3 years ago

Remodeling of the embryonic interventricular communication in regard to the description and classification of ventricular septal defects

Robert H. Anderson, Diane E. Spicer, Timothy J. Mohun, Jill P.J.M Hikspoors, Wouter H. Lamers

Abstract

Ventricular septal defects are the commonest congenital cardiac malformations. It is axiomatic that appropriate knowledge of the steps involved in formation and completion of ventricular septation should provide clues as to the morphology of the different types of such defects. Currently, however, consensus is lacking regarding the components of the developing ventricular septum, and how best to describe the different phenotypes seen in postnatal life. In this review, therefore, we have re‐assessed the previous investigations devoted to closure of the embryonic interventricular communication. We discuss how the studies of Odgers, in the early part of the 20th century, correctly identified the steps involved in the remodelling of the embryonic interventricular foramen subsequent to the stage at which the outflow tract arises entirely above the cavity of the developing right ventricle. There has, however, already been remodelling of the foramen from the stage at which the atrioventricular canal is supported exclusively by the developing left ventricle. We show how these temporal changes in morphology can provide explanations for the different ventricular septal defects seen in the setting of congenital cardiac diseases. Thus, muscular defects represent inappropriate coalescence of the cardiomyocytes forming the muscular ventricular septum. The channels that are perimembranous are due to failure of closure of the persisting embryonic interventricular foramen. Those that are doubly committed and juxta‐arterial reflect failure of formation of the free‐standing subpulmonary muscular infundibular sleeve. The findings also point to the importance of appropriate alignment, during development, between the developing atrial and ventricular septums, and between the apical component of the ventricular septum and the ventricular outlet components.

This article is protected by copyright. All rights reserved.

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.