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Published byBrook Hubbard
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Is Complete Heart Block After Surgical Closure of Ventricular Septum Defects Still an Issue? Henrik Ø. Andersen, MD, PhD, Marc R. de Leval, MD, Victor T. Tsang, MD, MS, Martin J. Elliott, MD, Robert H. Anderson, MD, Andrew C. Cook, PhD The Annals of Thoracic Surgery Volume 82, Issue 3, Pages (September 2006) DOI: /j.athoracsur Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
Fig 1 The graph shows the numbers of patients undergoing surgery in each year at Great Ormond Street Hospital in the period from 1976 to 2001 for patients having isolated ventricular septal defect (open columns) and patients with tetralogy of Fallot (shaded columns). The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
Fig 2 The graph shows the distribution of ages at the time of surgical closure of the patients with isolated ventricular septal defect (open columns) and patients with tetralogy of Fallot (shaded columns) operated on in the period from 1976 to (mth = months; yrs = years.) The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
Fig 3 The drawing shows the known disposition of the conduction axis, as seen by the surgeon operating through the right atrium, when there is straddling and overriding of the tricuspid valve . Note that the bundle does not originate from the regular atrioventricular node located at the apex of the triangle of Koch. The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
Fig 4 The drawings show the known disposition of the conduction system when the atrioventricular conduction axis descends through a muscle bar separating perimembranous and muscular inlet defects . In (a), the leaflets of the tricuspid valve are shown in-situ, whereas they are retracted in (b). (VSD = ventricular septal defect.) The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
Fig 5 The drawing shows the expected site of the conduction axis when a ventricular septal defect (VSD) is perimembranous , as it would be seen by the surgeon lifting up the septal leaflet of the tricuspid valve having approached the defect through the right atrium. The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
Fig 6 The drawing shows how the conduction axis penetrates through the central fibrous body at the apex of the triangle of Koch when a defect is perimembranous , and how this is more obvious to the surgeon when there is a deficiency of leaflet tissue at the zone of apposition between the septal and anterosuperior leaflets of the tricuspid valve. The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions
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