Anderson R H, Ho S Y, Wilcox B R
Department of Paediatrics, National Heart and Lung Institute, London, UK.
J Card Surg. 1996 Jan-Feb;11(1):2-11. doi: 10.1111/j.1540-8191.1996.tb00002.x.
In this fourth part of our series of articles concerned with the surgical anatomy of ventricular septal defects (VSDs), we have analyzed the arrangements when both arterial trunks arise from the same ventricle. The essence of these anomalies is that the interventricular communication is an integral part of the circulation. Unless the surgeon constructs an alternative route of exit, closure of this defect would isolate one of the ventricles. The usual surgical approach, therefore, is to patch the hole between the ventricles into one or other of the subarterial outflow tracts. This means that all the components of the ventricular outflow tracts are of potential surgical importance. In hearts with double outlet right ventricle, the VSD can be categorized as being subaortic, subpulmonary, doubly committed, or non-committed. It is also important to determine whether its anatomical borders, as seen from the right ventricle, are in part fibrous or exclusively muscular, so as to establish the location of the atrioventricular conduction axis. It is possible, according to the nature of these borders, to place the defects into one of three groups, perimenbranous, muscular, or doubly committed and juxta-arterial. The size of the defect is another important surgical consideration. Double outlet left ventricle is a significantly more rare malformation, but the rules for determining the disposition of the conducting tissues are the same.
在我们关于室间隔缺损（VSD）外科解剖学系列文章的第四部分中，我们分析了两个动脉干均发自同一心室时的情况。这些异常情况的本质在于室间隔交通是循环的一个组成部分。除非外科医生构建一条替代的流出途径，否则关闭该缺损会使其中一个心室孤立。因此，通常的手术方法是将心室之间的孔洞补入一个或另一个动脉下流出道。这意味着心室流出道的所有组成部分都具有潜在的手术重要性。在右心室双出口的心脏中，室间隔缺损可分为主动脉下、肺动脉下、双开口或无开口型。确定从右心室观察时其解剖边界部分是纤维性的还是完全为肌性的也很重要，以便确定房室传导轴的位置。根据这些边界的性质，有可能将缺损分为三组之一，即膜周部、肌部或双开口并紧邻动脉型。缺损的大小是另一个重要的手术考虑因素。左心室双出口是一种明显更罕见的畸形，但确定传导组织分布的规则是相同的。
