Univentricular Atrioventricular Connection Research Articles

Clinical implications of dextrocardia based on four visceroatrial situs studies

BackgroundPrevious studies on congenital heart diseases (CHD) associated with dextrocardia were based on selective patient databases and did not reflect the full spectrum of dextrocardia in the general population. Additionally, these studies had complex classification and presentation. Nor did these studies elaborate on the distribution of the associated CHD's complexity, the various segmental connections, and associated CHD among the four visceroatrial situs. MethodsWe retrospectively reviewed the medical records of 211 children with primary dextrocardia. We used a segmental approach to diagnose CHD. We then analyzed and compared the distribution of the above-mentioned issues among the four visceroatrial situs. ResultsDextrocardia occurred most commonly with situs inversus (52.6%), followed by situs solitus (28.4%), asplenia (17.1%), and polysplenia (1.9%). Although some patients had a structurally normal heart (22.7%) or they were associated with simple CHD (17.5%), most patients had complex CHD (59.7%) consisting of a single ventricle (34.6%) or conotruncal anomaly (25.1%) (double-outlet right ventricle [7.6%], corrected transposition of the great arteries [6.2%], complete transposition of the great arteries [5.7%], tetralogy of Fallot [4.7%], etc.). Situs inversus or polysplenia had a higher prevalence of a structurally normal heart or associated with simple CHD, two patent atrioventricular (AV) valves connections, and biventricular AV connections. Situs solitus or asplenia had a higher prevalence of associated complex CHD, common AV valve connection, univentricular AV connection, pulmonary outflow tract obstruction, and anomalous pulmonary venous drainage. ConclusionOur study finds that situs inversus is the most common visceroatrial situs in dextrocardia. Although some patients had a structurally normal heart or were associated with simple CHD, most patients have associated complex CHD consisting of a single ventricle or conotruncal anomaly. Dextrocardia is associated with a higher incidence of complex CHD in situs solitus and asplenia groups than in situs inversus and polysplenia groups.

Holms Heart in a Fetus with Maternal Anticonvulsant Drug Exposure: A Case Report

Double inlet left ventricle (DILV) is a rare congenital cardiac malformation that is defined as an anomaly with univentricular atrioventricular (AV) connection, and single ventricular morphology. This variation can be associated with the inlet and outlet cardiac abnormalities. In the current report, we present a case of Holms heart, as a rare variant of double-inlet left ventricle.

Uni-ventricular atrioventricular connection: dominant left ventricle with hypoplastic right ventricle in an 18-year-old female (case report)

Uni-ventricular atrioventricular connection: dominant left ventricle with hypoplastic right ventricle in an 18-year-old female (case report)

A rare coexistence of common atrium, univentricular atrioventricular connection, total anomalous pulmonary venous connection, and aortic atresia in an asymptomatic teenage girl

A rare coexistence of common atrium, univentricular atrioventricular connection, total anomalous pulmonary venous connection, and aortic atresia in an asymptomatic teenage girl

Double-Inlet Left Ventricle.

Double-inlet left ventricle (DILV) is most frequent among univentricular atrioventricular connections. In DILV, there is a single functioning ventricle, most commonly with left ventricular structure. This chamber receives both atrioventricular valves and is connected to an outlet chamber with morphologic features of the right ventricle. The great vessels are often transposed, and pulmonary stenosis is seen in two-thirds of patients. The anatomy and pathophysiology can be defined by echo-Doppler studies with a rare need for other imaging studies. The management is mostly related to the nature of associated heart defects and the degree of pathophysiological abnormality. When the infants present initially, treatment to address the hemodynamic issues is undertaken. Subsequently, these babies need staged total cavo-pulmonary connection, i.e., the Fontan procedure which is undertaken in three stages; these stages are described in this review. The existence of inter-stage mortality and post-Fontan complications is recognized and was reviewed. The paper concludes that DILV can be successfully diagnosed with echo-Doppler studies and this heart anomaly can be effectively treated with the currently prevailing medical, catheter interventional, and surgical treatment practices.

Surgical management of hearts with isomeric atrial appendages.

On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.

Anatomy of the Functionally Univentricular Heart.

