Morphologic spectrum of truncal valvar origin relative to the ventricular septum: correlation with the size of ventricular septal defect
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Iki Adachi1, Anna Seale, Hideki Uemura
1Cardiac Morphology Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Insights
The origin of the common arterial trunk varies, impacting ventricular septal defect size. Understanding truncal origin is crucial for optimizing surgical repair in patients with this congenital heart defect.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The common arterial trunk typically arises from both ventricles, overriding a ventricular septal defect.
- Variations in truncal origin, predominantly or exclusively from one ventricle, influence surgical repair strategies.
Purpose of the Study:
- To categorize the origin of the common arterial trunk into five types.
- To assess the correlation between truncal origin and ventricular septal defect size.
Main Methods:
- Examination of 56 autopsy specimens and review of 12 clinical cases.
- Categorization of truncal origin: exclusive right/left ventricular, predominant right/left ventricular, or balanced.
- Measurement of ventricular septal defect dimensions (width and depth).
Main Results:
- Balanced origin observed in about half of cases.
- Right ventricular predominant/exclusive origin was more common in autopsy (40%) than left (9%), but not in clinical series (25% each).
- Increased commitment of the truncal valve to the right ventricle correlated with smaller ventricular septal defect width and depth (P < .0001).
Conclusions:
- Truncal valve origin exhibits a spectrum of morphology.
- Truncal origin is linked to ventricular septal defect size, which can be the primary or sole outflow tract from the left ventricle.
- Recognizing truncal origin is essential for effective surgical intervention.
Objective:
The common arterial trunk usually has a balanced origin from both right and left ventricles overriding a ventricular septal defect. The trunk occasionally originates predominantly, or even exclusively, from either ventricle, making the size of the ventricular septal defect an important factor in surgical repair.
Methods:
We examined 56 autopsy specimens and reviewed another series of 12 consecutive patients with the malformation. Truncal origin was categorized as 1 of the following 5 types: exclusive origin from either the right or left ventricle, predominant origin from either ventricle, or balanced origin. We measured the size of ventricular septal defect ("width" and "depth") in specimens for any correlation with truncal origin.
Results:
Balanced origin was seen in approximately one half of cases in both autopsy and clinical series. Predominantly or exclusively right ventricular origin was more prevalent than left ventricular origin in autopsy series (40% vs 9%, respectively), but such predilection was not observed in clinical series (both 25%). The more the truncal valve was committed to the right ventricle, the smaller was the "width" of the ventricular septal defect (predominant and exclusive vs balanced origin; both P < .0001), with similar tendency in the "depth." In 1 heart with extreme right ventricular origin, the defect was slit-like.
Conclusion:
Origin of the truncal valve demonstrated a morphologic spectrum and correlated with the size of ventricular septal defect that was the main or even sole exit from the left ventricle in hearts with right ventricular origin. Truncal origin, therefore, requires recognition to optimize surgery.
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