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Development of the outflow tracts with reference to aortopulmonary windows and aortoventricular tunnels

Published online by Cambridge University Press:  01 December 2010

Robert H. Anderson ,
Andrew Cook ,
Nigel A. Brown ,
Deborah J. Henderson ,
Bill Chaudhry  and
Timothy Mohun
Robert H. Anderson*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America Cardiac Unit, Institute of Child Health, University College, London, United Kingdom Division of Basic Medical Sciences, St George’s Medical University, London, United Kingdom Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, London, United Kingdom
Andrew Cook
Affiliation:
Cardiac Unit, Institute of Child Health, University College, London, United Kingdom
Nigel A. Brown
Affiliation:
Division of Basic Medical Sciences, St George’s Medical University, London, United Kingdom
Deborah J. Henderson
Affiliation:
Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, London, United Kingdom
Bill Chaudhry
Affiliation:
Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, London, United Kingdom
Timothy Mohun
Affiliation:
National Institute of Medical Research, London, United Kingdom
*
Correspondence to: Professor R. H. Anderson, BSc, MD, FRCPath, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail: [email protected]
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Abstract

Although malformations involving the ventricular outflow tracts are often described as conotruncal malformations, there is no consensus as to the lesions included in, or excluded from, this category, reflecting, in part, the current lack of precise definitions of the embryonic truncus and conus. Analysis of development of the outflow tract in terms of proximal, intermediate, and distal components greatly facilitates understanding of the morphology of the aortopulmonary window and aortoventricular tunnels. The aortopulmonary windows reflect failure to close the embryonic aortopulmonary foramen, the space between the distal end of the cushions that divide the lumen of the outflow tract itself and the dorsal wall of the aortic sac. The aortopulmonary tunnels are produced subsequent to abnormal development of the cushions themselves. The distal ends of these cushions excavate to produce the sinuses and leaflets of the arterial valves. The proximal parts of the cushions muscularise to form the subpulmonary infundibulum. The middle part of the cushion mass disappears to provide a tissue plane between the infundibulum and the aortic root. Abnormal formation of this area accounts for the various types of aortoventricular tunnel. In our brief review, we show how the anatomy of these lesions correlates with development of the outflow tract.

Keywords

Aortopulmonary windowaorto-left ventricular tunnelsaorto-right ventricular tunnelscardiac development
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 92 - 99
Copyright
Copyright © Cambridge University Press 2010

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