By Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)
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Additional info for Atrioventricular Conduction in Congenital Heart Disease: Surgical Anatomy
17. Right ventricular view of same heart, showing superimposed reconstructed course of atrioventricular conduction tissue. Symbols as in Fig. 8 Perimembranous Ventricular Septal Defect Fig. 1S. Left ventricular view of same heart, showing superimposed reconstructed course of atrioventricular conduction tissues. Symbols as in Fig. 9 35 36 Isolaled Ventricular Septal Defect Trabecular Type The precise definition of a trabecular-type defect is cumbersome . Most defects in the trabecular area of the ventricular septum also show features of inlet or outlet expansion.
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. 22f). Perimembranous Ventricular Septal Defect Fig. 21. Right ventricular view of same defect following removal of tricuspid valve apparatus. A suture has been placed through posterior limb of trabecula septomarginalis medial papillar mu I mple.
M usc\e of inlet septum swings in superior direction toward membranous septum 37 38 Isolated Ventricular Septal Defect From a surgical point of view the differences between the trabecular type and the inlet type of perimembranous ventricular septal defect are subtle. The main difference is that in the trabecular type, muscle is now running up in the area where one may anticipate the penetrating bundle. Hence, one could argue that the bundle is not in the immediate border of the defect, because of this particular configuration.