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The echocardiographic anatomy of ventricular septal defects

Published online by Cambridge University Press:  19 August 2008

Michael A. Gatzoulis ,
Jia Li  and
Siew Yen Ho
Michael A. Gatzoulis
Affiliation:
Paediatrics, Royal Brompton Hospital and Imperial College School of Medicine at National Heart and Lung Institute, London, UK
Jia Li
Affiliation:
Paediatrics, Royal Brompton Hospital and Imperial College School of Medicine at National Heart and Lung Institute, London, UK
Siew Yen Ho*
Affiliation:
Paediatrics, Royal Brompton Hospital and Imperial College School of Medicine at National Heart and Lung Institute, London, UK
*
Dr. S. Y. Ho. Paediatrics, Imperial College School of Medicine at National Heart & Lung Institute, Dovehouse Street, London SW3 6LY. Tel: 0171 3518752; Fax: 0171 3518230.
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Abstract

Many of the controversies surrounding the description of ventricular septal defects arise from differences in the perspectives from which they are viewed. In this review, we analyse these defects as seen in cross-sectional echocardiographic images, correlating them with morphologic specimens. The classification we advocate, which now has a suitable pedigree, is a simple descriptive method distinguishing between perimembranous, muscular, and doubly committed types of defects. The approach is to categorise the defects as seen from the right ventricle, the usual port of access for surgeons. The term ‘perimembranous’ highlights the proximity of the atrioventricular conduction axis to the margin of the defects in which the remnant of the membranous septum forms a direct border. This system is applicable to all interventricular communications, no matter how malformed the heart may be in which they are enclosed.

Keywords

Congenital cardiac malformationsclassificationinterventricular communications
Type
Continuing Medical Education
Information
Cardiology in the Young , Volume 7 , Issue 4 , October 1997 , pp. 471 - 484
Copyright
Copyright © Cambridge University Press 1997

