Invited commentary

Abstract

This article by Van Praagh and associates presents the pathological findings and clinical management of apical muscular ventricular septal defects. This is an uncommon problem seen in 0.5% of the 3,155 heart specimens in the Cardiac Registry of the Boston Children’s Hospital. This article gives a detailed pathologic description of the morphology of the apical ventricular septal defect, which will not only help clinicians with the closure of these defects, but equally importantly, will allow for a common definition as to what constitutes an apical ventricular septal defect. The distinction between the infundibular apical recess (where apical muscular ventricular septal defects occur) and the right ventricular sinus is an important one nicely depicted in Figures 1B and 2A. It will be interesting to see if the description of a muscular band separating the infundibular apical recess from the right ventricular sinus apex (newly termed the infundibulosinus partition) is a true structure that will be recognized by others and will be adopted into our lexicon of cardiac anatomy.