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What is a ventricle? The single-ventricle trap
Insights
Ventricle identification relies on myocardial morphology, not atrioventricular valve connections. Current definitions of single ventricles are flawed and should be replaced with morphology-based terminology for accurate congenital heart disease diagnosis.
Area of Science:
- Cardiology
- Anatomy
- Congenital Heart Disease
Background:
- The definition of cardiac ventricles is traditionally based on atrioventricular (AV) connections.
- Existing definitions, particularly for single ventricle, are considered unsatisfactory and scientifically inaccurate.
- This leads to confusion in diagnosing and describing congenital heart disease.
Purpose of the Study:
- To advocate for a redefinition of cardiac ventricles based on myocardial morphology.
- To highlight the inadequacy of current definitions that rely on AV connections.
- To promote a return to a purely morphological approach in cardiac anatomy and congenital heart disease terminology.
Main Methods:
- Critical analysis of existing definitions of cardiac ventricles and single ventricles.
- Review of established anatomical and morphological principles in cardiology.
- Comparison of morphological characteristics versus AV connections for chamber identification.
Main Results:
- Myocardial morphology, not AV connections, definitively determines if a chamber is a ventricle.
- The morphologically right and left ventricles have well-established anatomic characteristics.
- The classic definition of a single ventricle is fundamentally flawed and violates morphological diagnostic principles.
Conclusions:
- Redefining ventricles based on AV connections is inappropriate and scientifically unsound.
- Terminology like "primitive ventricle" or "main chamber" should be abandoned in favor of precise morphological descriptions.
- Unadorned morphological anatomy is essential for clarity, simplicity, and accuracy in congenital heart disease classification and understanding.
Abstract:
Whether a chamber is or is not a ventricle is determined by its myocardial morphological characteristics, not by the entering atrioventricular (AV) valves. The anatomic characteristics of the morphologically right ventricle and the morphologically left ventricle have been well described, are widely understood, and do not need to be changed. What a ventricle is should not be redefined in terms of the AV connections because such redefinition is based on the classic definition of single ventricle, which itself is not satisfactory. This old definition is wrong in principle, violates the morphological method of diagnosis and designation of the cardiac principle, violates the morphological method of diagnosis and designation of the cardiac chambers, and has two kinds of exceptions. Consequently the classic definition of single ventricle must not be used as a paradigm (model) for the redefinition of what a ventricle is or is not. The approach and terminology based on the use of the unsatisfactory single-ventricle is or is not. The approach and terminology based on the use of the unsatisfactory single-ventricle paradigm approach and terminology based on the use of the unsatisfactory single-ventricle paradigm should be discontinued, eg, "primitive ventricle," "main chamber," "accessory chamber," "trabecular pouch." Being unnecessary, these nonmorphological components of the terminology of congenital heart disease may be omitted. Morphological anatomy, unadorned, is the key to clarity, simplicity, and accuracy.