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References

1.Hoffmann, JIE.Incidence, mortality and natural history. In: Anderson, RH, Macartney, FJ, Shinebourne, EA, Tynan, M (eds). Paediatric Cardiology. Edinburgh: Churchill Livingstone. 1987;pp 3–14.Google Scholar
2.Alpert, BS, Mellitis, ED, Rowe, RD. Spontaneous closure of small ventricular septal defects; probability rates in the first five years of life. Am J Dis Child 1973;125:194–196CrossRefGoogle ScholarPubMed
3.Corone, P, Doyen, F, Gaudeau, S, Guerin, F, Vernant, P, Ducam, H, Rumeau-Rouquette, G, Gaudeul, P. Natural history of ventricular septal defect. A study involving 790 cases. Circulation 1977;55:908–915CrossRefGoogle ScholarPubMed
4.Murphy, DJ, Ludomirsky, A, Huhta, JC. Continuous-wave Doppler in children with ventricular septal defect: Non-invasive estimation of interventricular pressure gradient. Am J Cardiol 1986;2:157–171Google Scholar
5.Cooper, MJ, Tyndall, M, Silverman, NH. Evaluation of the responsiveness of elevated pulmonary vascular resistance in children by Doppler echocardiography. J Am Coll Cardiol 1988;12:470–475CrossRefGoogle ScholarPubMed
6.Goldberg, SJ, Sahn, DJ, Allen, HD, Valdes-Cruz, LM, Hoenecke, H, Carnahan, Y. Evaluation of pulmonary and systemic blood flow by two-dimensional Doppler echocardiography using fast Fourier transform spectral analysis. Am J Cardiol 1982;50:1394–1400CrossRefGoogle ScholarPubMed
7.Soto, B, Becker, AE, Moulaert, AJ, Lie, JT, Anderson, RH. Classification of ventricular septal defects. Br Heart J 1980;43:332–343CrossRefGoogle ScholarPubMed
8.Milo, S, Ho, SY, Wilkinson, JL, Anderson, RH. The surgical anatomy and atrioventricular conduction tissues of hearts with isolated ventricular septal defects. J Thorac Cardiovasc Surg 1980;79:244–255CrossRefGoogle ScholarPubMed
9.Anderson, RH, Becker, AE, Tynan, M. Description of ventricular septal defects – or how long is a piece of string? Int J Cardiol 1986;13:267–278.CrossRefGoogle ScholarPubMed
10.Anderson, RH, Wilcox, BR. The surgical anatomy of ventricular septal defects associated with overriding valvar orifices. J Card Surg 1993;8:130–142.CrossRefGoogle ScholarPubMed
11.Soto, B, Ceballos, R, Kirklin, JW. Ventricular septal defects: a surgical viewpoint. JACC 1989; 14:1291–1297.CrossRefGoogle ScholarPubMed
12.Van, Praagh R, Geva, T, Kreutzer, J. Ventricular septal defects: how shall we describe, name and classify them? JACC 1989;14:1298–1299.Google Scholar
13.Baker, EJ, Leung, MP, Anderson, RH, Fischer, DR, Zuberbuhler, JR. The cross-sectional anatomy of ventricular septal defects: a reappraisal. Br Heart J 1988;59:339–351.CrossRefGoogle ScholarPubMed
14.Kawashima, Y, Danno, M, Shimizu, Y, Matsuda, H, Miyamoto, T. Ventricular septal defect associated with aortic insufficiency: anatomic classification and method of operation. Circulation 1973;47:1057–1064CrossRefGoogle ScholarPubMed
15.Al-Marsafawy, HMF, Ho, SY, Redington, AN, Anderson, RH. The relationship of the outlet septum to the aortic outflow tract in hearts with interruption of the aortic arch. J Thorac Cardiovasc Surg 1995;109:1225–1236.CrossRefGoogle Scholar
16.Oppenheimer-Dekker, A, Gittenberger-de-Groot, , Bartelings, MM, Wenink, ACG, Moene, RJ, van, der Harten JJ. Abnormal architecture of the ventricles in hearts with an overriding aortic valve and a perimembranous ventricular septal defect (“Eisenmenger VSD”). Int J Cardiol 1985;9:341–355.CrossRefGoogle Scholar
17.Yacoub, MH, Khan, H, Stavri, G, Shinebourne, E, Radley–Smith, R. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg 1997; 113:253–261.CrossRefGoogle ScholarPubMed
18. Editorial – April issue Anderson, RH. Surgical repair of straddling and overriding tricuspid valve. Editorial comment. Cardiol Young 1997;7Google Scholar
19.Lillihei, CW, Cohen, M, Warden, HE, Newell, RZ, Varco, RL. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surg Gynecol Obstet 1955; 101:447–449.Google Scholar
20.Goor, DA, Lillehei, CW. Congenital malformations of the heart. Grune & Stratton, New York 1975: 112–126.Google Scholar
21.Sutherland, GR, Godman, MJ, Smallhorn, JF, Guiterras, P, Anderson, RH, Hunter, S. Ventricular septal defect. Two-dimensional echocardiographic and morphological correlations. Br Heart J 1982;47:316–328.CrossRefGoogle ScholarPubMed
22.Anderson, RH, Wilcox, BR. The surgical anatomy of ventricular septal defect. J Cardiac Surg 1992;7:17–35.CrossRefGoogle ScholarPubMed
23.Capelli, H, Andrade, JL, Somerville, J. Classification of the site of ventricular septal defect by 2-dimensional echocardiography. Am J Cardiol 1983;51:1474–1480.CrossRefGoogle ScholarPubMed
24.Lev, M, Liberthson, RR, Kirkpatrick, JR, Eckner, FAO, Arcilla, RA. Single (primitive) ventricle. Circulation 1969;39: 577–591.CrossRefGoogle ScholarPubMed
25.Kumar, K, Lock, JE, Geva, T. Apical muscular ventricular septal defects between the left ventricle and right ventricular infundibulum. Diagnostic and interventional considerations. Circulation 1997;95:1207–1213.CrossRefGoogle ScholarPubMed
26.Lamers, WH, Wessels, A, Verbeek, FJ, Moorman, AF, Viragh, S, Wenink, AC, Gittenberger-de-Groot, AC, Anderson, RH. New findings concerning ventricular septation in the human heart. Implications for maldevelopment. Circulation 1992;86:1194–1205.CrossRefGoogle ScholarPubMed