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What is aortic overriding?

Published online by Cambridge University Press:  01 July 2014

Robert H. Anderson ,
Diane E. Spicer ,
G. William Henry ,
Cynthia Rigsby ,
Anthony M. Hlavacek  and
Timothy J. Mohun
Robert H. Anderson*
Affiliation:
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Diane E. Spicer
Affiliation:
Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, United States of America Congenital Heart Institute of Florida, St Petersburg, Florida, United States of America
G. William Henry
Affiliation:
Emeritus Founding Editor, Chapel Hill, North Carolina, United States of America
Cynthia Rigsby
Affiliation:
Department of Medical Imaging, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
Anthony M. Hlavacek
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Timothy J. Mohun
Affiliation:
Division of Developmental Biology, MRC National Institute for Medical Research, London, United Kingdom
*
Correspondence to: Professor R. H. Anderson, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail: [email protected]
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Abstract

Background: Disagreement currently exists regarding the definition of aortic dextroposition. It is suggested that the term be used interchangeably with aortic overriding, along with suggestions that the aortic valve overrides in the normal heart. The dextroposed aorta, however, does not always override the crest of the muscular ventricular septum. It is incorrect to argue that the normal aortic valve overrides. It is the cavity of the right aortic valvar sinus, rather than the valvar orifice, that sits above the muscular septum when the septum itself is intact. Therefore, to circumvent these difficulties, those using the term “dextroposition” find it necessary to distinguish “true” as opposed to “false” categories. The problems arise because “dextroposition” is remarkably ill-suited as an alternative term for aortic valvar overriding. Methods and Results: In this review, combining developmental, morphologic, and clinical data, we show how aortic overriding is best considered on the basis of biventricular connection of the aortic root in the setting of deficient ventricular septation. When analysed in this manner, it becomes an easy matter to distinguish between one-to-one and double outlet ventriculo-arterial connections. Appreciation of these features emphasises the different spatial alignments of interventricular communications as opposed to the plane of deficient ventricular septation. The concept of overriding is applicable not only to biventricular connection of the aortic root, but also the pulmonary and common arterial roots. Conclusions: The diagnostic techniques now available to the paediatric cardiologist illustrate the features of arterial valvar overriding with exquisite accuracy, informing the discussions now required for optimal decision making.

Keywords

Dextropositioninterventricular communicationtranspositiontetralogy of FallotEisenmenger defectdouble outlet right ventriclecardiac development
Type
Review Article
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 612 - 625
Copyright
© Cambridge University Press 2014 

