The relationship of the outlet septum to the aortic outflow tract in hearts with interruption of the aortic arch Hala M.F. Al-Marsafawy, MD*, Siew Yen.

Slides:

Advertisements

Similar presentations

Ventricular septal defects

Advertisements

Repair of Truncus Arteriosus With Interrupted Aortic Arch

Henrik Ø. Andersen, MD, PhD, Marc R. de Leval, MD, Victor T

Surgical treatment of subaortic stenosis after biventricular repair of double-outlet right ventricle Emre Belli, MD, Alain Serraf, MD, François Lacour-Gayet,

A. Transthoracic echocardiogram (ECHO) in patient with double outlet right ventricle with subaortic VSD. Left image: Subcostal four-chamber view with anterior.

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

Surgical management of the straddling mitral valve in the biventricular heart Ryo Aeba, MD, Toshiyuki Katogi, MD, Shigeyuki Takeuchi, MD, Shiaki Kawada,

Operative Techniques for Repair of Muscular Ventricular Septal Defects

Morphologic features of atrioventricular septal defect with only ventricular component: Further observations pertinent to surgical repair Iki Adachi,

Wretched Excess: Stool-softener Abuse and Cardiogenic Shock

Sitaram M. Emani, MD, Pedro J. del Nido, MD

Repair of Atrioventricular Septal Defect Associated With Tetralogy of Fallot or Double- Outlet Right Ventricle: 30 Years of Experience Jeremy Ong, BMedSci,

Coarctation of the aorta with right aortic arch and isolation of the left innominate artery: A surgical challenge in a patient without collateral posterior.

Aortic Translocation for Repair of Transposition of the Great Arteries (S,D,L) With Ventricular Septal Defect and Pulmonic Stenosis Justin G. Reeves,

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

Mitral leaflet anatomy revisited

Pulmonary and aortic root translocation in the management of transposition of the great arteries with ventricular septal defect and left ventricular outflow.

Morphologic Spectrum of Ventriculoarterial Connection in Hearts With Double Inlet Left Ventricle: Implications for Surgical Procedures Hideki Uemura,

The conduction system in hearts with pulmonary atresia and intact ventricular septum Aneel Ansari, MBBS, Diane Goltz, MD, Karen Patricia McCarthy, BS,

Surgically created double orifice repair of tricuspid regurgitation in infants with congenital heart disease Toyoki Fukuda, MD, Ichiro Kashima, MD, Shigeki.

Hideki Uemura, MD, Iki Adachi, MD, Karen P

Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy: The preferred approach for contemporary surgical candidates?

Tomoharu Akiba, MD*, Anton E. Becker, MD

Mazyar Kanani, MRCS, Antoon F. M. Moorman, PhD, Andrew C

Mobilization of the left and right fibrous trigones for relief of severe left ventricular outflow obstruction Magdi Yacoub, FRCS, FRCP, Obed Onuzo, MRCP,

Transatrial Repair of Tetralogy of Fallot

One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: A novel approach Giovanni Battista.

Doubly Committed and Juxtaarterial Ventricular Septal Defect: Outcomes of the Aortic and Pulmonary Valves Paul J. Devlin, BA, Hyde M. Russell, MD, Michael.

Interventricular communication in complete atrioventricular septal defect Kiyoshi Suzuki, MD, PhD, Siew Yen Ho, PhD, Robert H Anderson, MD, Anton E Becker,

Jong Hun Kim, MD, Jong Bum Choi, MD

The Ross Procedure: New Insights Into the Surgical Anatomy

Morphologic spectrum of truncal valvar origin relative to the ventricular septum: Correlation with the size of ventricular septal defect Iki Adachi,

Transposition of the great arteries {S, D, L}

Results of allograft aortic valve replacement for complex endocarditis

Cleft mitral valve without ostium primum defect: anatomic data and surgical considerations based on 41 cases Stella Van Praagh, MD, Diego Porras, MD,

Subaortic stenosis in the spectrum of atrioventricular septal defects

Anatomy of the muscular subpulmonary infundibulum with regard to the Ross procedure Anna F Merrick, Magdi H Yacoub, Siew Yen Ho, PhD, Robert H Anderson,

Roxane McKay, MD, FRCS, FRCSCa, Robert H. Anderson, BSc, MD, FRCPathb

Robot-assisted septal myectomy for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction Zain Khalpey, MD, PhD, MRCS (Eng), Lev.

Anatomy of the ventricular septal defect in outflow tract defects: Similarities and differences Meriem Mostefa-Kara, MD, Damien Bonnet, MD, PhD, Emre.

Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of valsalva, and ventricular septal defect Magdi.

The morphologic nature of noncommitted ventricular septal defects in specimens with double-outlet right ventricle Rudolf P. Beekman, MD, PhDa, Margot.

