Atrioventricular Conduction in Congenital Heart Disease: by Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)

By Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)

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Extra info for Atrioventricular Conduction in Congenital Heart Disease: Surgical Anatomy

Example text

The penetrating bundle is in its usual position on the crest of the inlet part of the ventricular septum at the base of the membranous septum. The first needle has been placed through the base of the septal tricuspid valve leaflet, but close to the bundle, as clearly illustrated in Fig. 16a. It is a safe rule, in perimembranous inlet-type defects, not to position the sutures in the posteroinferior angle of the defect. The second needle is in a slightly more posterior location and has been placed through the free part of the septal tricuspid valve leaflet.

C Branching bundle: needle placed through a fibrous ridge. d Origin of right bundle branch: needle placed through a fibrous ridge 34 Isolated Ventricular Septal Defect The reconstruction of the atrioventricular conduction tissues in this heart is shown in Figs. 18. The right-sided view (Fig. 17) shows the close relationship of the conduction tissues to the posteroinferior margins of the defect (cf. Fig. 11). The site of origin of the right bundle branch is on the crest of the defect, at the junction of the inferior and anterior margins.

20 Isolated Ventricular Septal Defect Perimembranous Ventricular Septal Defect Inlet Type The perimembranous inlet-type ventricular septal defect, by definition, borders on the membranous septum and has its main extension into the inlet part of the ventricular septum. The latter is the part underneath the septal attachment of the tricuspid valve, from which chordae arise to support the leaflet. When viewed from the right, the defect is largely hidden behind the septal tricuspid valve leaflet (Fig.

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