The world of pediatric cardiac surgery and cardiac surgery as a whole lost one of the great pioneers with the passing, at the beginning of 2018, of Francis Fontan. Hence to add to the recognition of his achievements, the European Congenital Heart Surgeons Association (ECHSA) has established a lecture to be given in his memory at their annual meetings. It was a significant honor and privilege to be invited to present the initial lecture. In this report, we describe the essence of the presentation. Many patients are now palliated by construction of the Fontan circulation. Very few of those put forward for this operative procedure have anatomically univentricular hearts. It remains frequent, nonetheless, to find accounts of many patients allegedly having "single" ventricles. We discuss the background to this illogical approach to description of hearts having one big and one small ventricle, showing that those with normal hearts have a single left ventricle, albeit co-existing with a single right ventricle. We show that analysis of the ventricular mass in tripartite fashion produces much needed clarity in the appropriate description of the ventricular mass in those increasingly submitted for construction of the Fontan circulation. We emphasize that although it was patients with univentricular atrioventricular connections who were the first to benefit from the procedure, the majority of patients now have biventricular atrioventricular connections, although the hypoplastic ventricle possesses all three of its normal components. We show that description of the ventricular arrangement as being functionally, or physiologically, univentricular provides logic in what had previously been an illogical environment.

The univentricular heart: Revisited

IntroductionA univentricular (UV) heart is found when both atria drain mainly into one ventricle; while if either ventricle cannot sustain the systemic or the pulmonary circulation, a functionally UV heart emerges. UV heart is the source of hot debates and discussions for decades that stem from controversies in terminologies, analysis, and management. ObjectiveTo study the morphological pattern of univentricular hearts. DesignCohort, descriptive study. SettingReview 13-year data from the file system of a high-volume, tertiary, teaching cardiac centre and study the patients having pathologies meeting the definition of UV heart. Results461 patients have UV hearts; constituting 1.4% of all patients with a congenital heart disease (CHD) visiting the centre of the study. Functionally UV heart in the form of biventricular atrioventricular (AV) connection plus one ventriculoarterial (VA) connection was seen in 179 cases (38%) with aortic atresia being the most common (N=98; 55%). On the other hand, UV AV connection was seen in 282 cases (62%). Under this category, 203 cases (72%) show an absent AV connection and 79 hearts (28%) with double-inlet anatomy. ConclusionUV heart is a rare complex CHD with lots of scientific debates. It is hoped that this long-term study will be the basis and a reference to paediatric cardiologists, echocardiographers, and other interested professionals.

The Spectrum of Congenital Heart Disease with Transposition of the Great Arteries from the Cardiac Registry of the University of Padua.

Transposition of the great arteries (TGA) is a cardiac condition in which the arterial trunks arise from the inappropriate ventricle: the aorta from the right ventricle and the pulmonary trunk from the left ventricle [discordant ventriculo-arterial (VA) connection]. In complete TGA, the discordant VA connection is associated with situs solitus or inversus and concordant atrioventricular (AV) connection. The hemodynamic consequence of these combined connections is that systemic and pulmonary circulations function in “parallel” rather than in “series”. The presence of situs solitus or inversus associated with both AV and VA discordant connections characterizes a different anatomical complex known as “corrected TGA.” In these hearts, the double discordance at AV and VA levels permits a normal sequence of the blood flow from the right atrium to the pulmonary artery and from the left atrium to the aorta. The systemic and pulmonary circulation in these hearts functions regularly in series, and the blood sequence is “physiologically corrected.” Thus, the term transposition, either complete or corrected, identifies two precise, different anatomical complexes, both characterized by VA discordance. However, among congenital heart disease (CHD), there are other anatomical complexes with discordant VA connection in the setting of isomeric atrial situs (right or left) or of univentricular AV connections (double inlet or absent connections). In these latter conditions, the term “transposition” is still necessary to stress that the great arteries are “transposed” in relation to the ventricular septum (aorta from the right ventricle and pulmonary trunk from the left ventricle) but certainly does not figure out the anatomical complexes named complete or corrected transposition. We reviewed the hearts with discordant VA connection of our Anatomical Collection, consisting of 1,640 specimens with CHD, with the aim to discuss the anatomy and the frequency of the anatomical variants of TGA and to clarify terminology and classification. The knowledge of the precise anatomy of these malformation are really important for clinical diagnosis and surgical planning.