Postinfarction ventricular septal rupture: Repair by endocardial patch with infarct exclusion Tirone E. David, MD, Laura Dale, RN (by invitation), Zhao.

Coronary blood supply of the inferior wall of the right ventricle in hearts with Ebstein malformation: relevance to vertical plication Iki Adachi, MD,

What is a ventricle? The Annals of Thoracic Surgery

Sixty Years After Tetralogy of Fallot Correction

Pulmonary root translocation for biventricular repair of double-outlet left ventricle with absent subpulmonic conus Doff B. McElhinney, MS, V.Mohan Reddy,

Anna Marciniak, PhD, Georgios T

Conotruncal Repair For Tetralogy Of Fallot: Midterm Results

Doff B. McElhinney, MSa, V. Mohan Reddy, MDa, Michael M

Clarifying the Surgical Morphology of Inlet Ventricular Septal Defects

Albert Starr, MD, Hagop Hovaguimian, MD

A simplified categorization for common arterial trunk

Surgical approaches for double-outlet right ventricle or transposition of the great arteries associated with straddling atrioventricular valves Alain.

Morphologic spectrum of ebstein's malformation: Revisitation relative to surgical repair Christian Schreiber, MD, Andrew Cook, BSc, Siew Yen Ho, PhD,

Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy Giovanni Stellin, MD, Massimo Padalino, MD,

Iki Adachi, MD, Siew Yen Ho, PhD, FRCPath, Karen P

Nikaidoh Procedure: How I Teach It

Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor.

Fig. 1. Bj mutant exhibits outflow tract malalignment defects.

Half-turned truncal switch operation for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis Masaaki Yamagishi,

Prioritizing quality improvement in pediatric cardiac surgery

Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae Kenji Minakata, MD, Joseph A.

Ross-Konno procedure in neonates: report of three patients

The Rastelli Operation

Management and outcome of patients with abnormal ventriculo-arterial connections and mitral valve cleft Alain Fraisse, MD, Tony Abdel Massih, MD, Pascal.

Echo-free perfused spaces: A current postoperative finding after homograft replacement of the aortic valve T. Carrel, MD, M. Pasic, MD, E. Oechslin,

Filip Casselman, MD, PhD, FETCS, Hugo Vanermen, MD, FETCS

Aspects of paediatric cardiovascular pathology

Further Anatomical Insights Regarding the Ross Procedure

Presentation transcript:

