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J Thorac Cardiovasc Surg 1996;111:1290-1291
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Location of the conduction tissue in double-inlet left ventricle with leftward rudimentary right ventricle

Department of Paediatrics
National Heart and Lung Institute
Imperial College School of Medicine
Dovehouse St.
London SW3 6LY, United Kingdom

To the Editor:

It seems to me that van Son and his colleagues ¹ may be confused with regard to the location of the atrioventricular bundle in hearts with univentricular connection to a dominant left ventricle and leftward rudimentary right ventricle. They state in their article that hearts with {S,L,L} segmental anatomy are at risk of surgical heart block because "the nonbranching atrioventricular bundle courses at the superior-anterior margin of the BVF [bulboventricular foramen]." But this is true only when the bundle is viewed through the morphologically left ventricle! As we explained in an article by Cheung and associates, ² cited by van Son and his colleagues (their reference 12), when viewed from the rudimentary and incomplete right ventricle, the bundle courses posteroinferiorly. Because of this, it is always safe to remove a wedge of muscular tissue from the apical trabecular septum by incising close to the obtuse margin of the ventricular mass (Fig. 1). This holds true whether the rudimentary right ventricle is right-sided or left-sided. These relationships are also discussed at length in the book Double Inlet Ventricle. ³

View larger version (139K): [in this window] [in a new window]   Fig. 1. The anterior view of the leftward rudimentary right ventricle from a heart with double-inlet left ventricle, showing the segment of apical trabecular septum that can safely be removed to enlarge the ventricular septal defect (VSD) without damaging the atrioventricular bundle.

1. van Son JAM, Reddy VM, Haas GS, Hanley FL. Modified surgical techniques for relief of aortic obstruction in {S,L,L} hearts with rudimentary right ventricle and restrictive bulboventricular foramen. J Thorac Cardiovasc Surg 1995;110:909-15.[Abstract/Free Full Text]
   
2. Cheung HC, Lincoln C, Anderson RH, et al. Options for surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis. J Thorac Cardiovasc Surg 1990;100:672-81.[Abstract]
   
3. Anderson RH, Becker AE, Ho SY, Zuberbuhler JR, Wilkinson JL. Disposition of the conducting tissues. In: Anderson RH, Crupi G, Parenzan L, editors. Double inlet ventricle. anatomy, diagnosis and surgical management. Tunbridge Wells, Kent: Castle House Publications, 1987:72-97.
   

This Article 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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert H. Anderson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, R. H. Search for Related Content PubMed PubMed Citation Articles by Anderson, R. H.