Magnetic Resonance Imaging of a Restrictive Atrial Septal Defect in a Univentricular Connection

Magnetic resonance imaging (MRI) provides accurate and valuable information regarding cardiac shunts including their location, size, and flow. We describe the MRI findings of a restrictive atrial septal defect within a complex case of congenital heart disease: univentricular atrioventricular connection of left ventricular type with right-sided discordant atrioventricular connection (single), absent left atrioventricular connection, and ventriculoarterial discordance. Few similar cases are reported in the literature. Magnetic resonance imaging may add valuable information regarding restrictive atrial shunts in univentricular hearts.

Anatomy of Functionally Single Ventricle

Hearts that have previously been called univentricular hearts, or single ventricles, can be described as having a univentricular atrioventricular connection. Most such hearts have two ventricular chambers, albeit one is small and incomplete-lacking an inlet component. The atriums of these hearts connect only to one of these ventricular chambers, which is usually the larger and dominant ventricle. Other hearts, with biventricular atrioventricular connections, may have hypoplasia of one ventricle, making it impossible to restore a biventricular circulation and such hearts are functionally univentricular. The term "functionally single ventricle" (or functionally univentricular heart) encompasses both these categories of malformation.

Doppler echocardiographic description of double-inlet left ventricle in an Arabian horse

Univentricular atrioventricular (AV) connections are rare and complex congenital cardiac anomalies in which both AV valves communicate into a large, common (single) receiving chamber. The common chamber can be of left, right, or mixed ventricular morphology. Although well documented in people, reports of the double-inlet ventricle malformation are rare in the veterinary literature. This report provides description of an Arabian horse with a double-inlet univentricular connection of left ventricular type, a hypoplastic subpulmonary right ventricle, two muscular ventricular septal defects, and a stenotic mitral valve. Transthoracic Doppler echocardiography enabled antemortem diagnosis, and provided an assessment of intracardiac hemodynamics. The findings indicate that Doppler echocardiography is a useful, noninvasive tool for evaluating equine patients with congenital univentricular AV connections, such as a double-inlet left ventricle.

Double inlet left ventricle

Double inlet left ventricle is a common form of univentricular atrioventricular connection. The clinical presentation is varied depending on associated lesions and the arrangement of great arteries. Management generally involves staging toward the ultimate goal of Fontan palliation. With advances in noninvasive diagnosis, surgical and postoperative care outcomes have significantly improved in the past decade. Most patients with double inlet left ventricle can go to school, play recreationally, and are gainfully employed. Some patients continue to pose difficult and frustrating medical problems, including arrhythmias, ventricular failure, atrioventricular valve insufficiency, subaortic obstruction, protein-losing enteropathy, and plastic bronchitis.

Outcome of the construction of a Blalock–Taussig shunt in adolescents and adults

The purpose of our study was to ascertain the outcome of the construction of a Blalock-Taussig shunt in patients aged 12 years and over. We identified 21 patients in whom a Blalock-Taussig shunt had been constructed subsequent to the age of 12 years. Of the patients, 9 were female, and their median age was 18.5 years, with a range from 12 to 46 years. All had usual atrial arrangement, and the atrioventricular connections were concordant in 11, with univentricular atrioventricular connection in 10. Pulmonary atresia was present in 8 (38 per cent), and pulmonary stenosis, either valvar or subvalvar, in 13. An interposition graft had been placed between the subclavian and pulmonary arteries in 16 patients, and an end-to-side anastomosis between the arteries in 5. One patient had died in hospital, while 4 patients had died during the period of follow-up after initial construction of the shunt. Long-term follow-up was available in 86 per cent of patients. In the 3 patients lost to follow-up, the shunt had been known to be functioning at periods of 4, 8, and 10 years, respectively. Actuarial freedom from death after a period of 17 years was 76 per cent. In 8 patients, a period of 10 years had elapsed with the shunt patent, and a further 10 had a patent shunt after 5 years follow-up. Symptomatic improvement was reported in 16 (76 per cent) patients, although adverse cardiac events had occurred during follow-up in 17, including congestive heart failure in 3, atrial fibrillation in 3, and endocarditis in 2. In 2 patients, it had been possible to proceed to biventricular repair, one with tetralogy of Fallot, and the other having a Rastelli procedure. Further in 3 patients, it had been possible to construct the Fontan circulation, or one of its variants. One patient has undergone cardiac transplantation, while 2 are awaiting transplantation. Symptomatic improvement can be achieved by construction of a Blalock-Taussig shunt in older subjects, and the risks of surgery are low. Later repair may be feasible in some patients, but adverse cardiac events may follow the increased volume load on the systemic ventricle.

