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2016 ; 7
(5
): 561-77
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Development and Morphology of the Ventricular Outflow Tracts
#MMPMID27587491
Anderson RH
; Mori S
; Spicer DE
; Brown NA
; Mohun TJ
World J Pediatr Congenit Heart Surg
2016[Sep]; 7
(5
): 561-77
PMID27587491
show ga
It is customary, at the current time, to consider many, if not most, of the
lesions involving the ventricular outflow tract in terms of conotruncal
malformations. This reflects the introduction, in the early 1940s, of the terms
conus and truncus to describe the components of the developing outflow tract. The
definitive outflow tracts in the postnatal heart, however, possess three, rather
than two, components. These are the intrapericardial arterial trunks, the
arterial roots, and the subvalvar ventricular outflow tracts. Congenital lesions
afflicting the arterial roots, however, are not currently considered to be
conotruncal malformations. This suggests a lack of logic in the description of
cardiac development and its use as a means of categorizing congenital
malformations. It is our belief that the developing outflow tract, like the
postnatal outflow tracts, can readily be described in tripartite fashion, with
its distal, intermediate, and proximal components forming the primordiums of the
postnatal parts. In this review, we present evidence obtained from developing
mice and human hearts to substantiate this notion. We show that the outflow
tract, initially with a common lumen, is divided into its aortic and pulmonary
components by a combination of an aortopulmonary septum derived from the dorsal
wall of the aortic sac and outflow tract cushions that spiral through its
intermediate and proximal components. These embryonic septal structures, however,
subsequently lose their septal functions as the outflow tracts develop their own
discrete walls. We then compare the developmental findings with the anatomic
arrangements seen postnatally in the normal human heart. We show how correlations
with the embryologic findings permit logical analysis of the congenital lesions
involving the outflow tracts.