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References

1. Anderson, RH. Truth relative to aortic overriding. Cardiol Young 2014; 24: 184–185.Google Scholar
2. Bozok, S, Kestelli, M, Akyuz, M. Dextroposition of the aorta in tetralogy of Fallot. Cardiol Young 2014; 24: 186.Google Scholar
3. Bozok, S, Kestelli, M, Ilhan, G, et al. Tips and pearls for “true” dextroposition of the aorta in tetralogy of Fallot. Cardiol Young 2013; 23: 377–380.Google Scholar
4. Restivo, A, Unolt, M, Putotto, C, Marino, B. Double outlet right ventricle versus aortic dextroposition: morphologically distinct effects. Anat Rec 2013; 296: 559–563.Google Scholar
5. Anderson, RH. How best can we define double outlet right ventricle when describing congenitally malformed hearts? Anat Rec 2013; 296: 993–994.CrossRefGoogle ScholarPubMed
6. Anderson, RH. Demolishing the tower of babel. Eur J Cardiothorac Surg 2012; 41: 483–484.Google Scholar
7. Sievers, HH, Hemmer, W, Beyersdorf, F, et al. The everyday used nomenclature of the aortic root components: the tower of Babel? Eur J Cardiothorac Surg 2012; 41: 478–482.Google Scholar
8. Mohun, TJ, Weninger, WJ. Imaging heart development using high-resolution episcopic microscopy. Curr Opin Genet Dev 2011; 21: 573–578.Google Scholar
9. Bailliard, F, Spicer, DE, Mohun, TJ, Henry, GW, Anderson, RH. The problems that exist when considering the anatomic variability between the channels that permit interventricular shunting. Cardiol Young 2014, doi:10.1017/S1047951114000869 (in press).Google Scholar
10. Peacock, TB. Malformations of the Human Heart, 2nd edn. John Churchill and Sons, London, 1866.Google Scholar
11. Becu, LM, Fontana, RS, Dushane, JW, et al. Anatomic and pathologic studies in ventricular septal defect. Circulation 1956; 14: 349–364.Google Scholar
12. Sherman, FE. An Atlas of Congenital Heart Disease. Henry Kimpton, London, 1963: 166–186.Google Scholar
13. Soto, B, Becker, AE, Moulaert, AJ, Lie, JT, Anderson, RH. Classification of ventricular septal defects. Br Heart J 1980; 43: 332–343.Google Scholar
14. Eisenmenger, V. Die angeborenen Defecte der Kammerscheidewand des Herzens. Ztschr F Klin Med 1898; 32 (Suppl): 1–56.Google Scholar
15. Oppenheimer-Dekker, A, Gittenberger-de Groot, AC, Bartelings, MM, 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.Google Scholar
16. Fallot, ELA. Contribution a` l’anatomie pathologique de la maladie bleue (cyanose cardiaque). Marseille Medical 1888; 25: 77–93.Google Scholar
17. Anderson, RH, Spicer, DE, Giroud, J, Mohun, TJ. Tetralogy of Fallot: nosological, morphological, and morphogenetic considerations. Cardiol Young 2013; 23: 857–865.Google Scholar
18. Lincoln, C, Anderson, RH, Shinebourne, EA, English, TAH, Wilkinson, JL. Double outlet right ventricle with L-malposition of the aorta. Br Heart J 1975; 37: 453–463.Google Scholar
19. Cavalle-Garrido, T, Bernasconi, A, Perrin, D, Anderson, RH. Hearts with concordant ventriculoarterial connections but parallel arterial trunks. Heart 2007; 93: 100–106.CrossRefGoogle ScholarPubMed
20. Taussig, HB, Bing, RJ. Complete transposition of the aorta and a levoposition of the pulmonary artery; clinical, physiological, and pathological findings. Am Heart J 1949; 37: 551–559.Google Scholar
21. Van Praagh, R. What is the Taussig–Bing malformation? Circulation 1968; 38: 445–449.Google Scholar
22. Hinkes, P, Rosenquist, GC, White, RJ Jr. Roentgenographic re-examination of the internal anatomy of the Taussig–Bing heart. Am Heart J 1971; 81: 335–339.Google Scholar
23. Stellin, G, Zuberbuhler, JR, Anderson, RH, Siewers, RD. The surgical anatomy of the Taussig-Bing malformation. J Thorac Cardiovasc Surg 1987; 93: 560–569.Google Scholar
24. Lev, M, Bharati, S, Meng, CC, Liberthson, RR, Paul, MH, Idriss, F. A concept of double-outlet right ventricle. J Thorac Cardiovasc Surg 1972; 64: 271–281.Google Scholar
25. Brandt, PWT, Calder, AL, Barratt-Boyes, BG, Neutze, JM. Double outlet left ventricle, morphology, cineangiocardiographic diagnosis and surgical treatment. Am J Cardiol 1976; 38: 897–909.Google Scholar
26. Ueda, M, Becker, AE. Double outlet right ventricle: an unusual variant with overriding of both great arteries, absent outlet septum and mitral-to-aortic-to-pulmonary valve continuity. Int J Cardiol 1986; 12: 155–164.Google Scholar
27. Vida, VL, Guariento, A, Castaldi, B, et al. Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: midterm results. J Thorac Cardiovasc Surg 2014; 147: 687–696.Google Scholar