Dextrocardia: an analysis of cardiac structures in 125 patients

Background: Dextrocardia is associated with multiple and complex congenital cardiac anomalies. Precise anatomical diagnosis is essential for successful surgery. Spectrum of congenital malformations in cases of dextrocardia is based primarily on two-dimensional echocardiographic studies. The purpose of the current study was to use colour Doppler echocardiography in large number of patients. Methods: Patients of dextrocardia were studied retrospectively, by reviewing database of our echocardiographic laboratory over last 10 years. Standard criteria for diagnosis of situs were used. Detailed segmental analysis for cardiac anatomy and associated malformations was done using previously suggested and well accepted terms and definitions. Cardiac anatomy was confirmed on catheterization and during surgery in few cases. Results: Of total 125 patients, dextrocardia was most common with situs inversus (39.2%) followed by situs solitus (34.4%) and situs ambiguous [26.4% (right isomerism in 18.4% and left isomerism in 8.0%)]. Mean age was 9.2±11.2 years (range; 3 days to 60 years), 82 males and 43 females. In situs inversus dextrocardia, majority (73.4%) had concordant atrioventricular (AV) connections while discordant AV connections and univentricular atrioventricular connections (UVAVC) were present in 12.2 and 14.3% patients, respectively. Majority of patients with concordant AV connections (72.2%) also had concordant VA (ventriculo–arterial) connections (conotruncal anomalies were commonest). Similarly, majority of patients with discordant AV connections (66.7%) also had discordant VA connections. Commonly (44.9%), these patients presented with decreased pulmonary blood flow (Qp). Total 28.6% patients had normal intracardiac anatomy (10.2% presented with rheumatic heart disease). In situs solitus dextrocardia, majority (51.2%) had AV concordance while discordant AV connections and UVAVC were present in 41.9 and 7.0% patients, respectively. In patients with concordant AV connections, majority (77.2%) had VA concordance (majority presented with increased Qp due to pre or post-tricuspid shunts). Similarly, majority of patients with discordant AV connections (88.9%) also had discordant VA connections (88.9% presented with decreased Qp). Only 7.0% patients with situs solitus dextrocardia had normal intracardiac anatomy. The striking features of right isomerism were male predominance (male:female ratio 2.2:1), cyanosis with decreased Qp in 86.9%, and high incidence of UVAVC and venous system anomalies (39.1% each). Striking features of left isomerism were biventricular ambiguous AV connections in all except one, presentation with increased Qp in 60.0% and presence of inferior vena caval interruption in 60.0% patients. Conclusions: Present study, largest study of dextrocardia till date reconfirms that these patients have variable intracardiac anatomy depending upon their situs and types of segmental connections. These patients can present with different haemodynamic subsets, which can be correctly identified by colour Doppler echocardiography. Diagnostic accuracy and a better understanding of the various types of dextrocardia are essential, since improved surgical techniques have made it possible to correct many of these complex abnormalities.

Birthweight distribution in southern Chinese infants with symptomatic congenital heart disease.

Western infants with congenital heart disease have frequently been reported to have a low birthweight for gestational age. Studies in Asian infants seem to be lacking in this area. This is the first extensive study presenting the birthweight distribution of Chinese newborns with symptomatic congenital heart disease. The birth data of 454, mainly southern-Chinese infants with symptomatic cardiovascular defects, born between 1990 and 1995 and admitted to Grantham Hospital, Hong Kong in 1994 and 1995, were analysed retrospectively. Infants with (non)-genetic syndromes or other major extracardiac malformations were excluded. Fifteen per cent of all newborns had a birthweight below the reference mean of - 2 Z-score. After correction for length of gestation, no significant difference could be detected in birthweight between the cyanotic and acyanotic groups, nor between the different haemodynamic disturbances. Infants with atrial or ventricular septal defects, tetralogy of Fallot, pulmonary atresia with ventricular septal defect, heart with univentricular atrio-ventricular connection or double outlet right ventricle showed significant birthweight deficits. Transposition of the great arteries was not related to being small for gestational age. Similar to Western infants, prenatal growth impairment was a common feature in Chinese infants with symptomatic congenital heart disease. The birthweight distribution in Chinese might be comparable to that in Western populations. Exceptions are possibly the high frequency of low birthweight in Chinese newborns with atrial septal defect or a single-ventricle abnormality. Further studies on fetal anthropometry and haemodynamics are necessary to provide insight into the relation between cardiovascular malformations and being small for gestational age.

