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

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Anatomy of the ventricular septal defect in outflow tract defects: Similarities and differences Meriem Mostefa-Kara, MD, Damien Bonnet, MD, PhD, Emre Belli, MD, Elie Fadel, MD, PhD, Lucile Houyel, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 3, Pages 682-688.e1 (March 2015) DOI: 10.1016/j.jtcvs.2014.11.087 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Right ventricular aspect of the ventricular septum in a normal heart. The muscular bands of the right ventricle are the ventriculo-infundibular fold, including the parietal band (1) and subpulmonary conus (2); the outlet septum (*); the septal band or septomarginal trabeculation with its 2 limbs, anterosuperior and posteroinferior (yellow Y); the moderator band; and the anterior papillary muscle of the tricuspid valve. MB, Moderator band; PV, pulmonary valve; TV, tricuspid valve; VIF, ventriculo-infundibular fold; SB, septal band. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Localization of the membranous septum in the normal heart viewed from the right ventricle. The membranous septum (transilluminated) ensures a fibrous continuity between the anteroseptal commissure of the tricuspid valve and the aortic valve. The posteroinferior limb of the septal band is separated from the ventriculo-infundibular fold by the membranous septum. PV, Pulmonary valve; SB, septal band; TV, tricuspid valve; VIF, ventriculo-infundibular fold. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Localization of the VSD in heart specimens with various outflow tract defects: TOF-PA (A), isolated outlet VSD (B), TOF (C), DORV with subaortic VSD (D), DORV with subpulmonary VSD (E), CAT (F), and IAA type B viewed from the right ventricle (G). The localization of the VSD is always the same, in the outlet of the right ventricle, between the 2 limbs of the septal band (anterosuperior and posteroinferior) (yellow Y). AO, Aorta; SB, septal band; PV, pulmonary valve; TrV, truncal valve; TV, tricuspid valve. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Two heart specimens with TOF-PA. A, The outlet VSD, located between the 2 limbs of the septal band (yellow Y), has entirely muscular rims. B, Outlet VSD (yellow Y) with fibrous continuity between the aortic and tricuspid valves. This continuity involves almost exclusively the anterior leaflet of the tricuspid valve, disrupting the muscular continuity between the ventriculo-infundibular fold and the posteroinferior limb of the septal band. AO, Aorta; ATL, anterior tricuspid leaflet; PTL, posterior tricuspid leaflet; SB, septal band; STL, septal tricuspid leaflet. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 The rate of fibrous continuity between the aortic and tricuspid valves in the heart specimens with outflow tract defects. The highest rate was found in the group with isolated outlet VSD, then in TOF and TOF-PA, rarely in DORV and CAT, and absent in IAA type B. CAT, Common arterial trunk; DORV, double outlet right ventricle; IAA, interruption of the aortic arch; PA, pulmonary atresia; VSD, ventricular septal defect. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

An outlet VSD viewed from the right ventricle, located between the 2 limbs of the septal band. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Heart specimen with IAA type B viewed from the left ventricle. The VSD is an outlet VSD. The outlet septum (*) is deviated posteriorly, creating a subaortic obstruction. Ao, Aorta; MV, mitral valve; VSD, ventricular septal defect. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 682-688.e1DOI: (10.1016/j.jtcvs.2014.11.087) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions