Surgical anatomy of the atrioventricular septum and atrioventricular septal defects

SummaryDefects of the atrioventricular septum impose changes in the septal architecture, atrioventricular valves, and conduction system that must be well understood for optimal repair. The atrioventricular node and bundles are shifted to more posterior and inferior positions that can be anticipated by the surgeon so as to maintain the integrity of atrioventricular conduction. The atrioventricular valve is a five leaflet structure that possesses a common orifice or separate orifices depending on characteristics of the superior and inferior bridging leaflets. These features are demonstrated by intraoperative photographs viewed from the surgeon's position.

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Anatomical variations in atrioventricular conduction system with reference to ventricular septal defects.

Heart ◽

10.1136/hrt.34.2.185 ◽

1972 ◽

Vol 34 (2) ◽

pp. 185-190 ◽

Cited By ~ 41

Author(s):

R A Latham ◽

R H Anderson

Keyword(s):

Anatomical Variations ◽

Conduction System ◽

Atrioventricular Conduction ◽

Ventricular Septal Defects ◽

Septal Defects

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Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2001.111969 ◽

2001 ◽

Vol 121 (2) ◽

pp. 352-365 ◽

Cited By ~ 15

Author(s):

Loïc Macé ◽

Patrice Dervanian ◽

Lucile Houyel ◽

Evelyne Chaillon-Fracchia ◽

Dominique Piot ◽

...

Keyword(s):

Atrioventricular Valve ◽

Atrioventricular Septal Defects ◽

Septal Defects ◽

Valve Sparing ◽

Double Orifice

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The spatial distribution and relative abundance of gap-junctional connexin40 and connexin43 correlate to functional properties of components of the cardiac atrioventricular conduction system

Journal of Cell Science ◽

10.1242/jcs.105.4.985 ◽

1993 ◽

Vol 105 (4) ◽

pp. 985-991 ◽

Cited By ~ 8

Author(s):

R.G. Gourdie ◽

N.J. Severs ◽

C.R. Green ◽

S. Rothery ◽

P. Germroth ◽

...

Keyword(s):

Spatial Distribution ◽

Relative Abundance ◽

Atrioventricular Node ◽

Conduction System ◽

Atrioventricular Conduction ◽

Purkinje Fibre ◽

Purkinje Fibres ◽

Atrioventricular Bundle ◽

Junctional Protein ◽

Gap Junctional

Electrical coupling between heart muscle cells is mediated by specialised regions of sarcolemmal interaction termed gap junctions. In previous work, we have demonstrated that connexin42, a recently identified gap-junctional protein, is present in the specialised conduction tissues of the avian heart. In the present study, the spatial distribution of the mammalian homologue of this protein, connexin40, was examined using immunofluorescence, confocal scanning laser microscopy and quantitative digital image analysis in order to determine whether a parallel distribution occurs in rat. Connexin40 was detected by immunofluorescence in all main components of the atrioventricular conduction system including the atrioventricular node, atrioventricular bundle, and Purkinje fibres. Quantitation revealed that levels of connexin40 immunofluorescence increased along the axis of atrioventricular conduction, rising over 10-fold between atrioventricular node and atrioventricular bundle and a further 10-fold between atrioventricular bundle and Purkinje fibres. Connexin40 and connexin43, the principal gap-junctional protein of the mammalian heart, were co-localised within atrioventricular nodal tissues and Purkinje fibres. By applying a novel photobleach/double-labelling protocol, it was demonstrated that connexin40 and connexin43 are co-localised in precisely the same Purkinje fibre myocytes. A model, integrating data on the spatial distribution and relative abundance of connexin40 and connexin43 in the heart, proposes how myocyte-type-specific patterns of connexin isform expression account for the electrical continuity of cardiac atrioventricular conduction.

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