Pulmonary artery banding and ventricular septal defect enlargement in patients with univentricular atrioventricular connection and the aorta originating from an incomplete ventricle.

In patients with univentricular atrioventricular connection and the aorta originating from an incomplete ventricle, subaortic stenosis is generally due to a restrictive ventricular septal defect (RVSD), that may be present at birth or develop after palliative procedures. In particular, a primary role in the genesis of the RVSD has been ascribed to pulmonary artery banding (PAB). The aim of this paper is to analyse the possible risk factors for the development of an RVSD, including PAB, and the results of one of the proposed procedures for treatment of this condition (RVSD enlargement). We retrospectively reviewed clinical records and outpatient records of 24 consecutive patients with univentricular atrioventricular connection and the aorta originating from the incomplete ventricle that received their first treatment at our institution from January 1991 to April 2000. The variables age, sex, weight, diagnosis, surgical procedures, associated anomalies, associated surgical procedures, were considered. Four patients (16.7%) had absent left atrioventricular connection, seven (29.7%) had absent right atrioventricular connection and discordant ventriculo-arterial connection, and 13 (54.7%) had double inlet left ventricle and discordant ventriculo-arterial connection. Five patients (20.8%) had associated coarctation or hypoplasia of the aorta, and eight (33.3%) had pulmonary stenosis or atresia. Median age at the first operation was 7.5 days (range: 1-376). Median weight was 3.5 kg (range: 1.9-6.3). Seventeen patients underwent pulmonary artery banding, one underwent a Damus-Kaye-Stansel connection, one received a Glenn shunt and five a modified Blalock-Taussig shunt. Early mortality was 12.5%. The only variable associated with operative mortality was the presence of coarctation or hypoplasia of the aorta (P=0.004). Ten patients (41.6%) developed subaortic stenosis. None of the tested variables, including pulmonary artery banding, was associated with the development of subaortic stenosis. Subaortic stenosis was due to a restrictive VSD in eight patients, six of whom underwent direct VSD enlargement by muscular resection and are well at last follow-up (four complete repairs). None of the procedures was complicated by complete heart block. In two cases subaortic stenosis was treated by a Damus-Kaye-Stansel connection. A single patient died during follow-up, and 11 patients have achieved a complete one-ventricle repair. In our experience, pulmonary artery banding was not associated with an increased risk of developing an RVSD. VSD enlargement proved to be safe and effective for treatment of subaortic stenosis due to an RVSD.

Long-term results of relief of subaortic stenosis in univentricular atrioventricular connection with discordant ventriculoarterial connections

Background. We set out to examine the long-term results of relief of subaortic stenosis by enlargement of ventricular septal defect in patients with univentricular atrioventricular connection to a dominant left ventricle and discordant ventriculoarterial connections. Methods. Twenty-four patients underwent enlargement of ventricular septal defect between 1985 and 1998 at a median age of 3.2 years (range, 3 weeks to 14 years). Ten patients were younger than 1 year of age. Eighteen had undergone previous banding of the pulmonary trunk, 9 of whom also required repair of coarctation of the aorta. The median subaortic gradient before enlargement was 46 mm Hg. Twenty-three patients had a patch to enlarge the rudimentary right ventricle. Results. Five patients (21%) died in the early postoperative period. The overall survival at 1 and 3 years was 73%, and at 5 and 10 years was 68% and 60%, respectively. Complete heart block requiring insertion of a pacemaker occurred in 2 patients (8%). A Fontan operation was performed in 10 patients, 5 underwent a bidirectional Glenn procedure, and 2 required cardiac transplantation. Follow-up was complete in all survivors at a median time of 6.7 years (range, 8 months to 13 years). From the earlier part of the series, 3 patients experienced aortic insufficiency and 2 had recurrent obstruction. Factors adversely affecting survival were age younger than 1 year at operation and presence of obstruction within the aortic arch. Conclusions. Our experience shows that, in patients with univentricular atrioventricular connection to a dominant left ventricle and subaortic stenosis, enlargement of the ventricular septal defect provides satisfactory relief of obstruction except in those younger than 1 year of age, and those who have associated obstruction in the aortic arch.

