Cardiac malformations associated with ventricular septal defect

A communication from the left ventricle to the right atrium: a defect in the central fibrous body

An isolated defect in the membranous atrioventricular septum was found in a five-year-old girl who presented with a cystic lesion in the right atrium. This type of left ventricular-right atrial communication could result from a structural abnormality of the central fibrous body in combination with arrested maturation of the membranous ventricular septum.

Congenital cardiac abnormalities in monozygotic twins. Report and review of the literature

A pair of monozygotic twin girls is reported with concordance for 3 congenital cardiac abnormalities: (1) secundum atrial septal defect, (2) aneurysm of the membraneous ventricular septum, and (3) electrocardiographic frontal plane left axis deviation. A review of the published materials shows a 9.5 per cent incidence of concordance for congenital heart disease among monozygotic twins. In those in whom a precise cardiological diagnosis was made, 15/16 pairs (95%) were concordant for a specific defect, 2 had an additional defect, and only 1 pair had completely dissimilar defects. Concordance for congenital heart disease in monozygotic twins is uncommon, but when it occurs the defects will most often be identical.

Congenital heart malformations associated with disproportionate ventricular septal thickening

Asymmetric septal hypertrophy, or ASH, is a genetically determined myocardial disorder that is transmitted as an autosomal dominant trait. ASH is characterized by a disproportionately thickened ventricular septum that contains numerous hypertrophied, bizarrely-shaped and disorganized cardiac muscle cells. Disproportionate hypertrophy of the ventricular septum has also been observed in association with certain congenital cardiac malformations. To determine whether such congenital cardiac malformations are part of the disease spectrum of genetically determined ASH, cardiac pathologic observations were made in eight patients with disproportionate septal thickening (ventricular septal to posterobasal left ventricular free wall thickness ratios of 1.5 to 2.5) and the following three categories of associated lesions: 1) parachute deformity of the mitral valve (occurring either as an isolated lesion or with ventricular septal defect, coarctation of the aorta, supravalvular ring of the left atrium, or double outlet right ventricle); 2) complete interruption of the aortic arch; and 3) ventricular septal defect. The arrangement of cardiac muscle cells in the disproportionately thickened ventricular septum was normal in six of the eight patients; in the other two patients (one with parachute deformity of the mitral valve and one with ventricular septal defect) numerous bundles of hypertrophied cardiac muscle cells were interlaced in a disorganized fashion among more normally arranged bundles of cells. First degree relatives of six of the eight patients were studied by echocardiography and found to have normal ventricular wall thicknesses and septal-free wall ratios. It is concluded that disproportionate ventricular septal thickening may occur in patients with a variety of congenital heart malformations, but that such a finding is not necessarily a manifestation of the disease spectrum of genetically determined ASH.

Aorticopulmonary septal defect coexisting with ventricular septal defect

Three cases, in each of which an aorticopulmonary septal defect (AP window) coexisted with a ventricular septal defect, are described. In two the ventricular septal defect was of the usual variety, and in one it was part of the tetralogy of Fallot.

The patients presented as examples of congestive cardiac failure with a large left-to-right shunt in infancy. Aortography was the most reliable method for identification of the AP window when a ventricular septal defect was associated. Associated features included a right aortic arch with mirror image branching in the first case and tetralogy of Fallot with muscular subaortic stenosis in the third case. In the case with the tetralogy of Fallot, the effects of pulmonary stenosis were masked by the left-to-right shunt through the AP window.

Aberrant muscle bundle of the right ventricle

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Right ventricular anomalous muscle bundle. Clinical and laboratory presentation and natural history

Eighteen patients with right ventricular anomalous muscle bundles associated with ventricular septal defect and one patient with isolated anomalous muscle bundle were studied. The clinical differentiation of these patients from those with isolated ventricular septal defects or tetralogy of Fallot was difficult. Eleven patients were asymptomatic at the time of diagnosis; eight had various degrees of dyspnea on exertion, with three of these having cyanosis. A physiologically split second sound with a pulmonic component of normal intensity and a diffuse thrill and holosystolic murmur maximal at the lower left sternal border suggest the diagnosis. Chest X-rays and electrocardiograms usually show evidence of right ventricular hypertrophy, but may suggest left ventricular hypertrophy in the presence of a large left-to-right shunt. However, the diagnosis is best made by cardiac catheterization with measurement of a pressure gradient in the body of the right ventricle and by selective angiography with the demonstration of a wedge-shaped filling defect in the right ventricle. Progressive obstruction by the muscle bundle occurred in four of seven patients who had repeated catheterization associated with the development of electrocardiographic changes of right ventricular hypertrophy. To date, 11 patients have had surgery; one died before surgery; and surgery is being planned for the remaining patients.

Double-chambered right ventricle. A report of five cases

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