Over the course of time, new developments associated with embryogenesis
of the murine heart have served to clarify the developmental processes
observed in the human heart. This evidence allows for creation of a
developmental framework for many congenital cardiac defects. Here, we
aim to solidify the framework related to the categorization of both
solitary and multiple ventricular septal defects. Mice having genetic
perturbation of the Furin enzyme have demonstrated perimembranous and
juxta-arterial ventricular septal defects, permitting the inference to
be made that these defects can co-exist with defects occurring within
the apical muscular septum. Based on developmental evidence,
furthermore, all interventricular communications can be placed into one
of three groups, namely, those which are perimembranous, juxta-arterial,
and muscular. All of the defects are described based on their borders as
seen from the morphologically right ventricle. Our focus here will be on
those defects within the muscular ventricular septum, recognizing that
such defects can co-exist with those that are perimembranous. We discuss
the differentiation of multiple discrete defects from those referred to
as the ‘Swiss cheese’ variant. As we show, appropriate surgical
management requires understanding of the specific terminology, as the
surgical approach may differ depending on the combination of the
individual defects. Data from the Society for Thoracic Surgeons revealed
that both mortality and morbidity were increased in the setting of
multiple as opposed to solitary ventricular septal defects.
Long term results of external valved conduit for right ventricle outflow reconstruction for congenital cardiac defects.
