European Journal of Cardio-Thoracic Surgery, Vol 10, 540-545, Copyright © 1996 by European Association for Cardio-thoracic Surgery
The nature of the annular attachment of a common atrioventricular valve in hearts with isomeric atrial appendages
H Uemura, SY Ho, RH Anderson, LL Kilpatrick, T Yagihara and K Yamashita
Department of Paediatrics, National Heart and Lung Institute, London, UK.
OBJECTIVE: To clarify the precise anatomic arrangement of the annular
attachment of a common atrioventricular valve in the setting of visceral
heterotaxy. METHODS: One hundred and twelve autopsied specimens with
isomeric atrial appendages were studied. RESULTS: Annular hinge points with
a planar orientation were found in only 7 hearts. All others showed a
nonplanar and undulating arrangement, including 7 with Ebsteins's
malformation. When the posterior half of the valvar attachment was taken as
a reference plane, the anterior part deviated superiorly, the distance from
the plane to the anterior point being 6.7 +/- 4.9% of the circumferential
length of the annulus. The ratio of the antero-posterior diameter to the
width of the annulus was smaller in hearts with biventricular connections
(0.77 +/- 0.15) than in those with double inlet ventricle (0.89 +/- 0.17, P
< 0.001). Reflecting this, the ratio of superior deviation of the
anterior valvar annulus compared to the antero-posterior diameter was
greater in hearts with biventricular atrioventricular connections (P =
0.016), particularly in those with isomeric right appendages. No
significant differences were found when the data was analyzed according to
variations in ventricular morphology. CONCLUSIONS: The precise evaluation
of the annular structure of a common atrioventricular valve may well prove
to be of clinical significance so as optimally to achieve valvar
annuloplasty.
