Anatomy of aortic atresia. Cases presenting with a ventricular septal defect

The anatomy of 58 specimens of aortic outflow tract atresia was studied. All cases had situs solitus and levocardia, 37 had atrioventricular (AV) concordance, two had common inlet to a right ventricle and 19 had mitral atresia. The great arteries were normally interrelated in all cases. Fifty-one cases had an intact ventricular septum, while seven presented with a ventricular septal defect (VSD). Of the seven with VSD, in two it was associated with a common AV orifice draining exclusively into the right ventricle in the presence of a rudimentary left ventricular chamber. In one case a small VSD accompanied combined mitral and aortic atresia. In the other four cases the left ventricles and mitral valves were fairly normal in size; the VSD was subpulmonary in three cases, due to infundibuloventricular malalignment, and perimembranous in one. These last four cases are of particular interest since they could be amenable to surgical correction. Possible approaches to surgical treatment and morphologic features pertinent to them are described and discussed.