The relationship of the outlet septum to the aortic outflow tract in hearts with interruption of the aortic arch Hala M.F. Al-Marsafawy, MD*, Siew Yen Ho, PhD, MRCPath, Andrew N. Redington, MD, FRCP, Robert H. Anderson, MD, FRCPath The Journal of Thoracic and Cardiovascular Surgery Volume 109, Issue 6, Pages 1225-1236 (June 1995) DOI: 10.1016/S0022-5223(95)70207-5 Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 Diagram showing concept of septal malalignment and deviation as distinguished by viewing heart along its short axis (A) and long axis (B), respectively. Malalignment is present when outlet septum makes an angle (θº) with muscular ventricular septum. Deviation is described when outlet septum tilts along its axis and protrudes into left or right ventricular outflow tract. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 a, Right ventricular view of this heart shows VSD situated between anterior (A) and posterior (P) limbs of septomarginal trabeculation (SMT). This defect is described as perimembranous owing to fibrous continuity between tricuspid and mitral valves at its posteroinferior margin (star). Pulmonary valve arises exclusively from right ventricle. Outlet septum roofs VSD and passes to left ventricle. Pulm., Pulmonary. b, This heart has interruption of aortic arch (double-ended arrow) between left common carotid and left subclavian arteries. VSD, viewed from right ventricle, has muscular posteroinferior (post. inf.) border. Asc., Ascending; Desc., descending. c, This heart, sectioned through arterial outflow tracts, shows doubly committed and juxta-arterial VSD with biventricular attachments of aortic valve. Outlet septum is absent. Arrow points to fibrous raphe between arterial valves. Pulm., Pulmonary. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 a, Right ventricular view of this heart shows VSD situated between anterior (A) and posterior (P) limbs of septomarginal trabeculation (SMT). This defect is described as perimembranous owing to fibrous continuity between tricuspid and mitral valves at its posteroinferior margin (star). Pulmonary valve arises exclusively from right ventricle. Outlet septum roofs VSD and passes to left ventricle. Pulm., Pulmonary. b, This heart has interruption of aortic arch (double-ended arrow) between left common carotid and left subclavian arteries. VSD, viewed from right ventricle, has muscular posteroinferior (post. inf.) border. Asc., Ascending; Desc., descending. c, This heart, sectioned through arterial outflow tracts, shows doubly committed and juxta-arterial VSD with biventricular attachments of aortic valve. Outlet septum is absent. Arrow points to fibrous raphe between arterial valves. Pulm., Pulmonary. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 a, Right ventricular view of this heart shows VSD situated between anterior (A) and posterior (P) limbs of septomarginal trabeculation (SMT). This defect is described as perimembranous owing to fibrous continuity between tricuspid and mitral valves at its posteroinferior margin (star). Pulmonary valve arises exclusively from right ventricle. Outlet septum roofs VSD and passes to left ventricle. Pulm., Pulmonary. b, This heart has interruption of aortic arch (double-ended arrow) between left common carotid and left subclavian arteries. VSD, viewed from right ventricle, has muscular posteroinferior (post. inf.) border. Asc., Ascending; Desc., descending. c, This heart, sectioned through arterial outflow tracts, shows doubly committed and juxta-arterial VSD with biventricular attachments of aortic valve. Outlet septum is absent. Arrow points to fibrous raphe between arterial valves. Pulm., Pulmonary. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 Two hearts showing septal malalignment. a, This left ventricular view shows anterior component of outlet septum malaligned and attached to anterolateral wall of left ventricle (star). b, Outlet septum in this heart is short and hinged to posterior margin (star) of VSD. Its anterior component, out of alignment with muscular ventricular septum, is attached to anomalous muscle bundle. Ant. lat., Anterolateral. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4 a,Right ventricular view of this heart shows VSD between limbs (anterior, A; posterior, P) of septomarginal trabeculation (SMT). Septal malalignment is not apparent in this view. Double-ended arrow indicates interruption of aortic arch between left common carotid and subclavian arteries. Pulm., Pulmonary. b, This dissection of left ventricle of same heart shows outlet septum veering away from ventricular septum to be attached to anterolateral muscle bundle. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 5 a, Right ventricular view of this heart shows perimembranous VSD extending apically toward trabecular portion. Diminutive outlet septum is hinged to anterior limb (A) of septomarginal trabeculation (SMT). P, posterior; Pulm., pulmonary. b, Outlet septum (arrows) inserts into anterolateral wall (star) in left ventricle. Posteroinferior margin (triangle) of VSD is area of fibrous continuity between tricuspid, aortic, and mitral valves. Aortic valve has two leaflets. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 6 Two hearts showing differing degrees of development of outlet septum. a, This right ventricular view of first heart shows diminished subpulmonary (Subpulm.) infundibulum at roof of VSD. Broken line marks attachments of leaflet of pulmonary (Pulm.) valve. b, Same heart, viewed from left, shows how small outlet septum is. In this display, outflow tracts are distorted such that pulmonary (Pulm.) valve is visible through VSD. However, view in a clearly shows no override of pulmonary valve across septum. c, Second heart shows extensive subpulmonary (Subpulm.) infundibulum with attachments of pulmonary valve solely to right ventricle. Outlet septum (star) also appears extensive. d, When sectioned through outflow tracts, much of "outlet septum" is in reality musculature of subpulmonary infundibulum (double-ended arrow). Outlet septum (brace) when measured from its free edge to attachment of leaflets of aortic valve (broken line) is relatively short. Pulm., Pulmonary. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 6 Two hearts showing differing degrees of development of outlet septum. a, This right ventricular view of first heart shows diminished subpulmonary (Subpulm.) infundibulum at roof of VSD. Broken line marks attachments of leaflet of pulmonary (Pulm.) valve. b, Same heart, viewed from left, shows how small outlet septum is. In this display, outflow tracts are distorted such that pulmonary (Pulm.) valve is visible through VSD. However, view in a clearly shows no override of pulmonary valve across septum. c, Second heart shows extensive subpulmonary (Subpulm.) infundibulum with attachments of pulmonary valve solely to right ventricle. Outlet septum (star) also appears extensive. d, When sectioned through outflow tracts, much of "outlet septum" is in reality musculature of subpulmonary infundibulum (double-ended arrow). Outlet septum (brace) when measured from its free edge to attachment of leaflets of aortic valve (broken line) is relatively short. Pulm., Pulmonary. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 7 This section through heart with doubly committed and juxta-arterial VSD shows override of pulmonary valve across crest (triangle) of defect. Posteroinferior border of defect is muscular (star). In absence of outlet septum, raphe (arrow) between aortic and pulmonary (Pulm.) valves is malaligned into left ventricle. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 8 Outlet septum in this heart is in alignment with rest of ventricular septum but its inferior part (arrowheads) protrudes into aortic outflow tract. Pulmonary valve (dotted line) is attached at considerably higher level than aortic valve (broken line). Double-ended arrow indicates long subpulmonary infundibulum and brace marks true length of outlet septum. Pulm., Pulmonary. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 9 There is near alignment of septal structures but anomalous attachments of cleft of mitral valve together with anterolateral muscle bundle obstruction of aortic outflow. Tear in area of anomalous attachment (small arrows) is artifactual. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 1225-1236DOI: (10.1016/S0022-5223(95)70207-5) Copyright © 1995 Mosby, Inc. Terms and Conditions