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

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Presentation transcript:

Morphologic features of atrioventricular septal defect with only ventricular component: Further observations pertinent to surgical repair Iki Adachi, MD, Hideki Uemura, MD, FRCS, Karen P. McCarthy, BS, Siew Yen Ho, PhD, FRCPath, FESC The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 1, Pages 132-138.e2 (January 2009) DOI: 10.1016/j.jtcvs.2008.03.032 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Left upper, Diagram showing the measurements made on the left ventricular aspect to determine the inlet, minimal, and outlet lengths. Middle and right upper, Diagrams showing the measurements made on the atrioventricular defect to determine the atrioventricular defect, scoop, counter-scoop and (if present) superior extension lengths. Lower, Diagrams showing angles of the bridging leaflets axis in relation to the atrioventricular junction (the chord x for SBL and y for IBL) are shown. If the axis is directed toward the ventricular side, a positive value is given and vice versa. SBL, Superior bridging leaflet; IBL, inferior bridging leaflet. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 132-138.e2DOI: (10.1016/j.jtcvs.2008.03.032) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Results of our measurements on the left ventricular aspect of the septum and the atrioventricular septal defect. AV, Atrioventricular. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 132-138.e2DOI: (10.1016/j.jtcvs.2008.03.032) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Relation between atrioventricular junction and outlet lengths. Linear relationship was found between the two lengths. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 132-138.e2DOI: (10.1016/j.jtcvs.2008.03.032) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Annular circumferential attachment of valve leaflets with or without inclusion of the septal length. RV, Right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 132-138.e2DOI: (10.1016/j.jtcvs.2008.03.032) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Angles of the bridging leaflets in relation to the atrioventricular junction. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 132-138.e2DOI: (10.1016/j.jtcvs.2008.03.032) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Photographs illustrating the Koch area of two hearts with atrioventricular septal defect with only a ventricular component (A and B), one heart with both atrial and ventricular components (C), and one heart with an atrial component only (D). The heart in part b has an enlarged coronary sinus owing to persistence of a left superior caval vein. The photographs were taken with the hearts positioned as they might be viewed by the surgeon at operation. The ventricular margin of the defect is indicated by the blue dotted line and the atrial margin is marked by the red dotted line. The black dotted line represents the tendon of Todaro and the broken line marks the posteroinferior hinge line (annulus) of the right atrioventricular valve. TK indicates the apex of the triangle of Koch. The connecting atrioventricular node (star) is displaced from TK and anticipated to be located on the atrial side of the meeting point between the ventricular margin of the defect and the posteroinferior hinge line, which marks the atrioventricular junction. In hearts with only a ventricular component of the defect (A and B), owing to a shorter distance between the anterior and posterior margins of the defect, the atrioventricular node is likely to be located closer to the apex of the triangle of Koch than in the other forms (C and D). SBL, Superior bridging leaflet; IBL, inferior bridging leaflet; TK, apex of triangle of Koch; CS, coronary sinus; OF, oval fossa. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 132-138.e2DOI: (10.1016/j.jtcvs.2008.03.032) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions