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
2. lOa). ns along the crest of the inlet ventricular septum (Fig. 22b). The site of the suture is shown in Fig. 22c. The branching bundle is almost on the crest of the septum, slightly to the left due to poor development of the posterior extension of the trabecula septomarginalis. The suture remains remote from the branching bundle at this site. The right bundle branch runs over the crest of the septum (Fig. 22d) then courses intramurally covered by the trabecula septomarginalis (Fig. 22e). Further tracing shows it to run subendocardially, where it fans out (Fig.
Micrographs showing course of atrioventricular conduction tissues in same heart. a Penetrating bundle. b Nonpenetrating, non branching bundle. c Branching bundle with needle superficially positioned on right septal side. d Right and left bundle branches. Right bundle branch courses over crest of septum. e Right bundle branch in intramural position. f Peripheral subendocardial position of right bundle branch 42 Isolated Ventricular Septal Defect The reconstruction of the atrioventricular conduction tissues in this specimen reveals the close relationship between the conduction tissues and the borders of the defect.
In fact, when approached from the right atrium the major part of the defect is to the surgeon's right, taking the anteroseptal commissure as point of reference. This is not always an easy and reliable landmark, since the detailed anatomy of the tricuspid anteroseptal commissure may vary considerably. This applies also to the tension apparatus supporting the commissure and its adjoining leaflet tissues. In the present specimen (Fig. 7) the medial papillary muscle complex is seen to arise from the outlet septum, crossing over the defect.