Univentricular atrioventricular connection. Review of the current therapeutical possibilities

Univentricular atrioventricular connection. Review of the current therapeutical possibilities

Evaluation of Regional Differences in Right Ventricular Systolic Function

HomeCirculationVol. 99, No. 5Evaluation of Regional Differences in Right Ventricular Systolic Function Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBEvaluation of Regional Differences in Right Ventricular Systolic Function Robert H. Anderson Robert H. AndersonRobert H. Anderson Paediatrics National Heart & Lung Institute, Imperial College School of Medicine, Royal Brompton Campus, London, UK Search for more papers by this author Originally published9 Feb 1999https://doi.org/10.1161/circ.99.5.722/cCirculation. 1999;99:722c–725To the Editor:In their recent study on right ventricular function, Geva and colleagues1 indicate that most previous studies have focused on the chamber as a unitary structure. They then present data supporting its traditional division into “sinus” and “infundibular” components. It is disingenuous of these investigators, however, not also to cite the considerable body of evidence that supports the concept that, morphologically, the right ventricle can be analyzed in terms of 3 components, namely, the inlet, the apical trabecular component, and the outlet. The ring of anatomic landmarks that they cite as the infundibular boundary is, in fact, far from uniformly present in the normal heart. The moderator band, extending from the septal band to the anterior papillary muscle of the tricuspid valve, is but one of the many coarse trabeculations to be found in the apical component. Equally important are the septoparietal bands, identified by Goor and Lillehei2 when they proposed the important tripartite approach to right ventricular structure.There is just as much, if not more, anatomic and embryological evidence to support this tripartite approach as that cited by Geva et al1 in substantiating their bipartite concept. Thus, division of the ventricle is equally well explained in tripartite fashion. The rudimentary right ventricle in double-inlet left ventricle and tricuspid atresia is separated from the dominant left ventricle by the remnant of the apical trabecular septum rather than the infundibular septum. It is this apical muscular septum that carries the atrioventricular conduction axis,3 conduction tissue never being found in the muscular outlet septum. Immunostaining has shown that the conduction axis develops astride this apical muscular septum from the outset.4 The ventricular outflow tracts are divided by the outflow ridges and then give rise to the muscular outlet septum in malformed hearts, but with no relationship to the conduction tissues.5 In the normal heart, however, these ridges are muscularized to form the free-standing subpulmonary infundibulum, the anatomic feature that makes it possible for the surgeon to remove the pulmonary valve as an autograft and use it in the Ross procedure. This would not be possible if the “infundibular septum” was positioned as shown by Geva et al.1 To have presented their results without any discussion of a potentially tripartite configuration presents an unduly biased account of right ventricular structure. References 1 Geva T, Powell AJ, Crawford EC, Chung T, Colan SD. Evaluation of regional differences in right ventricular systolic function by acoustic quantification echocardiography and cine magnetic resonance imaging. Circulation.1998; 98:339–345.CrossrefMedlineGoogle Scholar2 Goor DA, Lillehei CW. Congenital Malformations of the Heart. New York, NY: Grune & Stratton; 1975:1–37.Google Scholar3 Anderson RH, Ho SY, Wilcox BR. The surgical anatomy of ventricular septal defects with univentricular atrioventricular connection. J Card Surg.1994; 9:408–426.CrossrefMedlineGoogle Scholar4 Lamers WH, Wessels A, Verbeek FJ, Moorman AFM, Virágh S, Wenink ACG, Gittenberger-de Groot AC, Anderson RH. New findings concerning ventricular septation in the human heart: implications for maldevelopment. Circulation.1992; 86:1194–1205.CrossrefMedlineGoogle Scholar5 de Jong F, Virágh S, Moorman AFM. Cardiac development: a morphologically integrated molecular approach. Cardiol Young.1997; 7:131–146.CrossrefGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseGeva Tal, MD, Colan Steven D., MD, Powell Andrew J., MD, Chung Taylor, MD, and Crawford Elizabeth C.09021999We thank Dr Anderson for his interest in our article. His views regarding the anatomic partition of the right ventricle have been publishedR1 and are controversial.R2R3 Our article, however, is about regional differences in right ventricular systolic function. A discussion about the different views regarding the anatomic partition of the right ventricle is important but is beyond the scope of our article. Previous Back to top Next FiguresReferencesRelatedDetails February 9, 1999Vol 99, Issue 5 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/circ.99.5.722/c Originally publishedFebruary 9, 1999 PDF download Advertisement