). Frame 1 cuts through the posterior-most portion of the ventricular septum. Frame 2 cuts through the mid portions of the AV valves, and frame 3 illustrates the anterior portions of the AV valves. The VSD is seen in all three frames. The arrows indicate the deficient juxta-tricuspid rim. Further anterior sweep (frame 4) through the membranous septum and aortic valve does not reveal the defect. The numbered arrows in the drawing (Frame 5) indicate the planes of section for the corresponding frames and the shaded area represents the VSD. The arrowheads on the echocardiogram frames 2 and 3 indicate the crux of the heart. (AV = atrioventricular; LV = left ventricle; RV = right ventricle; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2003 76, 158-166DOI: (10.1016/S0003-4975(03)00336-9)

Fig 4 Parasternal short-axis sweep in a patient with a large mid-muscular VSD. Frame 1 reveals the intact inlet septum at the levels of the belly of the MV and TV. Frame 2 cuts through the trabecular septum at the level of MB insertion site. Here, a hypertrophied septal band may render the margins of a VSD irregular. Frame 3 illustrates the most apical cut. The VSD is not visualized. The numbered arrows in the drawing (Frame 4) indicate the planes of section for the corresponding frames, and the shaded area represents the VSD. (LV = left ventricle; MB = moderator band; MV = mitral valve; RV = right ventricle; TV = tricuspid valve; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2003 76, 158-166DOI: (10.1016/S0003-4975(03)00336-9)