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Ann Thorac Surg 2002;73:56-57
© 2002 The Society of Thoracic Surgeons

Invited commentary

^a Department of Surgery (Cardiothoracic), Emory University School of Medicine, 1365 Clifton Rd, Atlanta, GA 30322, USA

e-mail: kkanter{at}emory.edu

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.

Although the authors strongly recommend surgical closure of these defects through an apical right ventricular incision (with excellent results), they fail to emphasize that others have closed these defects without ventriculotomy with equally acceptable results [1, 2]. Although the presented right ventriculotomy approach is quite appealing in its apparent simplicity and effectiveness, one cannot discount a transatrial approach to these defects.

Finally, occasionally with apical ventricular septal defects, one will find that the distal anterior descending coronary artery is unusually small. This raises the possibility that the etiology for this uncommon lesion may be an intrauterine vascular accident with subsequent lack of development of this portion of the apical septum thus resulting in an apical ventricular septal defect.

In summary, this article gives an excellent anatomico-pathologic description of apical ventricular septal defects and presents surgical results against which transcatheter techniques must be compared in the future.

References

1. Seddio F., Reddy V.M., McElhinney D.B., Tworetzky W., Silverman N.H., Hanley F.L. Multiple ventricular septal defects: how and when should they be repaired?. J Thorac Cardiovasc Surg 1999;117:134-139.[Abstract/Free Full Text]
2. Black M.D., Shukla V., Rao V., Smallhorn J.F., Freedom R.M. Repair of isolated multiple muscular ventricular septal defects: the septal obliteration technique. Ann Thorac Surg 2000;70:106-110.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kirk R. Kanter Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kanter, K. R. Search for Related Content PubMed Articles by Kanter, K. R. Related Collections Related Article