Atrioventricular Conduction in Congenital Heart Disease: by Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)

By Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)

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31. A well-developed posterior limb of the trabecula septomarginalis is present and embraces the tiny interventricular part of the membranous septum. This configuration is also well appreciated on the left ventricular view (Fig. 32). Fig. 31. Right ventricular view of an unusual variant of perimembranous outlet-type ventricular septal defect. The defect is oval in shape with its long axis directed obliquely anterior and superior Perimembranous Ventricular Septal Defect Fig. 32. Left ventricular view of same heart 53 54 Isolated Ventricular Septal Defect From a surgical point of view this type of defect is of interest, since the penetrating bundle comes very close to the posteroinferior angle of this defect, at the site where the trabecula septomarginalis and the membranous septum meet.

In Fig. 9, a needle has been placed through the inlet septum, remote from the inferior margin of the defect. One may anticipate that the branching bundle and the origin of the right bundle branch are on the crest of the inlet septum. For that reason it is advisable to place the suture on the right septal side and away from the free inferior margin of the defect. The illustration from this view indicates the block of tissue removed for serial sectioning and the sites of the microscopical sections shown in subsequent figures.

13. Right ventricular view of small perimembranous ventricular septal defect with secondary endocardial fibrosis Perimembranous Ventricular Septal Defect Fig. 14. Left ventricular view of same heart 29 30 Isolated Ventricular Septal Defect In patching the defect in this particular heart the sutures may be placed through the fibrous ridges (Fig. 15). The illustration shows the block of tissue removed for serial sectioning and the site of microscopical sections in relation to the sutures. The penetrating bundle is in its usual position on the crest of the inlet part of the ventricular septum at the base of the membranous septum.

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